A2型急性髓系白血病患者血型鉴定及输血策略研究——附1例报道

Blood type identification and corresponding transfusion strategy of patients with type M2 A2 leukemia

目的对A2型M2白血病患者进行ABO血型鉴定,探讨适合此类亚型患者的红细胞和血小板的输注策略,提高输血疗效。方法采用血清学和分子生物学方法对本院2017年4月收治的1例M2型ABO正反定型不一致白血病患者的血型进行血型参比试验,同时对患者进行家系调查,并用血型血清学方法为该患者筛选适宜输注的悬浮红细胞和血小板。结果根据血清学、分子生物学方法的结果确定该患者为A2亚型,基因型A02/O01;不规则抗体筛查为阴性,血浆中存在抗-A1。在病程期间共进行输血治疗32次,输注O型洗涤红细胞16次（34 U）和A型血小板16次（16 U）,输血后试验数据及临床表现提示输血治疗达到预期的治疗效果;输血后无畏寒、寒颤及发热等不良输血反应。在后期治疗中,血型血清学检测结果与输血前比较,抗-A1并未检出。该患者ABO正反定型不一致与疾病无相关性,化疗会降低血液中抗体的含量;A2型患者输注A型血小板和O型洗涤红细胞可以满足临床治疗需要。结论 ABO血型鉴定时,应该坚持正、反定型结果一致的判定原则,对于不符合此原则的标本应同时采用分子生物学方法进行检测;对于可能因血液疾病造成抗原减弱而影响ABO血型定型的患者,在ABO血型确定以前有输血治疗需求的,应采用最严格的输血标准,以保证输血疗效,避免意外抗体的产生而影响后续的输血治疗。

Objective ABO type identification of patients with type M2 A2 leukemia was carried out to avoid potential errors caused by the disease. A patient-specific transfusion strategy of red blood cells（ RBCs） and platelets was proposed to improve transfusion efficacy and safety.Methods Serological and molecular biology tests were conducted on 1 case of type M2 leukemia patient with inconsistent forward-reverse ABO typing results. Serological methods were used to identify valid suspended RBC source and platelet supply for the patient. Results According to the results of serological and molecular biology tests,the patients were identified as A2 subtype and genotype A02/O01. The irregular antibody screening test showed negative,and A1 cells antibodies were detected in the plasma. A total of 32 transfusion treatments were made,including 16 treatments of washed type O transfusions（ 2 U per treatment） and 16 treatments of type A platelet（ 1 U per treatment）. Clinical data and patient recovery status confirmed desired therapeutic effect. No adverse reaction occurred such as chills,fever,etc. No anti-A1 antibody was detected during the later stage of the treatment. Conclusion The inconsistent forward-reverse ABO typing results were not associated with the disease. Chemotherapy did reduce antibody content in the blood. Type A platelet and type O washed RBC transfusion for this patient met the desired clinical requirement of the treatment. When encountering inconsistent ABO typing results,serological and molecular biology methods ought to be used for refined confirmation of the patient condition. For patients with ABO typing issues potentially caused by blood diseases,transfusion ought to be performed under the strictest standard possible to ensure transfusion effect and safety. Unexpected antibody reactions need to be taken into consideration to ensure effective treatment throughout.