125例骨髓增生异常综合征免疫血液学检查阳性结果分析

Analysis of positive results of immunohematology in 125 cases with myelodysplastic syndrome

目的对125例骨髓增生异常综合征(MDS)患者异常免疫血液学检查阳性结果进行分析。方法2010年1月—2019年12月收集患者的临床病史、输血信息及血清学检查结果,比较直接抗球试验(简称直抗)阳性与抗体筛查(简称抗筛)阳性患者的平均输血量、输血效果及输血强度。结果77例直抗阳性患者中有41例合并抗筛阳性(占53.2%);68例抗筛阳性患者中有26例为Rh系统(占38.2%);直抗阳性患者红细胞人均输注量(U)高于抗筛阳性者(52.39 vs 36.94),而输血效果(输血前后血红蛋白值)及6个月前后红细胞输注总量却相反(P<0.01)。21例血型抗原减弱中19例含有A抗原减弱。结论MDS输血患者自身免疫紊乱与输血所致的同种免疫可互为影响互为加重,扩展表型匹配红细胞输血可以最小化同种免疫且可降低输血依赖。

Objective To analyze the positive results of abnormal immunohematology in 125 patients with myelodysplastic syndrome(MDS).Methods The clinical,laboratory and treatment(including transfusion)details of patients diagnosed from January 2010 to December 2019 were collected.The mean blood transfusion volume,transfusion effect and transfusion intensity between patients who were positive with direct antiglobulin test(DAT)and positive with antibody screening were compared.Results Among the 77 DAT-positive patients,41(53.2%)were combined with positive antibody.Among the 68 antibody-positive patients,26(38.2%)were Rh blood group system.The mean RBC transfusion volume per capita in DAT-positive patients was higher than those antibody-positive patients(52.39 vs 36.94),while the blood transfusion effect(Hb value before and after blood transfusion)and blood transfusion intensity 6 months prior and 6 months after were the opposite(P<0.01).Among the 21 cases of blood group antigen weakening,19 had antigen A weakening.Conclusion Autoimmune disorder in MDS patients and alloimmunization caused by blood transfusion can affect and aggravate each other.The extended phenotype matching red blood cell transfusion can minimize alloimmunity and reduce blood transfusion dependence.