低离子强度盐溶液在交叉配血试验和不规则抗体检测中的应用

Application and discussion of low ionic strength salt solution in cross matching blood test and irregular antibody detection

目的研究一种低离子强度盐溶液的配方,并探讨其在微柱凝集法交叉配血试验和不规则抗体检测试验中的应用及影响因素。方法利用生理盐水、低离子强度盐溶液,分别对2015年10月—2016年12月在新疆医科大学第一附属医院昌吉分院住院与门诊申请输血和手术备血的3 125例受血者和3 125例供血者用长春博迅生物技术有限责任公司提供的抗人球蛋白检测卡进行凝集配血试验,并与瑞士达亚美2号稀释液(ID-Diluent 2)对相同的受血者和供血者在达亚美提供的微柱凝胶卡进行凝集配血试验对比;同样利用生理盐水、低离子强度盐溶液分别对6 250例不规则抗体筛选标本用长春博迅生物技术有限责任公司提供的抗人球蛋白检测卡进行不规则抗体筛查,并与瑞士达亚美2号稀释液对相同的样本在达亚美提供的微柱凝胶卡进行不规则抗体筛查结果对比。结果用低离子强度盐溶液配制的红细胞悬液进行交叉配血,其中阳性58例(1.9%),阴性3 067例(98.1%),与达亚美的检测结果完全相同;用生理盐水配制的红细胞悬液进行交叉配血,其中阳性33例(1.1%),阴性3 092例(98.9%)。用低离子强度盐溶液配制的红细胞悬液进行不规则抗体筛查,其中阳性62例(0.992%),阴性6 188例(99.008%),与达亚美的检测结果完全相同;用生理盐水配制的红细胞悬液进行不规则抗体筛查,其中阳性42例(0.672%),阴性6 208例(99.328%)。低离子强度盐溶液介质的红细胞悬液与生理盐水介质的红细胞悬液交叉配血及抗筛检测的反应强度比较,差异均有统计学意义[交叉配血:反应强度1+占6.9%(4/58)比42.4%(14/33),反应强度2+占24.1%(14/58)比33.3%(11/33),反应强度3+占41.4%(24/58)比9.1%(3/33),反应强度4+占27.6%(16/58)比15.2%(5/33);不规则抗体筛查:反应强度1+占9.7%(6/62)比38.1%(16/42),反应强度2+占22.6%(14/62)比33.3%(14/42),反应强度3+占41.9%(26/62)比9.5%(4/42),反应强度4+占25.8%(16/62)比19.0%(8/42),均P<0.05]。结论低离子强度盐溶液用于微柱凝集法交叉配血试验的敏感性高、特异性强、结果稳定,适用于临床输血前交叉配血试验及抗筛试验的血清学检测。

Objective To study a formulation of low ionic strength salt solution and discuss its application and influencing factors in micro column agglutination cross matching blood test and irregular antibody screening test. Methods From October 2015 to December 2016, 3125 blood recipients planning for blood transfusion and for surgical blood preparation and 3125 blood donors in Changji Branch of the First Affiliated Hospital of Xinjiang Medical University, including inpatients and outpatients, received agglutination cross matching blood tests in which normal saline and low ionic strength saline solution were used respectively to prepare the red blood cell（RBC） suspensions, and the anti-human globulin test card provided by Changchun Boxun Biotechnology Co. Ltd. was applied to carry out the tests; by the similar way, the Swiss Dia Med diluent 2（ID-Diluent 2） was used to make RBC suspensions for above recipients and donors to perform agglutination matching blood tests using the micro columngel card provided by Dia Med. The blood matching results of above two ways of performing the tests were compared. Similarly, normal saline and low ionic strength saline solution were applied respectively for irregular antibody screening samples from 6 250 cases to make RBC suspensions and anti-human globulin test card provided by Changchun Boxun Biotechnology Co. Ltd. was used to carry out the irregular antibody screening tests, and the test results were compared with those obtained from the irregular antibody screening tests performed on the same cases using Swiss Dia Med diluent 2 and the micro columngel card provided by Dia Med. Results There were 58 positive（1.9%） and 3 067 negative（98.1%） test results in the cross matching blood tests using low ionic strength salt solution to prepare RBC suspension, and the results were completely identical to those of Dia Med test results; thirty-three positive（1.1%） and 3 092 negative（98.9%） cases were the results of cross matching blood tests using normal saline to perform RBC suspension. In the results of irregular antibody screening tests utilizing low ionic strength salt solution to prepare RBC suspension, there were 62 positive（0.992%） and 6 188 negative（99.008%） cases, and the results were completely identical to those obtained from Dia Med method. There were 42 positive（0.672%） and 6 208 negative（99.328%） cases, when normal saline was used to prepare RBC suspension to perform irregular antibody screening tests. The comparisons of reaction intensity results between using low ionic strength salt solution and normal saline to make RBC suspensions in either cross matching blood test or irregular antibody screening test showed significant differences statistically [Cross blood matching： The reaction intensity 1＋ accounted for 6.9%（4/58） vs. 42.4%（14/33）; the reaction intensity 2＋, 24.1%（14/58） vs. 33.3%（11/33）; the reaction intensity 3＋, 41.4%（24/58） vs. 9.1%（3/33）; the reaction intensity 4＋, 27.6%（16/58） vs. 15.2%（5/33）. Irregular antibody screening： The reaction intensity 1＋ accounted for 9.7%（6/62） vs. 38.1%（16/42）; the reaction intensity 2＋, 22.6%（14/62） vs. 33.3%（14/42）; the reaction intensity 3＋, 41.9%（26/62） vs. 9.5%（4/42）; the reaction intensity 4＋, 25.8%（16/62） vs. 19.1%（8/42）; all P〈 0.05）]. Conclusion Low ionic strength salt solution used in micro column agglutination cross matching blood test has the characteristics of high sensitivity, strong specificity and stable results. It is clinically suitable for the serological detection of pre-transfusion cross matching blood test and antibody screening test.