多发性骨髓瘤患者ABO血型鉴定及交叉配血影响及对策

ABO blood group identification and cross-matching effect and countermeasures in patients with multiple myeloma

目的分析多发性骨髓瘤(MM)患者ABO血型鉴定及交叉配血影响及对策。方法选择2017年12月至2019年12月广西来宾市人民医院收治的MM患者100例作为研究对象,以微柱凝胶法鉴定ABO血型,以试管法对交叉配血不合、正反定型不符的血液标本进行重复检测、37℃加温处理、生理盐水稀释、特异性鉴定、不规则抗体筛选、吸收放散试验等。结果100例研究对象ABO血型鉴定异常原因:5例ABO血型抗原减弱,占5.00%(对策:增加ABO亚型鉴定试验以及血型物质检测);8例血型抗原与抗体变异,占8.00%(对策:增加血型物质检测、查阅患者临床病史以及血型等);15例抗-A、抗-B丢失,占15.00%(对策:进行吸收放散实验辅助检查);18例蛋白凝集干扰,占18.00%(对策:将适量生理盐水加入试管后观察);22例各种冷抗体干扰反应,占22.00%(对策:将反定型试管置于37℃水箱中观察10 min);32例抗-A、抗-B减弱,32.00%(对策:做反定型时加大患者血浆量)。结论冷凝集素、血型抗原抗体减弱、血浆蛋白干扰是影响ABO血型鉴定、交叉配血的主要因素,因此对于ABO血型鉴定应当正反定型同时进行特异性鉴定以及不规则抗体筛选,确保鉴定结果的准确性,最大限度提高临床输血安全性。

【Objective】To analyze the ABO blood group identification and cross-matching effects and countermeasures in patients with multiple myeloma(MM).【Methods】One hundred patients with MM treated in the People's Hospital of Laibin from December 2017 to December 2019 were enrolled in this study.The ABO blood group was identified by microcolumn gel method,and the cross-matching blood was incompatible with test tube method.Blood samples with inconsistent inversion were subjected to repeated tests,37°C warming treatment,physiological saline dilution,specific identification,irregular antibody screening,absorption and release tests,and the like.【Results】One hundred cases of ABO blood group identification abnormalities:5 cases of ABO blood group antigen weakened,accounting for 5.00%(response:increase ABO subtype identification test and blood type substance test);8 cases of blood group antigen and antibody variation,accounting for 8.00%(measure:increase blood group substance detection,review of patients'clinical history and blood type,etc.);15 cases of anti-A,anti-B loss,accounting for 15.00%(countermeasure:performing absorption and release test auxiliary examination);18 cases of protein agglutination interference,accounting for 18.00%(countermeasure:the appropriate amount of physiological saline was added to the test tube and observed);22 cases of various cold antibodies interfered with the reaction,accounting for 22.00%(countermeasure:the anti-shaped test tube was placed in a 37℃water tank for 10 minutes);32 cases of anti-A,anti-B weakened,32.00%(countermeasure:add the patient's plasma volume to the counter-shaped test tube).【Conclusion】The accumulation of cold agglutinin,blood group antigen and plasma protein are the main factors affecting ABO blood group identification and cross-matching.Therefore,ABO blood group identification should be positive and negative,and specific identification and irregular antibody screening should be carried out to ens ure identification.The accuracy of the results maximizes the safety of clinical transfusions.