75例ABO血型正反定型不符原因调查与分析

Causes of ABO forward and reverse grouping discrepancy:75 cases

目的 分析ABO血型正反定型不符标本处理结果及原因,保障临床用血安全。方法 对2019年12月-2022年3月75例患者正反定型鉴定不符的标本进行盐水法正反定型、直接抗球试验、抗体筛查、抗体鉴定、增加血浆量、4℃孵育增强试验、吸收放散试验、分子生物学检测等,并综合分析结果。结果 反定型异常:抗体减弱11例(11/75,14.67%)、意外抗体19例(19/75,25.33%)、白球比倒置9例(9/75,12.00%)、白细胞增高3例(3/75,4.00%)、抗凝不充分3例(3/75,4.00%)、移植后2例(2/75,2.67%)、多发性骨髓瘤4例(4/75,5.33%)、急性消化道出血3例(3/75,4.00%)。正定型异常:自凝1例(1/75,1.33%)、急性白血病7例(7/75,9.34%)、移植后1例(1/75,1.33%)。正、反定型异常:急性白血病1例(1/75,1.33%)、冷凝素综合征1例(1/75,1.33%)、自身免疫性溶血性贫血6例(6/75,8.00%)、亚型4例(4/75,5.33%)。7例基因检测结果:B(A)_(04)1例、B(A)_(02)2例、AB_(3)1例、A_(1)2例、新发现基因型1例。结论 对ABO血型正反不符的患者需结合临床病史、血清学检测、吸收放散试验、分子生物学检测等多种试验方法才能准确鉴定血型,保障输血安全。

Objective To analyze the causes and solutions of ABO forward and reverse grouping discrepancy,and to ensure the safety of blood transfusion in clinical.Methods Samples from 75 patients with discrepancy between forward and reverse grouping in December 2019 and March 2022 were tested and analyzed in combination with saline method(forward and reverse grouping),direct antiglobulin test,antibody screening,antibody identification,increasing plasma volume,incubation enhancement test at 4℃,absorption-eluation test and molecular biological tests.Results Causes for abnormal reverse typing were as follows:weak antibody in 11 cases(14.67%),unexpected antibody in 19 cases(25.33%),inverted albumin and globulin ratios in 9 cases(12.00%),increased white blood cells in 3 cases(4.00%),inadequate anticoagulation in 3 cases(4.00%),bone marrow transplantation in 2 cases(2.67%),multiple myeloma in 4 cases(5.33%),acute gastrointestinal bleeding in 3 cases(4.00%).Causes for abnormal forward typing were as follows:self-coagulating in 1 case(1.33%),acute leukemia in 7 cases(9.34%),post-transplantation in 1 case(1.33%).Causes for abnormal forward/reverse typing:acute leukemia in 1 case(1.33%),condensin syndrome in 1 case(1.33%),autoimmune hemolytic anemia in 6 cases(8.00%),subtype in 4 cases(5.33%).Results of genotying in 7 cases were as follows:B(A) _(04) for 1 case,B(A)_(02) 2 cases,AB_(3) 1 case,A_(1) 2 cases,and 1 case with new genotype.Conclusion For patients with forward and reverse typing discrepancy for ABO blood group,several studying methods,such as clinical/serological tests inquiring,absorption-eluation tests and molecular biological tests,should be combined to ensure blood transfusion safety.