患者意外抗体的分布情况及其输血疗效分析

Distribution and transfusion efficacy of unexpected antibody

目的调查意外抗体筛查阳性患者的临床特征和抗体分布特点,并评估其输血疗效。方法选择2022年1月1日—2023年3月31日,本院申请输血的住院患者共12235名,筛选出抗体筛查阳性患者,收集其临床数据,包括性别、年龄、诊断、血型、输血史、妊娠史,分析其抗体分布情况;同时从抗体筛查阳性患者中筛选出治疗用血患者,根据DAT结果以及输注红细胞成分进行分组,比较各组输血前后Hb值。结果患者抗体筛查阳性率为0.96%(118/12235)。其中,Rh血型系统的抗体最为常见(27.43%,48/175),其次为MNS系统(8.57%,15/175)和Lewis系统(6.29%,11/175);主要为抗-E(18.29%,32/175)、抗-M(8.00%,14/175)和抗-Le a(5.71%,10/175)。将62名治疗用血患者根据DAT阳性输注悬浮红细胞或洗涤红细胞分为A组和B组、DAT阴性为C组,3组红细胞输注后的Hb值均高于输注前,A组输血前后Hb值(g/L):(59.19±15.67)vs.(77.52±15.09),B组输血前后Hb值(g/L):(56.35±14.08)vs.(74.44±15.63),C组输血前后Hb值(g/L):(56.00±12.06)vs.(75.00±4.73),P均<0.05,差异有统计学意义。结论在意外抗体阳性患者中,Rh血型系统的抗-E最为常见。对贫血患者选择合适的红细胞进行输注,每输注1U红细胞Hb平均升高6~7g/L,疗效较好。针对DAT阳性患者,输注悬浮红细胞是可行的。

Objective To investigate the clinical characteristics and antibody distribution as well as evaluate the transfusion efficacy in unexpected antibody positive patients.Methods A total of 12235 patients from January 1,2022 to March 31,2023 who hospitalized in our hospital and applied for blood transfusion were selected,and those with unexpected antibody were included.The clinical data,including gender,age,diagnosis,blood type,history of transfusion and pregnancy were collected for antibody distribution analysis.Patients who received transfusion were grouped according to the DAT results and the components of red blood cells transfused,and the Hb values of each group before and after transfusion were compared.Results Among12235 patients,118 were positive for antibody screening,with a prevalence of 0.96%.The antibodies from Rh system were the most common(27.43%,48/175),followed by MNS system(8.57%,15/175)and Lewis system(6.29%,11/175),mainly anti-E(18.29%,32/175),anti-M(8.00%,14/175)and anti-Le a(5.71%,10/175).In addition,62 transfused patients were divided into group A with suspended red blood cell transfusion and group B with washed red blood cell transfusion for positive DAT,and group C for negative DAT.Hb values(g/L)pre-and post-transfusion were 59.19±15.67 vs 77.52±15.09 in group A,56.35±14.08 vs 74.44±15.63 in group B,56.00±12.06 vs 75.00±4.73 in group C,respectively.The Hb values of post-transfusion for three groups were all higher than those of pre-transfusion(P<0.05).Conclusion Anti-E from Rh system is the most common antibody in patients with unexpected antibody.Appropriate red blood cells transfusion with Hb increases by an average of 6-7 g/L per 1 U of red blood cells indicating good transfusion efficacy.For positive DAT patients,transfusion of suspended red blood cell is feasible.