变异型D产生抗-D合并抗-C及抗-Jkb抗体1例

A case of variant D type produced anti-D combined with anti-C and anti-Jkb

报道1例患有溶血性贫血、系统性红斑狼疮的患者,因配型困难由临床送检血样至实验室检测。患者初筛血型为O型RhD阴性,使用3种不同的单克隆抗-D试剂,分别在盐水介质和抗人球介质对患者RhD表型进行确认。在盐水介质中,患者血样与所有IgM型抗-D不凝集,在抗人球介质中与所有IgM+IgG型抗-D试剂均凝集,为RhD变异型。使用谱细胞对患者血清进行抗体鉴定,发现患者血清中含有抗-D、抗-C和抗-Jkb抗体。患者小因子表型为ccEe, Kidd系统抗原表型为Jk(a+b-)。选择与患者抗原匹配的供者红细胞4 U分2次予以输注,患者血红蛋白有效提升。Rh系统的抗原免疫原性高,Rh系统的抗体可引起严重的新生儿溶血病和溶血性输血反应,因此Rh系统表型和抗体的准确鉴定对于输血安全具有重要的临床意义。对于需要反复输血的患者,若能提供Rh抗原匹配的供者红细胞可大大降低患者被同种免疫的概率。

The blood sample of a patient with hemolytic anemia and systemic lupus erythematosus was sent to our reference laboratory for testing due to difficulty in matching. Regular preliminary serological result was O RhD negative. And then the D antigen status was further determined using another three different monoclonal anti-D reagents. The sample exhibited no agglutination by IgM anti-D reagents using a tube test but reacted with IgM/IgG blend anti-D using indirect antiglobulin test. The phenotype was classified as RhD variant. Commercial group O antibody screening cells were used to detect the presence of unexpected antibodies, and the anti-D, anti-C and anti-Jkbwere detected in the patient’s serum. The phenotype of the patient was ccEe, Jk(a+b-). Four units antigen matched donor blood were supplied to the patient and the hemoglobin was effectively improved. The Rh blood group system plays a pivotal role in the field of blood transfusion and severe hemolytic disease of fetus/newborn due to its high polymorphism and strong immunogenicity. Therefore, the accurate identification of Rh system phenotype and antibody may be important clinical significance for the safety of blood transfusion. For patients who required chronic transfusion support, if Rh antigen matched red blood cells could be provided, the risk of alloimmunization would be greatly reduced.