自身免疫性溶血性贫血患者的血型血清学特征及红细胞不相容输注的疗效及安全性研究

Study on the serological Characteristics of Blood Type and the Efficacy and Safety of Red Blood cell Incompatibility Transfusion in Patients with autoimmune hemolytic Anemia

目的分析自身免疫性溶血性贫血病患血型特征和红细胞不相容输注的疗效及安全性。方法选择2018年2月—2019年2月在湖南省岳阳市一人民医院进行自身免疫性溶血性贫血治疗的66例病患为研究样本进行回顾性分析,依据病患抗体类型差异进行ABO同型非洗涤红细胞或O型洗涤红细胞治疗,观察红细胞不相容输注的作用及安全性。结果66例病患经不规则抗体筛查及直接抗人球蛋白试验检查后结果均显示为阳性,且其中有9例为单独IgM类冷抗体,52例为单独IgG类温抗体,5例为双重自身抗体。同时经不规则抗体鉴定试验检测提示19例为同种抗体,47例为非同种抗体。66例病患中有39例病患实施119次红细胞不相容输注,其中89次为ABO同型非洗涤红细胞,30次为O型洗涤红细胞。ABO同型非洗涤红细胞组与O型洗涤红细胞组治疗效果优异率分别是58.43%、53.34%(P>0.05)。IgM类冷抗体组与IgG类温抗体组输注效果优异率分别是46.15%、54.90%(P>0.05),并且双重自身抗体输注优异率达到100.00%。结论自身免疫性溶血性贫血病患采用ABO同型非洗涤红细胞与O型洗涤红细胞治疗均可达到较高的治疗效果,并且无明显的溶血反应,安全价值较高,但使用ABO同型非洗涤红细胞治疗具有针对性,同时还可减少O型洗涤红细胞使用剂量,具有一定的临床应用价值。

Objective To analyze the characteristics of blood group and the efficacy and safety of red blood cell incompatibility transfusion in patients with autoimmune hemolytic anemia.Methods A retrospective analysis was conducted in 66 patients with autoimmune hemolytic anemia from February 2018 to February 2019 in Yueyang Hospital,Hunan province,to observe the effect and safety of red blood cell incompatible transfusion,ABO non-washed red blood cells or O washed red blood cells were treated according to the difference of patient antibody types.Results The results of irregular antibody screening and direct anti-human Globulin test were positive in 66 cases,among which 9 cases were isolated IgM cold-like antibodies,52 cases were isolated IGG warm-like antibodies and 5 cases were double autoantibodies.At the same time,the irregular antibody identification test showed that 19 cases were alloantibodies and 47 cases were non-alloantibodies.In 39 of the 66 patients,119 red blood cell incompatible transfusions were performed,of which 89 were ABO homomorphic unwashed red blood cells and 30 were O washed red blood cells.The effective rates of ABO group and O group were 58.43%and 53.34%respectively(P>0.05).The rate of excellence in IgM cold antibody group and IgG warm antibody group was 46.15%and 54.90%respectively(P>0.05),and the rate of excellence in double autoantibody group was 100.00%.Conclusion Treatment of patients with autoimmune hemolytic anemia disease using ABO type unwashed red blood cells and O type washed red blood cells can achieve a higher therapeutic effect,and there is no significant hemolytic reaction,and the safety value is higher,but using ABO non-washed red blood cell therapy has pertinence and can reduce the dosage of O washed red blood cell,so it has clinical application value.