422例ABO正反定型不符的原因分析及处理对策

Possible causes and strategies of ABO Typing discrepancies in patients

目的分析422例患者ABO正反定型不符的原因及处理对策。方法随机使用GRIFOLS ERYTRA、BIO-RAD IH-1000全自动血型仪采用微柱凝胶法检测患者ABO血型26 923例,检出ABO正反定型不符的标本422例。联合分析实验技术原因、患者临床资料以及针对性辅助实验进行ABO血型鉴定。结果 422例检出ABO正反定型不符,其中325例为ABO血型不合造血干细胞移植患者。除造血干细胞移植患者外,正反定型不符的患者有97例,正定型减弱或缺失患者40例,其中恶性血液病患者24例,在正定型减弱或缺失中占60%(24/40);反定型减弱或缺失者9例,正定型额外反应者6例,反定型额外反应者36例,正定型、反定型同时额外反应者6例;检出自身抗体患者21例,在正反定型额外反应中占43.8%(21/48)。结论本研究病例中引起ABO正反定型不符的主要原因有ABO血型不合造血干细胞移植、恶性血液病以及自身抗体(假阳性)。根据ABO正反定型不符的实验室技术原因、患者临床资料以及针对性辅助实验可以正确鉴定血型,明确患者的ABO血型,从而指导临床输血的选择。

Objective To identify possible causes and resolution strategies for ABO typing discrepancies in 422 patients. Methods All the samples from 26 923 patients were detected by automatic machine of GRIFOLS ERYTRA or BIORAD IH-1000 at random with microcolumn gel technique to determine ABO group. Among these patients,422 individuals were identified to have ABO discrepancies. The combination of testing technical errors and patient＇s medical records was used to determine ABO group. Results Among 422 patients with ABO typing discrepancies,325 patients have experienced ABO mismatch during hematopoietic stem cell transplantation. Among those who accepted stem cell transplantation,97 cases were defined as having ABO discrepancies,among which,40 cases had weak / missing red blood cell reactivity,9 cases had weak /missing serum reactivity,6 cases had extra red cell reactivity and 36 cases had extra serum reactivity. Hematopoietic malignancy was seen in 60%（ 24 /60） of people who were classified as having weak / missing red cell reactivity. Autoantibody was detected in 43. 8%（ 21 /48） of those who were classified as having extra red cell / serum reactivity. Conclusion In our study,the main reasons for ABO discrepancies are attributed to ABO mismatch hematopoietic stem cell transplantation,hematologic malignancy and autoantibody（ false positive）. ABO group can be clarified by the analysis of technical errors,medical record and additional studies. Thus,this can allow selection of appropriate blood type for clinical transfusion.