Ax22亚型导致家族性血型鉴定错误的研究

Analysis of familial blood typing errors caused by Ax22 subtypes

目的通过对ABO血型为Ax22/B型的患者及其家属因A亚型造成血清学血型鉴定错误的案例进行分析,总结ABO血型鉴定过程中的注意事项及A亚型的输血策略。方法分别选取A、B两种不同厂家的微柱凝胶血型鉴定卡及试管法在常温和4℃孵育10 min两种条件下对患者及其子女进行血清学血型鉴定;对所有标本进行吸收放散试验及血型基因鉴定;分别用微柱凝胶法和聚凝胺法对同一组标本进行交叉配血。结果B试剂卡凝集强度明显高于A试剂卡,且正定型B试剂卡可以在常温下检测到A抗原,A试剂卡仅在4℃孵育10 min后才可检测到A抗原。试管法血型可明确显示A亚型的反应格局。吸收放散试验显示所有标本红细胞表面均存在A抗原,经基因测序患者为Ax22/B.01,其子女基因型为Ax22/O.01.01。微柱凝胶法交叉配血相合,聚凝胺法镜下可见细胞凝集,交叉配血不合。结论Ax22会造成检测结果假阴性,如正反定型不一致或者对检测结果有任何疑问,应选用试管法或其他检测系统进行复核,必要时进行基因检测;Ax22亚型在配血时有假阴性的可能,有较高的输血风险。

Objective Through the analysis of the cases of serological blood group identification errors caused by A subtype in patients with ABO blood type Ax22/B and their family members,the precautions in the process of ABO blood group identification and the transfusion strategy of A subtype were summarized.Methods Two different manufacturers′microcolumn gel blood type identification cards and tube method were used to identify the blood types of the patient and their children under two conditions,including room temperature and 4℃for 10 minutes.Perform absorption-elution test and genetic identification on all samples.The same set of samples was cross-matched using microcolumn gel method and polyamine method.Results The agglutination strength of the B reagent card was significantly higher than that of the A reagent card,and the B reagent card could detect A antigen at room temperature,while the A reagent card could only detect A antigen after being incubated at 4℃for 10 minutes.The tube method can clearly display the reaction pattern of A-subtypes.The absorption-elution test showed the presence of antigen A on the surface of red blood cells in all samples.Based on the genetic sequencing,the patient′s blood type was Ax22/B.01,and his children′s genotype was Ax22/O.01.01.The microcolumn gel cross-match was consistent,and cell agglutination was visible under the microscope with the polyamine method,which was incompatible.Conclusion Ax22 subtype will cause false negative test results.If there are inconsistencies or any doubts about the test results,tube methods or other testing systems should be used for verification,and genetic testing should be performed if it is necessary.The Ax22 subtype may have a higher risk of transfusion due to false negatives during blood matching.