类抗E自身抗体的鉴定分析及输血策略探讨

Identification and analysis of mimicking anti-E autoantibodies and exploration of blood transfusion strategy

目的对类自身抗体患者的不规则抗体进行鉴定分析,探讨类抗体的检测方法,为其制定输血策略,为临床合理用血提供借鉴和参考。方法实验室接诊疑难交叉配血患者1例,采用试管法进行ABO血型、Rh血型鉴定、抗体筛查、抗体特异性鉴定、直接抗人球蛋白试验、吸收放散试验、抗体效价和交叉配血试验,采用毛细管超速离心法分离新旧红细胞,进行红细胞Rh系统血型抗原鉴定。结果患者血型为B型,Rh血型为CcDEe,直接抗球蛋白试验、自身对照试验均阳性;盐水试管法进行血浆抗体筛查呈阴性,而间接抗人球蛋白试验呈阳性,红细胞(ccee)吸收后上清液与红细胞(ccee、CCEe)均呈阴性反应;放散液与红细胞(ccee)反应阴性,与红细胞(CCEe)呈弱阳性,自身红细胞吸收后血清抗体筛选试验结果为阴性;选择ee血型红细胞与其交叉配血显示相合。结论患者血浆中存在类抗-E特异性自身抗体,此类患者输注ee血型红细胞,可提高输注效果。

Objective To identify and analyze irregular antibodies in autoantibody patients,explore the detection methods of antibody-like antibodies,and provide reference for formulating transfusion strategies and guiding clinical rational use of blood.Methods A patient with difficult cross-matching blood was admitted in our laboratory.The ABO and Rh blood type,antibody screening,antibody specificity identification,direct anti-human globulin test,absorption and diffusion test,antibody titer and cross-matching blood test were performed by test tube method.The new and old red blood cells were separated by capillary ultra-centrifugal method,and Rh blood type was identified.Results The patient's blood type was B and Rh blood type was CcDEe.Both direct antiglobulin test and self-controlled test were positive.Serum antibody screening by saline test tube was negative,but Liss-IAT test was positive,after absorption of red blood cell(ccee),the supernatant of red blood cell was negative with red blood cell(ccee,CCEe).The reaction between the diffusion solution and erythrocyte(ccee)was negative,the reaction with erythrocyte(CCEe)was weakly positive,after absorption of autoerythrocyte,the serum antibody screening test was negative.Cross matching test with Erythrocytes of ee blood type was negtive.Conclusion There were mimicking anti-E autoantibodies in the plasma of the patients.Infusion of red blood cell(ee)could improve the transfusions effect.