直接抗人球蛋白试验阳性患者血型鉴定及交叉配血试验分析

Blood grouping and cross-matching test in 54 patients with positive results of direct anti-human globulin test

目的分析直接抗人球蛋白试验(DAT)阳性患者血型鉴定及交叉配血试验结果,为临床输血提供一定的参考。方法 2017年6月至2018年6月我院确诊的54例自身免疫性溶血性贫血(AIHA)、DAT阳性患者,行DAT、交叉配血试验(凝聚胺法)、冷抗体吸收试验、磷酸氯喹放散试验及自身抗体吸收试验,观察DAT阳性凝集、DAT分型、血型鉴定、交叉配血检测及处理结果。结果 DAT阳性患者中W+～2+凝集98. 15%; DAT分型中Ig G、C3d占50. 00%,单Ig G型占29. 63%,单C3d型占20. 37%; ABO血型正反定型不符占79. 63%,自身红细胞、血清凝集占61. 11%;经冷抗体吸收试验、磷酸氯喹放散试验后确定血型:A型Rh阳性13例,B型Rh阳性12例,O型Rh阳性9例,AB型Rh 9例; 54例DAT阳性患者中显示配血不合44例,其中主、次侧均显示阳性反应22例,主侧阳性反应、次侧阴性反应14例,主侧阴性反应、次侧阳性反应8例;配血不合原因:冷抗体因素17例,冷凝集素效价1:256以上8例,冷凝集素效价1:128 19例;行冷抗体吸收试验、磷酸氯喹放散试验、自身抗体吸收试验后显示交叉配血相合36例,交叉配血不合8例。结论冷抗体吸收试验、磷酸氯喹放散试验或自身抗体吸收试验应用有利于DAT阳性患者血型鉴定,提高交叉配血相合率。

Objective To provide the references for clinical blood transfusion through analyzing the results of blood grouping and cross-matching test of 54 patients with positive results of direct anti-human globulin test(DAT).Methods Fifty-four DAT positive patients with autoimmune hemolytic anemia(AIHA)diagnosed in our hospital were enrolled in the study.The DAT,cross-matching test(polybrene method),cold resistant body absorption test,chloroquine phosphate elution test and autoantibody absorption test were performed.The detection and treatment results of DAT positive agglutination,DAT classification,blood grouping and cross-matching test were observed.Results In the DAT positive patients,W+~2+agglutination accounted for 98.15%.In the DAT classification,IgG and C3d accounted for 50.00%in which single IgG type accounted for 29.63%and single C3d type accounted for 20.37%.Unconformable ABO group typing and reverse typing accounted for 79.63%.Autologous erythrocyte and serum agglutination accounted for 61.11%.The cold resistant body absorption test and chloroquine phosphate elution test showed that the blood type was A Rh positive type in 13 cases,B Rh positive type in 12 cases,O Rh positive type in 9 cases and AB Rh type in 9 cases.Among the 54 DAT positive patients,there were 44 cases with unconformable blood matching,including positive reactions on both the primary side and the secondary side of 22 cases each.There were positive reactions on the primary side and negative reactions on the secondary side in 14 cases,and negative reactions on the primary side and positive reactions on the secondary side in 8 cases.The causes of unconformable blood matching included cold antibody factors(N=17),cold agglutinin titer higher than 1:256(N=8)and cold agglutinin titer of 1:128(N=19).The cold resistant body absorption test,chloroquine phosphate elution test and autoantibody absorption test showed 36 cases with cross-matching compatibility and 8 cases with incompatibility.Conclusion The cold resistant body absorption test,chloroquine phosphate elution test and autoantibody absorption test are beneficial to the blood grouping of DAT positive patients,which can improve the compatibility of cross matching.