免疫性溶血性输血反应100例分析

Analysis of 100 Cases of Immune Hemolytic Transfusion Reaction

目的近年来,临床样本的检测中,免疫性溶血性输血反应(IHTR)样本检出率不断增加。同时,毛细管离心技术、PEG增强技术、微柱凝集卡技术等逐渐普及应用,这些技术上的变化可能影响IHTR检出率。为了减少IHTR漏检,有必要对以往IHTR样本特点进行总结,分析造成临床漏检的可能原因,以及实验室及时发现IHTR的检测技术关键。方法回顾2011年3月~2021年3月,上海市血液中心血型参比实验室检出的IHTR案例。纳入案例需同时符合:有近期输血史;检出同种抗体;检出或确认输入了与该同种抗体反应的红细胞。所有入组样本中,不包括新生儿及检出自身抗体的案例,以防止来自产妇的被动免疫抗体和"类同种自身抗体"的干扰。对所有纳入的案例,统计抗体特异性、效价、直抗、患者诊断、血红蛋白及性别年龄分布、输血至检出溶血反应的时间等特征。结果IHTR样本共100例,患者诊断以肿瘤、MDS(骨髓异常增生综合征)居多;其中Rh系统抗体造成的溶血性输血反应占78%,Kidd系统造成的输血反应占11%,涉及抗体大多效价较低80%≤4;患者直抗可持续阳性超过8周;年龄分布不存在性别差异。结论溶血性输血反应可使受血者产生溶血,可能严重危害患者生命安全。IHTR样本中抗体大多为Rh系统抗体,通过Rh同型输注可有效降低IHTR的发生率。通过统计还发现,造成溶血的抗体普遍较弱,且输入的不配合红细胞在体内迅速代谢,使IHTR容易被漏检,造成反复输入不配合红细胞,危及患者生命。在检测技术上,有必要提高检测的灵敏度,应用毛细管离心分离技术对IHTR的检测有较大的帮助。

Objective The positive rate of immune hemolytic reaction(IHTR)samples in Shanghai Blood Center has been increasing in recent years,gradually popularized with capillary technology,PEG enhancement technology and microcolumn agglutination card technology.These changes may affect the detection rate of IHTRs.Methods IHTR cases detected in the blood group reference laboratory of Shanghai Blood Center from March 2011 to March 2021 were reviewed.The inclusion criteria were the recent history of blood transfusion,the detection of Alloantibody and the detection or confirmation of the input of red blood cells reacting with the antibody.All included cases excluded newborns and patients with autoantibodies to prevent interference from maternal antibodies and mimicking antibodies.The antibody specificity and titer,patient diagnosis,hemoglobin,gender and age distribution,and the time from blood transfusion to detection of hemolytic reaction were caculated for all included cases.Results There were 100 IHTR samples.The diagnosis of patients was mostly tumor and MDS(myelodysplastic syndrome);Among them,the hemolytic blood transfusion reaction caused by RH system antibody accounts for 78%,and the blood transfusion reaction caused by Kidd system accounts for 11%.Most of the antibody effects are low,and 80%of the titration is less than 4;The patient’s DAT positive lasted for more than 8 weeks.Conclusion Hemolytic transfusion reaction can cause severe hemolysis in the recipient,which may seriously endanger the life safety of the patient.Most of the antibodies in IHTR samples are RH system antibodies.RhD,CcEe typing and the homotype transfusion can effectively reduce the occurrence of IHTR.The antibodies causing hemolysis are generally weak,and the incompatible transfused red blood cells are metabolized rapidly in vivo and are not easy to be detected,which makes IHTR easy to be ignored,resulting in repeated input of“matched”red blood cells and endangering the life of patients.In terms of detection technology,it is necessary to improve the detection sensitivity.The capillary technology is of great help to the detection of IHTR.