经MGT法检测的60例血标本ABO血型正反定型不符的主要影响因素及干预对策

Main Influencing Factors and Intervention Strategies of Positive and Negative ABO Blood Type Inconsistency in 60 Blood Samples by MGT Method

目的 对ABO血型正反定型不符的相关影响因素进行分析并针对性制定干预策略,确保ABO血型的定型及保障临床上输血的安全性。方法 回顾性分析我院2017年1月至2022年1月收治的71 163例经输血科诊断为ABO血型患者的临床资料,其中正反定型不符的标本为60例(排除进行多次重复送检的标本)。对所有标本均采用微柱凝胶(MGT)法进行检测,对影响正反定型不符、致血型抗原/抗体减弱或缺失、ABO血型抗原抗体出现额外反应的相关因素进行分析,并给予针对性的干预措施。结果71 163例ABO血型的患者中,正反定型不符的标本有60例,其中A、B、O血型正反定型不符分别为22例(36.67%)、26例(43.33%)、12例(20.00%),差异有统计学意义(P <0.05);在影响ABO正反定型不符的因素中,人为因素为6例(10.00%),生理因素为19例(31.67%),疾病因素为16例(26.67%),治疗因素为2例(3.33%),其他因素为17例(28.33%);60例正反定型不符的标本中,血型抗原/抗体减弱或缺失的标本有16例,其中年龄> 60岁、恶性血液疾病、试剂干扰、ABO亚型、恶性实体肿瘤是致血型抗体减弱或缺失的主要影响因素;60例正反定型不符的标本中,ABO血型抗原抗体出现额外反应的标本有19例,其中ABO亚型、自身抗体是正定型额外反应的主要影响因素,血清蛋白较高、同种抗体、试剂、同种抗体及自身抗体、自身抗体是反定型额外反应的主要影响因素,自身抗体是同时额外反应的主要影响因素。结论 对于ABO正反定型不符患者影响较大的为生理因素,其次为其他因素和疾病因素,人为因素次之;当患者年龄> 60岁时易导致血型抗原减弱或缺失,而血型抗原减弱或缺失的主要因素为恶性血液疾病、试剂干扰、ABO亚型、恶性实体肿瘤;ABO血型抗原抗体出现正定型额外反应的主要因素为ABO亚型、自身抗体,出现反定型额外反应的主要影响因素为血清蛋白较高、同种抗体、试剂、同种抗体及自身抗体、自身抗体。临床上可针对患者的疾病史、自身血液等情况进行针对性的血清学试验来确认患者的ABO血型,对血型进行准确的区分,进而保证患者临床上输血的安全性。

Objective To analyze the related influencing factors of ABO blood type inconsistency between positive and negative blood type in order to formulate targeted intervention strategies to ensure the determination of ABO blood type and the safety of clinical blood transfusion.Methods The clinical data of 71163 patients with ABO blood group diagnosed by the blood transfusion department in our hospital from January 2017 to January 2022 were retrospectively analyzed. Among them, 60 specimens did not match the positive and negative stereotypes(excluding those who had undergone multiple repeated examinations). All specimens were detected by microtubes gel test(MGT), and the related factors affecting positive and negative stereotypes, weakened or absent blood group antigens/antibodies, and additional reactions to ABO blood group antigens and antibodies were analyzed, and targeted interventions was given. Results Among the 71163 patients with ABO blood, there were 60 specimens with blood type inconsistency, among which respectively 22(36.67%), 26(43.33%), and 12(20.00%) of the A, B, and O. The difference was statistically significant(P<0.05). Among the factors affecting the discrepancy between positive and negative ABO stereotypes,human factors were 6 cases(10.00%), physiological factors were 19 cases(31.67%), disease factors were 16 cases(26.67%), treatment factors were 2 cases(3.33%), and other factors were 17 cases(28.33%);among the 60 specimens with inconsistent positive and negative stereotypes,16 specimens had weakened or absent blood group antigens/antibodies, of which age > 60 years, malignant hematological diseases, reagent interference, ABO subtypes, malignant solid tumors were the main influencing factors for the weakening or loss of blood group antibodies;among the 60 specimens that did not match positive and negative stereotypes, 19 specimens showed additional reactions to ABO blood group antigens and antibodies. Among them, ABO subtype and autoantibodies were the main influencing factors for the additional reactions of positive and negative stereotypes. Alloantibodies, autoantibodies, and autoantibodies were the main influencing factors for the additional reaction of reverse stereotype,and autoantibodies were the main influencing factors for the additional reaction at the same time. Conclusion Physiological factors have a greater impact on patients with ABO positive and negative stereotypes, followed by other factors and disease factors, followed by human factors. When the patient’s age > 60 years old, it is easy to lead to the weakening or deletion of blood group antigens, and the weakening or loss of blood group antigens. The main missing factors are hematological malignancies, reagent interference, ABO subtypes, and malignant solid tumors;the main factors for positive-type additional responses to ABO blood group antigens and antibodies are ABO subtypes and autoantibodies, and the main factors for negative-type additional responses are higher serum protein, alloantibodies, reagents, alloantibodies and autoantibodies, autoantibodies;clinically, targeted serological tests can be carried out according to the patient’s disease history, own blood, etc. To confirm the patient’s ABO blood type, and to accurately distinguish the blood type, thereby ensuring the safety of the patient’s clinical blood transfusion.