微柱凝胶法交叉配血次侧不合的原因探讨及临床意义分析

Analysis and Clinical Significance of Minor Cross-match Incompatibility with Micro-column Gel Test

目的分析微柱凝胶法交叉配血次侧不合的原因及临床意义,为临床输血提供参考。方法收集2022年7月—2023年7月在本院开展输血前不规则抗体筛查结果为阴性且交叉配血次侧不合的患者标本,开展直接抗人球蛋白试验(direct antiglobulin test,DAT)检测,DAT阳性者进行酸放散试验,并对放散液进行抗体筛查和鉴定,DAT阴性者做献血者抗体筛查或复查次侧配血。部分DAT阳性输血患者作为实验组和用倾向性评分匹配方法筛选交叉配血主次侧均相合且DAT阴性的患者作为对照组,比较并评估输血疗效。结果380例交叉配血主侧相合、次侧不合患者中,患者DAT阳性372例(占97.89%),酸放散试验后放散液抗体筛查结果为364例全阴(占97.85%),6例全阳(占1.61%)且无格局,抗体鉴定仍为全阳无格局,2例疑似有反应格局(占0.54%),但经抗体鉴定后未检测出特异性抗体,患者输注红细胞悬液后血红蛋白明显升高(P<0.05),与对照组相比未影响输血的安全性和输血疗效。DAT阴性中献血者抗筛阳性4例(占1.05%),凝胶卡异常1例(占0.26%)。人为操作错误2例(占0.52%),假凝集1例(占0.26%)。结论微柱凝胶法次侧配血不合对患者输血的安全性和疗效几乎无影响,绝大多数交叉配血次侧不合原因在于患者DAT阳性,少量由人为操作错误、假凝集或凝胶卡异常等导致。

Objective To analyze the cause and significance of minor cross-match incompatibility by using microcolumn gel test(MGT),and to provide reference for clinical transfusion.Methods Samples of transfusion recipients were collected from July 2022 to July 2023 with minor cross-match incompatible while antibody screening test negative.Direct antiglobulin test(DAT)was performed,Positive samples undergoing acid elution test.Antibody screening and identification were conducted on the eluate.DAT-negative individuals underwent donor antibody screening or re-cross-matching.A part of DAT-positive transfused patients were selected as the experimental group,and patients with major and minor cross-match compatibility and negative DAT were selected by propensity score matching as the control group for comparison and evaluation of transfusion efficacy.Results Among 380 patients with major cross-match compatibility and the minor cross-match incompatibility,372 patients were DAT positive(97.89%).Antibody test of the acid elute,364 cases showing negative results(97.85%),6 cases were positive(1.61%)with no pattern.Two cases showed suspected reactive patterns(0.54%),but no specific antibodies were identified.These patients exhibited a significant increase in hemoglobin after receiving red blood cell suspension transfusion(P<0.05),with no impact on the safety and efficacy of transfusion compared to the control group.Among DATnegative patients,4 cases were antibody screening positive(1.05%),1 case had gel card abnormalities(0.26%),2 cases were due to human error(0.52%),and 1 case was a false aggregation(0.26%).Conclusion The minor cross-match incompatibility with MGT has almost no impact on the safety and efficacy of transfusion for patients,and the majority of reasons for minor crossmatch incompatibility are due to DAT positivity in patients.In addition,a small number of minor cross-match incompatibility were caused by human error,false aggregation and abnormal gel cards.