目的对1例高频抗体导致的胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)进行检测、鉴定及配血。方法对患儿进行新生儿溶血试验,对母亲进行血清学意外抗体鉴定,并对母亲红细胞进行常见高频抗原鉴定;对检出抗体进行...目的对1例高频抗体导致的胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)进行检测、鉴定及配血。方法对患儿进行新生儿溶血试验,对母亲进行血清学意外抗体鉴定,并对母亲红细胞进行常见高频抗原鉴定;对检出抗体进行IgG分型检测,并用流式细胞术进行单核细胞体外吞噬致敏红细胞试验,以检测抗体相关的吞噬率;对患儿母亲、父亲及舅舅进行相关红细胞血型基因测序;利用稀释的母亲血浆和抗人球卡法,在献血者中进行大规模相合血液的筛选。结果产妇鉴定为Di(b-)稀有血型,产生了抗-Di b(效价512)并导致了严重的HDFN;抗-Di b亚型分型为IgG1和IgG2型,单核细胞体外吞噬效率为88.83%(74.7/84.09);产妇亲属中没有相合献血者,后续从5520名献血者中筛选到2例Di(b-)相合血液,患儿接收输血治疗后康复出院。后续在51334名献血者中筛查到17名Di(b-)献血者,该数据表明Di(b-)在广州地区献血者中的分布频率约为三千分之一(0.033%,17/51334)。结论综合利用血型血清学及分子生物学方法诊断了抗-Di b所致的严重HDFN,建立了1种有效大规模筛查Di(b-)稀有血型的方法并找到相合血液,为建立Di(b-)稀有血型库奠定了基础。展开更多
Rh血型系统是输血医学中重要的常规检测血型系统,因RhD血型不合引起的溶血性输血反应及新生儿溶血病一直以来倍受临床重视。本研究报道了2例罕见的RHD基因变异型RHD*DEL37个体的血清学和基因特征,这2例个体的血液样本经血清学方法(试管...Rh血型系统是输血医学中重要的常规检测血型系统,因RhD血型不合引起的溶血性输血反应及新生儿溶血病一直以来倍受临床重视。本研究报道了2例罕见的RHD基因变异型RHD*DEL37个体的血清学和基因特征,这2例个体的血液样本经血清学方法(试管法和微柱凝胶法)鉴定为RhD阴性。采用聚合酶链反应-序列特异性引物(polymerase chain reaction-sequence specific prime,PCR-SSP)对样本进行RHD基因分型和合子型分析,基因分型结果为RHD基因阳性,并排除了常见的几种RHD基因变异体的可能。RHD基因合子型检测阳性,证明其中一条RHD等位基因1~10外显子全部缺失。进一步对样本RHD基因1~10外显子基因进行Sanger法测序,测序结果显示在另一条等位基因第8内含子上的第1154-31号碱基发生了T>C突变,国际输血协会(International Society of Blood Transfusion,ISBT)将该突变等位基因命名为RHD*DEL37,表型为RhD放散型(D-elute,Del)。本研究中,2例血清学初筛RhD阴性的样本通过分子生物学检测,其基因型为RHD*DEL37/RHD-(RHD*01N.01)。由于这2例个体无血缘关系,提示我国可能存在携带该基因突变的人群。本研究提示分子生物学方法可辅助鉴别血清学初筛为阴性的RhD变异体样本,联用分子生物学方法和血清学方法在准确鉴定血型、保障患者输血安全方面有重要意义。展开更多
BACKGROUND Allogeneic hematopoietic stem cell transplantation(Allo-HSCT)is currently the only viable method of curing patients with acute myeloid leukaemia.In 30%to 50%of patients,donors and recipients have some level...BACKGROUND Allogeneic hematopoietic stem cell transplantation(Allo-HSCT)is currently the only viable method of curing patients with acute myeloid leukaemia.In 30%to 50%of patients,donors and recipients have some level of ABO blood group incompatibility.ABO blood group incompatibility can cause antibodies against the donor's red blood cells to persist in the recipient's body,resulting in a delay of several months in the recovery of red blood cells.A number of different treatments have been reported for post-transplant pure red cell aplastic anaemia(PRCA),such as plasmapheresis,donor lymphocyte