急性白血病致Rh血型系统D抗原减弱1例

Case study:acute leukemia induced Rh-D antigen weakening

目的对1例Rh血型系统D抗原血清学检测呈现混合视野凝集的患者进行基因分型,以明确患者的Rh D表型,确定血型后给予Rh D同型红细胞输注,探讨实验室检测方法和输血方案的选择。方法分别采用血型血清学和基因检测试剂盒对患者Rh血型系统D抗原进行检测,血型确认后多次输血观察输血后反应。结果患者Rh D抗原检测,微柱凝胶卡式初检及确认试验均为双群表现,IgM抗-D试管法为1+混合视野凝集,基因分型确认为正常D抗原,多次输注Rh D阳性红细胞,无抗-D产生。结论白血病常引起红细胞血型抗原减弱,当血清学试验不能确认时可进一步进行基因分型鉴定,一旦血型确认,可以输注同型血液。

Objective To genotype one patient with mixed-field agglutination in RhD antigen using serological tests,to identify patient＆#39;s RhD phenotype,to infuse with same phenotype of RhD,and to explore the methods of laboratory detection and options of transfusion.Methods Serological tests and gene detection tests were used to identify RhD antigens in the patient.After determination of RhD phenotype,transfusion reactions were observed after infusion of identical RhD blood.Resuits From micro column gel chromatography and confirmation tests,patient＆#39;s RhD antigens were confirmed to have characteristics from two phenotypes.IgM anti-D tube test determined that the sample had more than one mixed-field agglutination.Genotype was determined to be positive for RhD antigen.Multiple infusions of RhD positive blood did not result in production of anti-D antibodies.Conclusion Leukemia often causes weakening of RhD antigen.When serological tests cannot be used to confirm the phenotype,it can be complemented with genotyping.Upon determination of blood type,blood transfusion with blood of identical genotypes can be performed.