溶血性输血反应病例分析及国内文献回顾

Hemolytic transfusion reaction analysis and domestic literature review

目的调查溶血性输血反应发生的原因,鉴别临床症状及严重程度,探索临床检测方法思路及意义,为安全合理用血提供依据。方法对本院发生溶血性输血反应的3个病例进行临床资料分析,复查血型,意外抗体筛查,血清及放散液抗体鉴定,同时对国内溶血性输血反应病例进行文献回顾。结果病例1诊断为迟发性溶血性输血反应,输血7d后抗体鉴定为抗-JK^(a);病例2诊断为急性溶血性输血反应,输血后d5和d7分别检出抗-Ce和抗-JK^(b);病例3诊断为不明类型的溶血性输血反应,输血3 d后检出抗-E。2005—2021年国内共报告33例溶血性输血反应,包括14例急性溶血性输血反应、18例迟发性溶血性输血反应,另1例未进行分类。回顾33例溶血反应原因,其中ABO血型系统抗体4例,Rh血型系统抗体17例,Kidd血型系统抗体4例,非免疫因素导致3例,未注明抗体特异性5例。结论多种血型系统抗体均可引起溶血反应。随着临床认识和实验室检测技术的提升,明确溶血原因,鉴定同种抗体类型,抗原同型输血,对用血安全有重要意义。

Objective To investigate the causes of hemolytic transfusion reaction(HTR),identify clinical symptoms and severity,explore clinical detection methods,so as to provide reference for safe and rational blood use.Methods Clinical data of 3 cases of HTR in our hospital were analyzed.Blood type,unexpected antibody screening,antibody identification by serological method and elution test were reexamined in laboratory,and domestic literatures of HTR were reviewed.Results Case 1,2,and 3 were diagnosed as DHTR(with anti-JK^(a) antibody identified 7 days after transfusion),AHTR(with anti-Ce and anti-JK^(b) antibodies respectively detected 5 and 7 days after transfusion)and HTR of unknown type(with anti-E antibody detected 3 days after transfusion).A total of 33 cases of HTR were reported from 2005 to 2021 in China,including 14 cases of AHTR,18 cases of DHTR and 1 case as unknown type.The causes of HTR in 33 cases were as follows:ABO system antibodies in 4 cases,Rh system antibodies in 17 cases,4 Kidd system antibodies in 4 cases,non-immune factors in 3 cases,and without antibody specificity in 5 cases.Conclusion Since various blood system antibodies may cause hemolysis reaction,it is of great significance to clarify the causes and identify the alloantibody for the safe use of blood in clinical practice.