微柱凝胶法交叉配血出现不规则凝集的原因和安全输血对策

The reasons for irregular blood coagulation in microcolumn gel crossover blood matching and the safety blood transfusion measures

目的探讨微柱凝胶法交叉配血出现不规则凝集的原因和安全输血对策。方法选择2017年1月—2018年12月广东省四会市人民医院3 983例进行交叉配血的受血者作为研究对象,进行交叉配血前对受血者和供血者的正反定型,然后采用微柱凝胶法交叉配血。观察交叉配血结果,统计交叉配血的凝集阳性率和交叉配血不符合情况。结果 3 983例受血者全部为同型血输注,凝集阳性率2.54%。分析原因包括,受血者产生自身抗体,如有输血史的贫血患者或有妊娠史的经产妇;体内产生免疫性抗原吸附在红细胞表面,造成红细胞致敏,对供血者血浆产生不规则凝集。采用安全输血对策,即预约洗涤红细胞,可排除次侧凝集的影响,确保输血疗效。紧急用血,使用盲配,选用多个供血袋,寻找完全相合的供血者,可降低输血风险。结论微柱凝胶法交叉配血出现不规则凝集的原因包括抗人球蛋白试验阳性、假凝集、抗筛阳性、操作不当、微柱凝胶干涸等,需要按照原因分析和安全输血原则,采取不同解决办法和对策。最佳的安全输血对策,是减少异体输血的风险,大力推行自体血回输,达到降低输血风险和输血成本的良好效果。

Objective To investigate the causes of irregular blood coagulation occurring in microcolumn gel crossover blood matching and safety blood transfusion measures. Methods A total of 3 983 patients were selected as the study objects to undergo cross matching of blood in the Sihui City People's Hospital from January 2017 to December 2018. Before crossover blood matching, the blood positive and negative patterns of blood recipient and donor were performed and then the micro-column gel method was used to conduct cross blood matching. The results of cross-matching were observed, and the positive rate of agglutination and the mismatching situation of cross-matching were calculated. Results All of the 3 983 patients received the same type of blood transfusion, and the positive agglutination rate of the transfusion was 2.54%. The causes were analyzed, including the patient producing autoantibody, for example, a patient with anemia having multiple blood transfusion histories (such as thalassemia patient) or a multiparous woman with a number of pregnancy histories in whose body the immune antigen was produced and absorbed onto the surface of the red blood cells (RBCs) leading to RBCs sensitization, resulting in the RBCs irregular aggregation with the donor plasma. The safety blood transfusion measure, making an appointment for washing the RBCs before cross transfusion, was applied to exclude the secondary aggregation and guarantee the efficacy of transfusion of blood. In emergency blood transfusion, blind matching could be used, in which multiple blood supply bags were selected to look for a complete matching blood donor, and by using that the risk of blood transfusion can be reduced. Conclusions The causes of irregular agglutination occurring in using microcolumn gel method for cross blood matching include anti-human globulin test positive, false agglutination, anti-screen positive, improper operation, micro-column gel drying, etc. It was necessary in accord with the analyses of different causes and safety blood transfusion principles toselect different resolving methods and countermeasures. The best safe blood transfusion strategy is to reduce the riskof allogeneic blood transfusion and vigorously promote the development of autologous blood transfusion technology to achieve a good effect of reducing transfusion risk and blood transfusion cost.