2846例输血前不规则抗体筛查抗体检出情况分析

Analysis of irregular antibody screening of 2 846 cases before transfusion

目的分析临床输血前不规则抗体筛查抗体检出情况，减少输血不良反应的发生，加强临床输血的安全性。方法选择2015年1月至2016年12月中国人民解放军第一七四医院收治并拟接受输血治疗的2846例患者为研究对象，其中男性1408例，女性1438例。所有患者输血前均采用微柱凝胶技术对患者进行不规则抗体筛查，筛查结果阳性者再进行抗体鉴定，统计相关结果并分析。结果2846例受检者不规则抗体筛查结果：阳性者共221例，不规则抗体阳性率7．77％（221／2846）；其中女性受检者阳性率为10．78％（155／1438），男性受检者阳性率为4．69％（66／1408），女性阳性率高于男性，差异有统计学意义（x^2=36．86，P〈0．001）；有输血史或妊娠史或外伤史受检者阳性率为10．68％（173／1620），无输血史、妊娠史和外伤史受检者阳性率为3．92％（48／1226），前者阳性率高于后者，差异有统计学意义（x^2=44．58，P〈0．001）。不同年龄受检者不规则抗体阳性率随年龄的增长呈上升趋势。221例抗体筛查阳性受检者经抗体鉴定，同种异型抗体为168例，以Rh血型系统、MNS血型系统和Lewis血型系统为主，分别占比37．6％、22．2％和10．0％；非特异性抗体为53例，以自身抗体为主，占14．0％。结论患者临床输血前血清中抗体分布存在一定特征，以Rh系统、MNS系统和Lewis系统为主，对输血患者进行不规则抗体筛查，可以有效较少或避免输血反应的发生，提高输血疗效和输血安全。

Objective To analyze the detection results of irregular antibody before clinical transfusion, to reduce the occurrence of adverse blood transfusion reactions and improve the safety of clinical transfusion. Methods 2 846 patients admitted to No. 174 Hospital of Chinese People＇s Liberation Army from January 2015 to December 2016 were selected as the subjects, including 1 438 females and 1 408 males. All patients were performed irregular antibody screening with microcolumn gel technology before transfusion, and antibody identification test was performed if the screening result was positive, then made statistics and analysis for the relevant results. Results The irregular antibodies were found in 221 cases in 2 846 cases, and the positive rate of irregular antibody screening was 7.77% （221/2 846）. The positive rate of female subjects was 10.78% （155/1438）, and the positive rate of male subjects was 4.69% （66/1 408）, the positive rate of female subjects was higher than that of male subjects, with statistically significant difference （x^2=36.86, P〈0.001）. The positive rate of the subjects with history of blood transfusion, pregnancy or trauma was 10.68% （173/1 620）, while the positive rate of the subjects without history of blood transfusion, pregnancy or trauma was 3.92% （48/1 226）, the positive rate of the former was higher that of the latter, with statistically significant difference （x^2=44.58, P〈0.001）. In age distribution, there was an upward trend in the positive rate of antibody screening with the age of all the subjects. In the 221 positive cases with irregular antibody screening, there were 168 cases of allogeneic antibodies, in which there were 83 cases of Rh blood group system （37.6%）, 49 cases of MNS blood group system （22.2%）, 22 cases of Lewis blood type system （10.0%）; there were 53 cases of non-specific antibody, in which there was 31 cases of autoantibodies （14.0%）. Conclusions The distribution of antibody in serum before the clinical transfusion is characterized by Rh system, MNS system, and Lewis system. Irregular antibody screening for transfusion patients can reduce or avoid the occurrence of transfusion reaction effectively, and improve the safety of blood transfusion.