不明原因直接抗人球白试验结果阳性而不规则抗体筛查结果呈阴性患者的输血管理及疗效分析

Blood transfusion management and efficacy analysis for patients with unexplained direct antiglobulin test positive and irregular antibody screening negative results

目的探讨不明原因直接抗人球白试验(DAT)结果阳性而不规则抗体筛查结果阴性患者的输血管理及疗效。方法选择2013年1月至2022年12月东营市人民医院收治的72例不规则抗体筛查阴性而DAT阳性输血患者为研究对象。患者年龄为(35.0±2.1)岁;男性患者为23例,女性为49例。根据患者接受的输血管理模式,将这72例患者分为输血管理组(n=46,患者收治时间为2019年1月至2022年12月)和对照组(n=26,患者收治时间为2013年1月至2018年12月)。输血管理组患者根据不同DAT阳性分型采取针对性的输血管理和高级别输血护理措施,对照组患者采取常规输血护理措施。2组患者输血量、年龄、性别构成比分别比较,差异均无统计学意义(均P>0.05)。采用回顾性研究方法,收集2组患者输血反应发生率、输血有效率,以及输血管理组患者DAT阳性分型结果。2组患者输血有效率、输血反应发生率比较,采用χ^(2)检验。本研究遵循的程序符合2013年修订版《世界医学协会赫尔辛基宣言》要求,并且与所有患者签署临床研究知情同意书。结果①输血管理组患者的输血反应发生率低于对照组[2.2%(1/46)比23.1%(6/26)],而输血有效率高于对照组[97.8%(45/46)比76.9%(20/26)],并且差异均有统计学意义(χ^(2)=8.27,P=0.004;χ^(2)=8.27,P=0.004)。2组患者输血反应均为轻度血管外溶血。②输血管理组46例患者DAT阳性分型结果显示,免疫球蛋白(Ig)G、IgG+C3d、C3d型分别为13、31和2例,占比分别为28.3%(13/46)、67.4%(31/46)、4.3%(2/46)。本组发生输血反应的1例患者为C3d型。结论不规则抗体阴性而DAT阳性患者输血反应发生率较高,输血疗效不佳,采取针对性输血管理和特殊护理,可提高输血疗效,降低输血反应。C3d型DAT阳性患者接受输血时,应给予更高的关注。

ObjectiveTo investigate blood transfusion management and efficacy for patients with unexplained direct antiglobulin test(DAT)positive and negative irregular antibody screening results.MethodsFrom January 2013 to December 2022,a total of 72 patients who underwent blood transfusion and had negative irregular antibody screening but positive DAT and were admitted to Dongying People′s Hospital were selected as research subjects.These patients was(35.0±2.1)years old,including 23 male and 49 female patients.According to transfusion management model received by patients,all the 72 patients were divided into transfusion management group(n=46,patients were admitted from January 2019 to December 2022)and control group(n=26,patients were admitted from January 2013 to December 2018).Patients in transfusion management group received blood transfusion management based on different DAT positive typing and high-level transfusion nursing,while patients in control group received routine transfusion nursing.There were no significant differences in blood transfusion volume,age,and gender composition between the two groups(all P>0.05).A retrospective method was used to collect incidence of transfusion reactions,transfusion effectiveness rates of patients in the two groups,DAT positive typing results of patients in blood transfusion management group.The chi-square test was used to compare transfusion efficacy and transfusion reaction incidence between the two groups.This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed contents were obtained from the subjects.Results①The incidence of transfusion reactions in transfusion management group was lower than that in control group[2.2%(1/46)vs 23.1%(6/26)],while the transfusion effective rate was higher than that in control group[97.8%(45/46)vs 76.9%(20/26)],and the differences were statistically significant(χ^(2)=8.27,P=0.004;χ^(2)=8.27,P=0.004).The transfusion reactions in both groups were mild extravascular hemolysis.②The DAT positive typing results of 46 patients in transfusion management group showed that 13,31 and 2 cases were immunoglobulin(Ig)G,IgG+C3d and C3d,respectively,accounting for 28.3%(13/46),67.4%(31/46)and 4.3%(2/46),respectively.One patient who had a transfusion reaction in this group was C3d type.ConclusionsPatients with negative irregular antibodies but positive DAT have a higher incidence of transfusion reactions and poor transfusion effects.Targeted blood management transfusion and special clinical nursing can improve transfusion efficacy and reduce transfusion reactions.Greater attention should be paid to patients with C3d type DAT positive when receiving blood transfusion.