改良56℃热放散法与冷冻复融放散法对ABO型新生儿溶血病的临床应用价值比较

Comparison of Clinical Application Value of Modified 56℃Heat Elution Method and Freeze-thaw Elution Method for ABO Hemolytic Disease of Fetus and Newborn

目的比较改良56℃热放散法和冷冻复融放散法对检测ABO型新生儿溶血病(ABO-HDFN)的阳性检出率、试验成本等方面进行比较,探讨两种方法的临床应用价值。方法选择2023年3月本院接收的所有进行新生儿/脐带血标本进行ABO溶血病检测(直接抗人球蛋白试验、游离抗体试验、放散试验),其放散试验时同时进行改良56℃热放散和冷冻复融放散,用统计学方法对两种放散方法结果进行比较分析。结果共纳入非O型的新生儿/脐带血标本256例进行ABO-HDFN检测,其中A型145例,B型109例,AB型2例。改良56℃热放散法的阳性检测率69.92%,冷冻复融放散法的阳性检出率为64.45%,二者无统计学差异。比较两种方法在不同血型、不同凝集强度、不同直接抗人球蛋白试验结果(阴性/阳性)情况下的放散结果,二者均无统计学差异;仅游离抗体结果为阳性时,两种方法具有统计学差异。结论在大多数情况下两种放散方法对于ABO-HDFN的诊断价值无统计学差异。各实验室可以结合临床患者的紧急程度以及本实验室的仪器设备、耗材配置、工作人员经验和时间成本等综合考虑,选择适合本实验室的方法。

Objective To compare the positive rate and the cost of modified 56℃heat elution method and freezethaw elution method in detecting ABO hemolytic disease of fetus and newborn(ABO-HDFN),and to discuss the clinical application value of the two methods.Methods All neonatal/umbilical cord blood samples received in our hospital in March 2023 were selected for ABO-HDFN detection(direct anti-human globulin test,free antibody test,elution test),and the elution method was used of modified 56℃heat elution and freeze-thraw elution simultaneously,the results of the two elution methods were compared and analyzed by specific statistical methods.Results A total of 256 non-O blood type neonatal/umbilical cord blood samples were included for ABO-HDFN detection,of which 145 were type A,109 were type B and 2 were type AB.The positive rate of modified 56℃heat elution method was 69.92%,and the freeze-thraw method was 64.45%,there is no statistical difference between the two methods,either in the condition of different blood type,different aggregation intensity and different DAT.Only when free antibody was positive,the modified 56℃heat elution method was better than the freezethraw method.Conclusion There is no statistical difference between the two methods for the diagnostic value of ABO-HDFN in most situations.Each laboratory can choose the method suitable for the laboratory according to the emergency degree of clinical patients,the equipment,consumables configuration,staff experience and time cost of the laboratory.