同种抗-C、e伴类同种抗-e、Jk b自身抗体的鉴定及输血治疗

Dentification and blood transfusion therapy of anti-C,e alloantibodies with anti-e,Jk b mimicking alloantibodies

目的应用吸收放散和效价积分法对1例抗-C、e同种抗体合并抗-e、Jk b类同种自身抗体进行鉴别诊断。方法采用试管法对ABO、Rh和Kidd血型抗原进行鉴定;盐水、凝聚胺、微柱凝胶3种方法联用2套谱细胞进行抗体筛查及抗体特异性鉴定;多重吸收放散试验和效价积分原则对抗体进一步确认;多重PCR技术对RHCE基因、JK基因进行测序。结果通过血清学分析,该患者血型为A型、Rh分型ccDEE,直抗阳性。结合不同的Rh和Jk表型细胞吸收放散试验以及效价积分原则得出患者血清中含有抗-C、e同种抗体以及抗-e、Jk b类同种自身抗体,红细胞上有抗-e、Jk b类同种自身抗体。基因测序分析RHCE基因第5外显子676位出现G>C,其余外显子没有发生突变,推断Rh分型ccEE型;JK基因中第9外显子838 G/A杂合,Jk血型表型Jk(a+b+),选择交叉配血相合的A型ccDEE、Jk(a+b-)红细胞给患者输注,输血效果良好。结论应用吸收放散试验和效价积分法对患者血清进行抗体鉴定,以及血清学结合分子生物学对患者红细胞表型鉴定,可综合分析及区分出抗体的类型,为患者精准输血提供方案。

Objective To investigate the differential diagnosis of 1 anti-C,e alloantibodies combined with anti-e,Jk b mimicking alloantibodies by absorption-elution test and titer integral method.Methods ABO,Rh and Kidd blood group antigens were identified by tube method.Two sets of panel cells were used for antibody screening and antibody specificity identification by saline method,polyamine method and microcolumn gel method.The antibody was further confirmed by multiple absorption-elution tests and titer integral method.RHCE and JK gene were sequenced by multiple PCR.Results Serological gene sequencing analysis showed that the ABO blood group of the patient was A type with Rh subtype ccDEE and was positive for direct antiglobulin test(DAT).Multiple absorption-elution tests and titer integral method demonstrated that the serum of the patient contained anti-C,e alloantibodies along with anti-e,Jk b mimicking autoantibodies and there were anti-e,Jk b mimicking autoantibodies on red blood cells(RBCs).According to gene sequencing analysis,there was G>C at exon 676 of the RHCE gene,and the remaining exons were not mutated,suggesting that the RHCE phenotype was ccEE.The 838 G/A heterozygote of exon 9 in JK gene,Jk blood group phenotype was Jk(a+b+).Cross matched type A ccDEE and Jk(a+b-)RBCs were transfused,and no adverse reactions occurred.Conclusion Serology combined with molecular biology to identify the phenotype of the patient′s RBCs,absorption-elution test and titer integral method to identify the antibody of the patient′s serum can detect the alloantibody type,thus providing strategies for targeted blood transfusion.