447例ABO血型鉴定自动审核不通过原因分析及解决方法的探讨

An Analysis and Evaluation of Causal Factors of Failure Results and Corresponding Solutions in 447 Cases of ABO Blood Type Identification Auto-audit

目的分析477例ABO血型鉴定自动审核不通过的原因及其影响因素,初步建立相应的处理流程。方法依据并参考临床实验室定量检验结果的自动审核(WS/T 616-2018)的行标,制定了我室ABO血型鉴定的自动审核规则。收集2021年1月至2022年12月北京协和医院检验科ABO血型鉴定自动审核不通过的共计477患者的临床资料,分析ABO血型鉴定不通过的原因,结合患者的临床诊断特征,制定相应的处理流程。结果按原因分类:抗原所致为79例,其中抗原减弱或缺失为50例,亚型为29例;抗体所致为398例,其中血清抗体减弱/缺失为305例,冷凝集素(冷抗体)为23例/自身抗体为27例,红细胞同种抗体为43例。按患者所患疾病类型:肿瘤为94例占19.7%;血液病为59例占12.4%;免疫性疾病为43例占9%;内分泌疾病为25例占5.2%;妇科疾病及妊娠为72例占15.1%;其他疾病为184例占38.6%。结论在477例ABO血型鉴定自动审核不通过的原因中,以年龄变化导致的生理变化最为常见;此外不规则抗体、ABO亚型、抗原减弱也可造成此结果。在血型鉴定工作中,应综合考虑患者的情况,针对其原因选择相应辅助实验方法进行鉴定,以提高ABO血型的鉴定准确性,保证临床用血安全。

Objective To analyze the causal and influencing factors in 477 cases of ABO blood type identification auto-audit failures,and to preliminarily establish corresponding processing procedures.Methods Referring to the criteria for automatic audit of quantitative test results in clinical laboratories(WS/T 616-2018),we formulated automatic audit rules for ABO blood type identification in our department.Clinical data of a total of 477 patients with ABO blood type identification auto-audit failures at Peking Union Medical College Hospital Laboratory Department,from January,2021 to December,2022,were collected for the study.The causal factors for ABO blood type identification failure were analyzed,and corresponding processing procedures were established in conjunction with the clinical diagnostic characteristics of these patients.Results Patients were categorized by causes:79 cases were due to antigens,of whom:50 cases involved weakened or absent antigens,while 29 cases were subtypes;398 cases were due to antibodies,of whom:305 cases involved weakened/absent serum antibodies,23 cases involved cold agglutinins(cold antibodies)/27 cases involved autoantibodies,and 43cases involved red blood cell alloantibodies.According to the types of diseases suffered by these patients,results showed:tumors accounted for 94 cases,or 19.7%;hematologic diseases accounted for 59 cases,or 12.4%;autoimmune diseases accounted for 43 cases,or 9%;endocrine diseases accounted for 25 cases,or 5.2%;gynecological diseases and pregnancy accounted for 72 cases,or 15.1%;other diseases accounted for 184 cases,or 38.6%.Conclusion Among 477 cases of ABO blood type identification auto-audit failures,physiological changes caused by age-related changes are the most common cause.In addition,irregular antibodies,ABO subtypes,and weakened antigens can also lead to this result.In blood type identification process,patient’s status should be comprehensively considered,and appropriate auxiliary experimental methods should be selected to improve the accuracy of ABO blood type identification and ensure the safety of clinical blood transfusions.