多发性骨髓瘤全凝集血型处理及输血实践

ABO total coagulation treatment and blood transfusion practice in multiple myeloma

目的:对多发骨髓瘤全凝集病例进行血清学及分子生物学定型,并探讨其输血实践。方法:初检血型呈全凝集者,红细胞37℃生理盐水洗涤3遍,正定型检测仍有凝集时,56℃水浴箱热放散1 min,再次洗涤后做正定型;血浆用多人份O型洗涤红细胞4℃进行吸收4 h,离心取上清做反定型,结果不理想者复做一次;仍未能判读者取上清置37℃水浴30 min再次如上方式进行反定型检测。经上述处理结果仍然不理想时,进一步应用二硫苏糖醇(DTT)处理检测红细胞或患者红细胞。同时采用中和抑制试验测定患者唾液中和血型物质及PCR扩增1～7外显子测序佐证血型。结果:血型全部得以确认;唾液中和试验与基因定型结果与血清学结果一致;配血试验血红蛋白均有提升。结论:全凝集患者血型定型正确,输血效果良好。

Objective:To do the serology-typing and geno-typing test in multiple myeloma patients with agglutination. Method:For unidentified cases,red blood cells(RBC)was washed with 37℃ saline,and dissipated at 56℃ for 1 min.Serum was absorbed with 4℃ multiple-people-O-type compressed RBC,then RBC and serum were treated with DTT.1 to 7 exons were amplified.The same type of blood or O washed red cells were selected for transfusion. Result:After RBCs washed with saline and serum absorpted with O-type RBC,blood type of the patient 2 was A.After 56℃ dissipating 1 min,blood groups of the patient 3 and 4 were confirmed.Treated with DTT,blood type of the patient 1 was AB.Amplification sequences of 1 to 7 exons were consistent with the serological results.Cross-matching results showed that patient 2 and 4 with primary and secondary blood side were not agglutination,but the patient 1 was.After transfusion,there were no adverse reactions.Conclusion:The blood types of the patients were correct and the transfusion was reasonable.