地中海贫血和再生障碍性贫血患者输注不同Rh抗原匹配红细胞后的血清学特征及疗效

Analysis of serological characteristics and therapeutic effect of different Rh antigen matching red blood cells in patients with thalassemia and aplastic anemia

目的:分析地中海贫血(地贫)、再生障碍性贫血(AA)患者输注不同Rh抗原匹配红细胞(RBC)后,血清学特征和输血治疗效果差异,指导此2类疾病临床用血。方法:选取2015-01—2019-12治疗的地贫106例,其中男61例,女45例,AA患者94例,其中男51例,女43例,根据受血者Rh抗原与献血员Rh抗原匹配程度和疾病类别,将所有患者分为Rh抗原完全匹配组、部分匹配组、Rh抗原随机组,比较2类疾病不同组别,不规则抗体阳性率、直接抗人球蛋白试验(DAT)阳性率、不良输血反应率和输血有效率的差异,并进行统计学分析。结果:2种疾病性别构成比差异无统计学意义(χ~2=0.219,P>0.05),不规则抗体以Rh血型系统为主,地贫患者中,Rh抗原完全匹配组不规则抗体阳性率、DAT阳性率均低于Rh抗原随机组,差异有统计学意义(χ~2=7.433;χ~2=3.941,P<0.05);Rh抗原完全匹配组,输血有效率高于其他组,差异有统计学意义(χ~2=5.453;χ~2=6.717,P<0.05)。3组间不良输血反应率差异无统计学意义(χ~2=0.656,P>0.05);AA患者各组间,不规则抗体阳性率、DAT阳性率、不良输血反应率、输血有效率差异无统计学意义(χ~2=0.180~5.241,P>0.05);地贫患者,不规则抗体阳性率、DAT阳性率高于AA患者,差异有统计学意义(χ~2=4.318;χ~2=5.572,P<0.05);AA患者输血有效率高于地贫患者,差异有统计学意义(χ~2=13.798,P<0.05),2类疾病不良输血反应率差异无统计学意义(χ~2=0.004,P>0.05)。结论:地贫患者应尽量选择ABO、Rh抗原匹配的RBC输注,减少同种抗体的产生,AA患者可选择ABO同型血输注,既减少血液筛查费用,又可确保输血有效性。

Objective:To analyze the difference of serological characteristics and therapeutic effect of blood transfusion between thalassemia and aplastic anemia(AA)patients after transfusion of RBC with different Rh antigens,and guide the clinical use of blood in the patients with these two diseases. Method:A total of 106 patients with thalassemia diagnosed and treated in our hospital from January 2015 to December 2019 were selected,including 61 males and 45 females,and 94 AA patients,including 51 males and 43 females.According to the matching degree and disease category of Rh antigen between the recipient and the donor,all patients were divided into Rh antigen complete matching group,Rh antigen partial matching group and Rh antigen random group.The differences of the positive rate of irregular antibody,the positive rate of direct anti human globulin test(DAT),the rate of adverse transfusion reaction and the efficiency of transfusion were compared and analyzed statistically. Result:There was no significant difference in the ratio of male to female in the two diseases(χ~2=0.219,P>0.05).The main irregular antibody was Rh blood group system.The positive rates of irregular antibody and DAT in the patients with aplastic anemia were lower than those in the patients with Rh antigen,and the difference was statistically significant(χ~2=7.433;χ~2=3.941,P<0.05).The efficiency of blood transfusion in Rh antigen matched group was higher than that in Rh antigen partial matched group and Rh antigen random group,the difference was statistically significant(χ~2=5.453;χ~2=6.717,P<0.05).There was no significant difference in the rate of adverse transfusion reaction among the groups(χ~2=0.656,P>0.05);there was no significant difference in the rate of irregular antibody,DAT,adverse transfusion reaction and transfusion efficiency among the groups of AA patients(χ~2=0.180-5.241,P>0.05).The positive rates of irregular antibody and DAT in patients with thalassemia were higher than those in patients with AA(χ~2=4.318;χ~2=5.572,P<0.05).The blood transfusion efficiency of AA patients was higher than that of globin producing anemia,the difference was statistically significant(χ~2=13.798,<0.05).There was no significant difference in adverse transfusion reaction rate between the two diseases(χ~2=0.004,P>0.05).Conclusion:Patients with thalassemia should try to choose ABO and Rh anti-matched RBC infusions to reduce the production of alloantibodies.AA patients can only choose ABO same blood transfusion,which can reduce blood screening costs and ensure blood transfusion effectiveness.