迟发性溶血反应致输血相容性检测结果异常与输血策略

Abnormal blood transfusion compatibility test results caused by delayed hemolytic reaction:a case report and transfusion strategy

目的 探讨1例地中海贫血患儿发生迟发性溶血反应后的输血相容性检测结果,结合其它临床资料综合分析制定输血策略以保障临床用血安全。方法 通过Rh血型系统分型,结合患儿输血史、血清胆红素变化、临床症状等资料综合分析1例地中海贫血患儿的输血相容性检测结果,以明确其是否发生迟发性溶血反应,并制定适宜的配血策略。结果 入院时患儿血型为B型DccEE,血红蛋白(Hb)38 g/L,网织红细胞比率(Ret%)2.92%,总胆红素(TBil)65.8μmol/L,直接胆红素(DBil)12.0μmol/L,间接胆红素(IBil)53.8μmol/L,血型不规则抗体筛查阴性,与B型DCcEe供者交叉配血主次侧均无凝集无溶血,直接抗人球蛋白试验(DAT)阴性,间接抗人球蛋白试验(IAT)阴性,乳酸脱氢酶(LDH)1 050 U/L,天门冬氨酸氨基转移酶(AST)113 U/L,尿潜血2+,尿胆原4+,入院5 d前有红细胞输注史。结合以上结果及对比既往实验室数据,明确患儿发生了迟发性溶血反应,随即筛选B型DccEE去白细胞悬浮红细胞给予输注,输血后各项指标趋好。结论 地贫患儿输血前应综合输血相容性检测结果和临床其它资料制定合适的配血策略,以有效保障输血安全。

Objective To investigate the blood transfusion compatibility test results of a child with thalassemia after delayed hemolysis reaction,and to formulate transfusion strategies based on other clinical data to ensure the safety of clinical blood use.Methods A comprehensive analysis was conducted on the transfusion compatibility test results of a child with thalassemia,combined with Rh blood type system detection,blood transfusion history,serum bilirubin changes,clinical symptoms and other data to determine the occurrence of delayed hemolytic reaction,and formulate the subsequent appropriate blood matching strategies.Results On admission,the blood type of the patient was B DccEE,with hemoglobin(Hb)38 g/L,reticulocyte ratio(Ret%)2.92%,total bilirubin(TBil)65.8μmol/L,direct bilirubin(DBil)12.0μmol/L,indirect Bilirubin(IBil)53.8μmol/L,negative for unexpected antibody screening,no agglutination or hemolysis on both primary and secondary sides of the cross-matching over with type B DCcEe donors,negative for direct anti human globulin test(DAT),negative for indirect anti human globulin test(IAT),lactate dehydrogenase(LDH)1050 U/L,aspartate aminotransferase(AST)113 U/L,urine occult blood 2+,urine bilinogen 4+,and a history of red blood cell transfusion 5 days before admission.The above results indicated that the child had a delayed hemolytic reaction,then type B DccEE leukocyte-depleted suspension red blood cell was transfused,and various indicators improved after transfusion.Conclusion Appropriate blood matching strategies should be formulated based on the results of blood transfusion compatibility testing and other clinical data before transfusion for children with thalassemia in order to effectively ensure transfusion safety.