不规则抗体筛查试验在安全输血中的重要性

Importance of irregular antibody screening in safe blood transfusion

目的分析拟输血患者不规则抗体阳性检出率及抗体分布特征,探讨不规则抗体筛查试验与临床输血安全的关系。方法收集2020年7月—2022年6月河南大学附属郑州颐和医院收治的12216例拟输血患者的血液标本,采用微柱凝胶卡式法进行不规则抗体筛查试验,对结果为阳性的标本采用盐水法、凝聚胺法、抗人球蛋白法分别进行不规则抗体筛查,最后采用谱细胞进行抗体鉴定。统计不规则抗体的阳性率,分析不规则抗体阳性样本在不同输血史及妊娠史患者中的检出率,以及不同科室、不同疾病患者中不规则抗体的分布特征。结果12216份拟输血患者标本中检出不规则抗体阳性72份,阳性率为0.6%(72/12216),其中Rh系统抗体40份,占比为55.6%(40/72);MNSs系统12份,占比为16.7%(12/72);Lewis系统(抗Le^(a))10份,占比为13.9%(10/72);Kidd系统(抗JK^(a))2份,占比为2.8%(2/72)。不规则抗体受检者中,女性阳性检出率明显高于男性〔1.00%(60/6006)比0.19%(12/6210),P<0.05〕,有输血史患者检出率明显高于无输血史患者〔1.02%(46/4512)比0.34%(26/7704),P<0.05〕,有妊娠史患者检出率明显高于无妊娠史患者〔1.52%(58/3819)比0.09%(2/2187),P<0.05〕。产科患者不规则抗体阳性占比最高,为54.2%(39/72),明显高于其他科室,如血液内科〔12.5%(9/72)〕、妇科〔11.1%(8/72)〕、神经外科〔4.2%(3/72)〕。结论输血前进行不规则抗体筛查对提高临床输血安全性具有重要意义。

Objective To analyze the positive detectable rate and distribution of irregular antibodies in patients with blood transfusion,and explore the relationship between irregular antibody screening and clinical safe blood transfusion.Methods From July 2020 to June 2022,blood samples of 12216 patients with blood transfusion from Zhengzhou Yihe Hospital Affiliated to Henan University were collected.The irregular antibodies were screened by the card type microcolumn gel method.The positive samples were screened by saline method,polyamine method and anti human globulin method.Finally,the antibodies were identified by the spectrum cells.The positive rate of irregular antibodies was counted,and the proportion of irregular antibodies in patients with blood transfusion history and pregnancy history was analyzed,as well as the distribution characteristics of irregular antibodies in patients with different departments and diseases.Results Among the 12216 samples of patients with blood transfusion,72 samples were positive for irregular antibodies,the positive rate was 0.6%(72/12216),of which 40 cases were Rh system antibodies,accounting for 55.6%(40/72),12 cases were of MNSs system,accounting for 16.7%(12/72),10 cases were of Lewis system(anti-Le^(a)),accounting for 13.9%(10/72),2 cases were of Kidd system(anti-JK^(a)),accounting for 2.8%(2/72).In patients with irregular antibodies,the positive detectable rate of female was higher than that of male[1.00%(60/6006)vs.0.19%(12/6210),P<0.05].The detectable rate of patients with blood transfusion history was higher than that of patients without blood transfusion history[1.02%(46/4512)vs.0.34%(26/7704),P<0.05].The detectable rate of patients with pregnancy history was higher than that of patients without pregnancy history[1.52%(58/3819)vs.0.09%(2/2187),P<0.05].The proportion of patients in department of obstetric was the highest,which was 54.2%(39/72)and higher than that of other departments,such as department of hematology[12.5%(9/72)],department of gynecology[11.1%(8/72)]and department of neurosurgery[4.2%(3/72)].Conclusion Irregular antibody screening before blood transfusion is of great significance to improve the clinical safety of blood transfusionn.