免疫性疾病患者输血前血型血清学特征分析

Analysis of blood group serological detecting characteristics in patients with autoimmune disease before bloodtransfusion

目的 分析免疫性疾病患者的输血前血型血清学特征。方法选择于2008年1月至2015年12月在第四军医大学西京医院拟接受输血治疗的6 890例免疫性疾病患者为研究对象。本研究纳入标准：临床诊断明确、病历资料完整者。排除标准：病历资料不完整者。应用试管法、微柱凝胶法、抗人球蛋白法、吸收放散试验等方法，于输血前对研究对象进行血型鉴定、抗体筛选、抗体鉴定及交叉配血检测。本研究遵循的程序符合第四军医大学西京医院人体试验委员会所制定的伦理学标准，得到该委员会批准。结果①本研究检出ABO正反定型不符患者为370例（5.4%, 370/6 890），其ABO正反定型不符的发生原因按照检出率由高到低依次为免疫球蛋白（Ig）M类不规则抗体（32.4%，120/370），冷自身抗体（26.8%，99/370），冷抗体（16.2%，60/370），緡钱状凝集（11.1%，41/370），直接抗人球蛋白试验阳性（9.5%，35/370），抗原、抗体减弱（4.0%，15/370）。②本研究检出不规则抗体患者为570例（8.3%，570/6 890），其不规则抗体按照检出率由高到低依次为复合抗体（44.0%，251/570），同种抗体（35.8%，204/570），冷自身抗体＋温自身抗体（13.8%，79/570），类同种抗体（4.4%，25/570），药物性抗体（1.9%，11/570）。③本研究出现交叉配血困难患者为610例（8.8%，610/6 890），其罹患的免疫性疾病按照发生率由高至低依次为自身免疫性溶血性贫血（34.9%，213/610），结缔组织病（19.0%，116/610），系统性红斑狼疮（14.8%，90/610），类风湿性关节炎（9.0%，55/610），狼疮性肾炎（5.7%，35/610），强直性脊柱炎（5.2%，32/610）等。结论免疫性疾病患者易发生血型鉴定及交叉配血困难。通过对免疫性疾病患者进行输血前血型血清学检测，可尽早发现其ABO正反定型不符原因，并且选择患者相合血液，进而确保临床输血安全。

Objective To investigate the blood group serological detecting characteristics in patients with autoimmune disease before blood transfusion. Methods From January 2008 to December 2015,a total of 6 890 patients with autoimmune disease in Xijing Hospital of the Fourth Military Medical University were included in the study. They were plan to take blood transfusion. Inclusion criteria of the study： patients＇ diagnoses were conformed as autoimmune disease and clinical data were complete. Blood type identification, antibody screening, antibody identification and cross matching of blood correlation detection were taken by the classical test tube method, mierocolumn gel method, anti human globulin test, absorption elution tests and so on. Exclusion criteria： other anemia disease and clinical data were not complete. The study protocol was approved by the Ethical Review Board of Investigation in Human of Xijing Hospital of the Fourth Military Medical University. Results （DThere were 370 cases with unconformity of positive and reverse ABO blood typing（5.4 %, 370/6 890）. The reason of unconformity of positive and reverse ABO blood typing were immunoglobulin（Ig） M irregular antibodies（32.4%, 120/370）, cold autoantihodies（26.8%, 99/370）, cold leetin（ 16.2%, 60/370）, routeaux agglutination （ 11. 1%, 41/370）, direct antiglohulin test positive （9.5% ,35/370）,antigen and antibody weakened（4.0K ,15/370） . （1）There were 570 patients with irregular antibody（8.3%, 570/6 890）. The main type of the irregular antibody were combined antibodies （44.0%, 251/570）, homologous antibody （ 35.8%, 204/570 ）, cold and warm autoantibodies （ 13.9%, 79/570 ）,autoantibodies with mimicking specificity （4.4 %, 25/570 ）, drug antibody （ 1. 9 %, 11/570 ）. There were 610 cases with difficulty in cross matching（8.8%, 610/6 890）. The main disease of them were autoimmune hemolytic anemia （ 34. 9%, 213/610 ）, connective tissue disease （ 19. 0%, 116/610 ）, systemic lupus erythematosus（ 14.8 %, 90/610）, rheumatoid arthritis （9.0 %, 55/610）, lupus nephritis （5. 7 %, 35/610 ） and so on. Conclusions Autoimmune disease can easily cause difficulties in blood type identification and cross matching. Through the blood group serological detection of patients with immune disease before blood transfusion,it can find out the reasons of unconformity of positive and reverse ABO blood typing, and choose the suitable blood components, in order to ensure the safe and effective in clinical blood transfusion.