静脉输注丙种球蛋白对非新生儿溶血患儿交叉配血的影响

The Effect of Intravenous Immunoglobulin on Cross-match in Non-neonatal Hemolytic Children

目的研究非溶血患儿静脉输注丙种球蛋白(intravenous immunoglobulin,IVIG)后对交叉配血的影响,探究最佳输血策略。方法对2020年1月—2022年12月我科收到的12例抗体筛选阴性、交叉配血不合的非ABO溶血患儿标本进行分析,使用试管法进行血型鉴定,使用微柱凝胶法进行抗体筛查、交叉配血、直接抗人球蛋白试验、游离血浆及放散液中抗-A和抗-B检测。结果IVIG患儿,6例A型、2例AB型患儿血浆中检测到抗-A,3例B型患儿血浆中检测出抗-B,1例AB型患儿血浆中检测出抗-A和抗-B,所有患儿直接抗人球蛋白试验阳性,且均出现不同程度溶血表现,并与同型悬浮红细胞交叉配血不合、与O型洗涤红细胞配血相合。结论IVIG会导致部分非ABO溶血患儿出现交叉配血不合、轻微溶血症状,宜选择O型洗涤红细胞输注。

Objective To study the effect of intravenous immunoglobulin(IVIG)on cross-match in non-hemolytic anemia in children to discuss the best-practice transfusion strategy.Methods A total of 12 non-ABO hemolytic patients with negative antibody screening and cross-match incompatibility from January 2020 to December 2022 were included.Blood type identification was performed by tube test method.Antibody screening,cross-match,direct antiglobulin test(DAT),and anti-A and anti-B detection in free plasma and elution test were performed by microcolumn gel card method.Results After receiving IVIG,anti-A was detected in 6 type A and 2 type AB,anti-B in 3 type B,and anti-A and anti-B in 1 type AB.All patients were DAT positive,and appeared different degrees of hemolysis.Those were cross-match incompatible with same blood type suspended red blood cells,but cross-match compatible with type O washed red blood cells.Conclusion After administration of IVIG,some non-ABO hemolysis children have cross-match incompatibility and mild hemolytic symptoms,so it is advisable to choose O-type washed red blood cell.