提高红细胞意外抗体检出率解决策略初探

A Preliminary Study of the Strategies to Improvethe Screening Rate of Irregular Antibody

目的为避免意外抗体漏检造成输血不良反应,寻求适合本实验室的红细胞意外抗体血型血清学鉴定方法,保障临床输血安全。方法本研究纳入了2021年10月至12月于苏州大学附属第一医院进行输血治疗的602例患者作为研究对象,使用盐水法、微柱凝胶法、Capture-R法对血浆中的红细胞意外抗体进行检测。通过对比3种方法检出5种意外抗体的血浆效价来比较不同方法的灵敏度。通过对40份血样的检测来分析3种方法对意外抗体的检出能力。最后对65例红细胞输注无效者进行意外抗体复检,以验证本实验室方法学的安全性和可靠性。结果Capture-R法检测抗-E、抗-D、抗-Jk a等IgG类抗体的灵敏度相比微柱凝胶法高1~2个效价值,但对IgM类抗体的灵敏度较低。微柱凝胶法对各类型抗体的检出率最高为95%。所有输血无效患者的抗体复检率为0%,排除了因意外抗体漏检导致的免疫性输血不良反应。结论采用Capture-R法进行输血前红细胞意外抗体筛查,结合盐水法和微柱凝胶法交叉配血,能进一步提高意外抗体的检出率,可作为本实验室输血前试验最佳检测策略。

Objective To avoid adverse influences by missing red cell irregular antibodies,we aimed to seek a serological identification method suitable for irregular antibody in our laboratory to ensure the safety of clinical blood transfusion.Methods A total of 602 patients who underwent blood transfusion in the First Affiliated Hospital of Soochow University from October to December,2021 were included in this study.Saline method,micro-column gel technique and Capture-R Ready-Screen were performed to detect antibodies in plasma prospectively.The sensitivity of the methodology were evaluated by comparing the highest value of plasma dilution for five antibodies.Based on the ability to successfully detect different antibodies in 40 samples,the accuracy of each methods were summarized.As the last step,65 cases with ineffective erythrocyte infusion were re-tested for antibodies to verify the safety and reliability of the methodology used in this laboratory.Results The sensitivity of the Capture-R method for detecting anti-E,anti-D,anti-JK a and other IgG antibodies were 1-2 values higher than that of the micro-column gel method,but the sensitivity to IgM antibodies was poor.The accuracy of micro-column gel method was up to 95%.Antibody re-test rate was 0%in all patients with ineffective transfusion,excluding adverse immune transfusion reactions caused by missed antibodies.Conclusion The use of Capture-R method for pre-transfusion irregular antibodies screening,combined with saline method and micro-column gel technique for crossmatching,can improve the detection rate of accidental antibodies,could be implemented as the best strategy for pre-transfusion test in this laboratory.