Lewis血型系统抗体检出情况分析及其临床输血策略的探讨

Analysis of Lewis Blood Group System Antibody Detection and Discussion on Clinical Transfusion Strategy

目的通过对现阶段Lewis血型系统抗体检出率的分析,探讨产生Lewis血型系统抗体患者的临床输血策略。方法应用盐水试管法及卡式抗人球蛋白法等血清学方法进行实验检测,对证实存在Lewis血型系统抗体的标本进行回顾性分析。结果 2 923例送检标本中有147例检出Lewis抗体,抗Le^a抗体83例占56.5%(83/147),抗Le^b抗体51例占34.7%(51/147),抗Le^a+Le^b抗体13例占8.8%(13/147)。单纯IgM型135例占91.8%(135/147),IgG型或IgG+IgM型Lewis抗体12例占8.2%(12/147)。血型正反不一致标本中有38例检出Lewis抗体,其中26例为抗Le^b抗体,占68.4%(26/38),卡式抗体筛选试验Lewis抗体漏检率为28.5%(42/147)。51例输注了红细胞,未发生输注无效或输血反应。结论 Lewis血型系统抗体检出率与文献报道[6,9]存在差异,Lewis血型系统抗体的临床意义不可忽视,应尽可能采用三种介质交叉配血来保证输血安全。

Objective To discuss the clinical transfusion strategy on patients producing Lewis blood group system antibody through analysing the antibody detection rate of Lewis blood group system at present.Methods The specificity of irregular antibody was determined by using saltwater medium test tube method,anti-human globulin medium card method and other serological methods.The Lewis blood group system antibody was confirmed the presence in the samples which were analyzed retrospectively.Results Of the 2 923 samples submitted for examination,Lewis antibody were detected in 147 cases,83 cases of anti-Le^a antibody account for 56.5%(83/147),51 cases of anti-Le^b antibody account for 34.7%(51/147),and 13 cases of anti-Le^a+Le^b antibody account for 8.8%(13/147).There were 135 cases of pure IgM type accounting for 91.8%(135/147) and 12 cases of IgG type or IgG+IgM type Lewis antibody accounting for 8.2%(12/147).Lewis antibodies were detected in 38 cases of ABO typing discrepancy specimens,among which anti-Le^b antibodies were detected in 26 cases,accounting for 68.4%(26/38).Lewis antibody missed rate in the card-type antibody screening test was 28.5%(42/147).There were 51 cases of erythrocyte transfusion,and none of them had ineffective transfusion or transfusion reaction.Conclusion The detection of Lewis blood group system antibodies was different from the literature reports[6,9], and the clinical significance of Lewis blood group system antibodies should not be ignored.As far as possible,cross matching of three mediators should be adopted to ensure the safety of blood transfusion.