反复输血患者体内产生不规则抗体的临床分析及解决策略

Clinical analysis and solution for irregular antibodies in patients with repeated blood transfusion

目的探讨在临床上多次输血患者体内产生不规则抗体的情况及输血解决策略。方法回顾性分析2015年1月-2016年4月,本院住院患者中符合输血至少2次以上,且第1次输血前不规则抗体筛查为阴性,之后至少有1次输血前不规则抗体筛查阳性,并与库存至少20单位同型献血者血液交叉配血,部分或全部不相合的患者9名,并对此9名患者进行血型鉴定、不规则抗体筛查及进一步抗体鉴定等多种血型血清学试验,确定抗体类型并结合临床病史,给与适合血液输注。结果随着患者输血量和输血次数的增加,患者体内出现不规则抗体的机率增大、抗体类型也越为复杂,致使血型鉴定及交叉配血困难,寻找相合血液输注的机率越小。结论对有输血史及妊娠史的患者应常规进行不规则抗体筛查,及时发现有临床意义的抗体,确保临床用血及时、安全、有效。

Objective To investigate the situation on irregular antibodies in patients with multiple blood transfusions and explore the strategies for the treatment of blood transfusion. Methods A retrospective analysis was conducted on nine patients in our hospital during January 2015-2016, who had received blood transfusion for at least 2 times or above and was screened negative for irregular antibodies before the first transfusion, but was screened positive for irregular antibodies at least once before a blood transfusion, and already cross matched with at least 20 units of same type of blood in the inventory. In these nine patients, blood group identification and further antibody identification of various blood group by serological detec- tion method were used to determine the type of antibody and to guide the indication for blood transfusion with information from the clinical history. Results With the increase in the amount of blood transfusion and the number of blood transfusions, pa- tients were more likely to have irregular antibody, with greater complexity in the type of antibody, and lower probability of finding appropriate blood. Conclusion Patients with a history of blood transfusion and pregnancy should be routinely screened for irregular antibodies. Timely detection of unexpected antibodies can save the time during crossmatch in order to ensure the clinical use of blood in a timely, safe and effective manner.