新生儿血标本交叉配血不符主要影响因素分析及处置策略分析

Main influencing factors and treatment strategy of inconsistent cross matching of neonatal blood samples

目的探究新生儿血标本交叉配血不符主要影响因素及处置策略。方法回顾性分析2018年7月至2020年5月周口市妇幼保健院收治的32例血标本交叉配血不符新生儿临床资料。对新生儿血标本进行ABO和Rh (D)血型鉴定、抗人球蛋白实验、抗体鉴定、交叉配血实验;统计新生儿血型、分析交叉配血不符原因并制定针对性处理措施。结果血液中含有免疫球蛋白G (IgG)抗A抗体,是A型Rh (D)阳性血标本交叉配血不符的原因。交叉配血选取O型Rh (D)阳性洗涤红细胞、配血相合。B型Rh (D)阳性患儿血标本交叉配血不符的原因为血液中含有IgG抗B抗体,建议处置策略为给予O型Rh (D)阳性洗涤红细胞进行交叉配血相合。O型Rh (D)阳性患儿血标本交叉配血不符的原因为血液中含有IgG抗D抗体或血液中含有IgG抗E抗体,前者交叉配血选取O型Rh (D)阴性洗涤红细胞、配血相合,后者交叉配血选取O型Rh (D)阳性E抗原阴性洗涤红细胞、配血相合。结论新生儿血标本交叉配血不符的主要影响因素为血液中含有母体IgG抗体。输血前应积极行抗人球蛋白实验、抗体鉴定等明确具体抗体,给予相对应抗体的抗原阴性血液进行交叉配血。

【Objective】To explore the main influencing factors and treatment strategies of inconsistent cross matching of neonatal blood samples.【Methods】Clinical data of 32 neonates with inconsistent cross matching of blood samples treated in our hospital from July 2018 to May 2020 were retrospectively studied.Neonatal blood samples were collected for ABO and Rh(D)blood group identification,anti-human globulin test,antibody identification,cross matching test.Newborn blood group was counted,reasons for inconsistent cross matching were analyzed,and targeted treatment measures were formulated.【Results】The blood samples containing immunoglobulin G(IgG)anti-A antibody was the reason for the mismatching of Rh(D)positive blood samples of type A.The cross matching blood samples of type O Rh(D)positive washed red blood cells were consistent.The cause of inconsistent cross matching of blood samples of children with type B Rh(D)positive was due to the presence of IgG anti-B antibody in the blood,and the suggested treatment strategy was to give type O Rh(D)positive washed red blood cells.The reason for the inconsistent cross matching of blood samples from children with type O Rh(D)positive was that the blood contained IgG anti-D antibody,or the blood contained IgG anti-E antibody.The former cross matching selected O-type Rh(D)negative washed red blood cells and matched with each other,while the latter selected O-type Rh(D)positive E antigen negative washed red blood cells for blood matching.【Conclusion】The main influencing factor of inconsistent cross matching of neonatal blood samples is maternal IgG antibody in the blood.Before blood transfusion,anti-human globulin test and antibody identification should be carried out to confirm specific antibodies,and antigen negative blood of corresponding antibodies should be given for cross matching.