自身免疫性溶血性贫血抗体特征与不同输血方案疗效评估

Antibody characteristics of autoimmune hemolytic anemia and evaluation of efficacy of different blood transfusion schemes

目的:分析自身免疫性溶血性贫血(AIHA)患者不规则抗体情况,确定抗体性质,对比不同RBC筛选方式输注效果,为AIHA临床输血提供依据。方法:回顾性统计125例AIHA患者自身抗体、同种抗体、DAT情况,分析自身抗体、DAT凝集强度与溶血关系。将AIHA患者分为3组,A组输注最小不相容洗涤RBC,B组输注Rh相同或匹配性RBC,C组输注体外溶血试验匹配RBC,比较3组间RBC治疗效果和不良输血反应。结果:125例患者单独含自身抗体89例,自身抗体合并同种抗体33例,自身抗体、DAT凝集强度越高,患者血红蛋白(Hb)越低,差异有统计学意义(P<0.05);各组RBC输注前后Hb、RBC、Hct、胆红素、Ret差异均有统计学意义(P<0.05);C组RBC输注显效率高于A组,差异有统计学意义(P<0.05);各组不良输血反应率差异无统计学意义(P>0.05)。结论:紧急情况可以输注ABO、Rh相同或配合性RBC,非紧急情况可以筛选ABO、Rh同型RBC后利用体外溶血试验交叉配血。

Objective:To analyze the situation of irregular antibodies in autoimmune hemolytic anemia(AIHA) patients,determine the nature of the antibodies,compare the effects of different RBC screening and infusion methods,and provide a basis for AIHA clinical transfusion. Method:The autoantibodies,alloantibodies,and DAT of 125 patients with AIHA were retrospectively analyzed,and the relationship between the autoantibodies and DAT agglutination intensity and hemolysis was analyzed.AIHA patients were divided into 3 groups.Group A was infused with minimally incompatible wash RBC.Group B was infused with the same Rh or matched RBC.Group C was infused with matching RBC with hemolysis test in vitro.The RBC treatment effects and adverse transfusion reactions between the three groups were compared. Result:There were 89 cases of 125 patients with autoantibodies alone and 33 cases of autoantibodies combined with alloantibodies.The higher the agglutination intensity of autoantibodies and DAT,the lower the Hb of the patients.The difference was statistically significant(P<0.05).There were significant differences in Hb,RBC,HCT,bilirubin and RET before and after RBC infusion in each group(all P<0.05).The RBC infusion efficiency in group C was significantly higher than that in groups A.The difference was statistically significant(P<0.05).There was no significant difference in adverse transfusion reaction rate among the groups(P>0.05).Conclusion:In the case of emergency,infusion of the same or compatible RBC of ABO and Rh could be performed.In non-emergency situations,RBC of ABO and Rh of the same type could be screened for cross-matching after hemolysis test in vitro.