高效价冷凝集素对输血相容性的准确性与安全性研究

Study on the Accuracy and Safety of High-Efficiency Cold Agglutinin for Blood Transfusion Compatibility

目的探讨高效价冷凝集素和蛋白样凝集对输血相容性检测结果准确性与输血安全的影响。方法在2019年4月—2022年3月进行输血相容性检测的血液样本中,选取出现强凝集现象的输血相容性检测不合的血液样本27份。针对血液样本进行红细胞、血清处理后进行血型鉴定、抗人球蛋白试验、交叉配血试验,对比处理前后的检测结果。结果血型鉴定结果:血液样本处理前27份血液样本鉴定结果均显示正反定型不相符,自身细胞对照阳性;血液样本处理后:在A型患者(n=8)中,鉴定结果显示抗-A(4+)、抗-B(-)、抗-D(4+)、A细胞(-)、B细胞(3+)、O细胞(-)、自身细胞(-);在B型患者(n=7)中,鉴定结果显示抗-A(-)、抗-B(4+)、抗-D(4+)、A细胞(3+)、B细胞(-)、O细胞(-)、自身细胞(-);在O型患者(n=10)中,鉴定结果显示抗-A(-)、抗-B(-)、抗-D(4+)、A细胞(3+)、B细胞(3+)、O细胞(-)、自身细胞(-);在AB型患者(n=2)中,鉴定结果显示抗-A(4+)、抗-B(4+)、抗-D(4+)、A细胞(-)、B细胞(-)、O细胞(-)、自身细胞(-)。直接抗人球蛋白试验结果:在冷凝集素综合征、骨髓异常增生综合征、多发性骨髓瘤患者中,血液样本处理前的检测结果为多抗(+)、抗-IgG(+)、抗-C3d(+)、AB浆(+),血液样本处理后的检测结果为多抗(+)、抗-IgG(-)、抗-C3d(+)、AB浆(-)。在自身免疫性贫血患者中,血液样本处理前的检测结果为多抗(+)、抗-IgG(+)、抗-C3d(+)、AB浆(+),血液样本处理后的检测结果为多抗(+)抗-IgG(+)、抗-C3d(+)、AB浆(-)。在27例患者中,对受冷凝集素干扰的21例血标本进行冷凝集素效价测定,结果效价为128~512、1024、2048的患者分别为18、2、1例。结论在输血相容性检测中,高效价冷凝集素、蛋白样凝集是影响检测结果准确性的重要因素,关系输血治疗的安全性。将发生输血相容性检测不合现象的血液样本进行处理,可以有效减少高效价冷凝集素、蛋白样凝集的影响,获取准确的检测结果,进而为输血治疗的安全、顺利进行提供可靠的保障。

Objective To explore the impact of high efficiency cold agglutinin and protein like agglutination on the accuracy of transfusion compatibility test results and transfusion safety.Methods From April 2019 to March 2022,a total of 27 blood samples with strong agglutination were selected for transfusion compatibility testing.After red blood cell and serum treatment,blood type identification,anti human globulin test,and cross matching test were conducted to compare the test results before and after treatment.Results Analyzing the blood type identification results,all 27 blood sample identification results before blood sample processing showed mismatched positive and negative typing,with positive self cell control.After blood sample processing:In type A patients(n=8),the identification results showed anti A(4+),anti B(-),anti D(4+),A cells(-),B cells(3+),O cells(-),and autologous cells(-).In type B patients(n=7),the identification results showed anti A(-),anti B(4+),anti D(4+),A cells(3+),B cells(-),O cells(-),and autologous cells(-).In type O patients(n=10),the identification results showed anti A(-),anti B(-),anti D(4+),A cells(3+),B cells(3+),O cells(-),and autologous cells(-).in AB type patients(n=2),the identification results showed anti A(4+),anti B(4+),anti D(4+),A cells(-),B cells(-),O cells(-),and autologous cells(-).Analysis of direct anti human globulin test results showed that in patients with cold agglutinin syndrome,myelodysplastic syndrome,and multiple myeloma,the test results before blood sample processing were polyclonal antibodies(+),anti IgG(+),anti C3d(+),and AB plasma(+).The test results after blood sample processing were polyclonal antibodies(+),anti IgG(-),anti C3d(+),and AB plasma(-).In patients with autoimmune anemia,the test results of blood samples before treatment were polyclonal antibodies(+),anti IgG(+),anti C3d(+),and AB plasma(+).The test results of blood samples after treatment were polyclonal antibodies(+),anti IgG(+),anti C3d(+),and AB plasma(-).Out of 27 patients,21 blood samples were subjected to cold agglutinin interference for cold agglutinin titer determination.The results showed that there were 18,2,and 1 patients with titers ranging from 128 to 512,1024,and 2048,respectively.Conclusion In blood transfusion compatibility testing,efficient cold agglutinin and protein like agglutination are important factors that affect the accuracy of test results and are related to the safety of blood transfusion treatment.Processing blood samples that do not meet the requirements for blood transfusion compatibility testing can effectively reduce the impact of highly efficient cold agglutinin and protein like agglutination,obtain accurate test results,and provide reliable guarantees for the safety and smooth progress of blood transfusion treatment.