临床Rh D变异型鉴定分析

Clinical identification and analysis of RhD variant

目的 通过分析丽水市中心医院2016年1月—2020年9月10例Rh D变异型,探讨更准确鉴定Rh血型的方法,提高临床用血安全性。方法 自身对照阴性,Ig M抗D试剂与受检者红细胞凝胶微柱卡凝集强度<4+时试管法采用3种不同克隆株Ig M抗D试剂进行检测;自身对照阳性,DTT处理后再鉴定。结果 6例患者红细胞与Ig M抗D试剂凝集度1+~2+,4例患者红细胞与Ig M抗D试剂凝集度2+~3+且与3种不同克隆株凝集强度差异较大,根据其反应类型可判定为D变异型,其中1例自身凝集影响Rh D变异型鉴定。结论 Rh血型鉴定中凝胶微柱卡凝集度<4+,试管法凝集度<3+要考虑D变异,也要注意避免患者红细胞自身凝集带来的干扰。

Objective By analyzing 10 cases of RhD variant from January 2016 to September 2020 in Lishui Central Hospital,a more accurate method for identifying Rh blood type was explored to improve the safety of clinical use of blood.Methods Self-control was negative,IgM resistance D was detected by the test tube method with the IgM resistance D of three different clone strains when the agglutination intensity of RBC gel microcolumn was less than 4+;the self-control was positive,DTT treatment was followed by identification.Results Six cases showed red blood cells and IgM anti-D cohesion 1+-2+,four cases showed IgM anti-D cohesion V 3+,and the agglutination intensity of the three clones was significantly different;according to their reaction,they can be judged as D variant,and one case of auto agglutination affected the identification of RhD variant.Conclusion D variation should be considered in the identification of Rh blood group with gel microcolumn agglutination<4+and in the test tube agglutination<3+,and interference caused by the hemagglutination of patients7 red blood cells should also be prevented.