infusions,anti-thymocyte globulin,rituximab and steroids.CASE SUMMARY A 41-year-old female diagnosed with acute myeloid leukaemia underwent peripheral blood allogeneic haematopoietic stem cell transplantation in November 2013 from an HLA matched unrelated donor.The donor was AB-positive and the recipient was O-positive.The patient was diagnosed with PRCA three months after receiving the donor stem cell transplant.After failing multiple lines of therapy,the patient applied for daratumumab.After receiving three doses of daratumumab,the patient developed a reticulocyte response and no longer required CONCLUSION The use of daratumumab anti-CD38 for the remove of plasma cells is safe and effective and may be tried for refractory patients with PRCA after undergoing allo-HSCT for ABO incompatibility.展开更多
血液复苏是严重失血患者的关键急救措施。血液复苏液体的选用,经历了从全血到晶体液/胶体液、晶体液联合红细胞、等比例血液成分的演进过程。近20年来,采用低效价抗体O型全血(low titer group O whole blood,LTOWB)作为血液复苏的首选...血液复苏是严重失血患者的关键急救措施。血液复苏液体的选用,经历了从全血到晶体液/胶体液、晶体液联合红细胞、等比例血液成分的演进过程。近20年来,采用低效价抗体O型全血(low titer group O whole blood,LTOWB)作为血液复苏的首选应急通用桥接复苏液,已发展成为大趋势。我们对全血在严重失血患者的应用历史和现状做一介绍,并提出我国采用LTOWB作为首选应急通用血液的进一步论证和验证研究建议。展开更多
文摘目的对1例高频抗体导致的胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)进行检测、鉴定及配血。方法对患儿进行新生儿溶血试验,对母亲进行血清学意外抗体鉴定,并对母亲红细胞进行常见高频抗原鉴定;对检出抗体进行IgG分型检测,并用流式细胞术进行单核细胞体外吞噬致敏红细胞试验,以检测抗体相关的吞噬率;对患儿母亲、父亲及舅舅进行相关红细胞血型基因测序;利用稀释的母亲血浆和抗人球卡法,在献血者中进行大规模相合血液的筛选。结果产妇鉴定为Di(b-)稀有血型,产生了抗-Di b(效价512)并导致了严重的HDFN;抗-Di b亚型分型为IgG1和IgG2型,单核细胞体外吞噬效率为88.83%(74.7/84.09);产妇亲属中没有相合献血者,后续从5520名献血者中筛选到2例Di(b-)相合血液,患儿接收输血治疗后康复出院。后续在51334名献血者中筛查到17名Di(b-)献血者,该数据表明Di(b-)在广州地区献血者中的分布频率约为三千分之一(0.033%,17/51334)。结论综合利用血型血清学及分子生物学方法诊断了抗-Di b所致的严重HDFN,建立了1种有效大规模筛查Di(b-)稀有血型的方法并找到相合血液,为建立Di(b-)稀有血型库奠定了基础。
文摘Rh血型系统是输血医学中重要的常规检测血型系统,因RhD血型不合引起的溶血性输血反应及新生儿溶血病一直以来倍受临床重视。本研究报道了2例罕见的RHD基因变异型RHD*DEL37个体的血清学和基因特征,这2例个体的血液样本经血清学方法(试管法和微柱凝胶法)鉴定为RhD阴性。采用聚合酶链反应-序列特异性引物(polymerase chain reaction-sequence specific prime,PCR-SSP)对样本进行RHD基因分型和合子型分析,基因分型结果为RHD基因阳性,并排除了常见的几种RHD基因变异体的可能。RHD基因合子型检测阳性,证明其中一条RHD等位基因1~10外显子全部缺失。进一步对样本RHD基因1~10外显子基因进行Sanger法测序,测序结果显示在另一条等位基因第8内含子上的第1154-31号碱基发生了T>C突变,国际输血协会(International Society of Blood Transfusion,ISBT)将该突变等位基因命名为RHD*DEL37,表型为RhD放散型(D-elute,Del)。本研究中,2例血清学初筛RhD阴性的样本通过分子生物学检测,其基因型为RHD*DEL37/RHD-(RHD*01N.01)。由于这2例个体无血缘关系,提示我国可能存在携带该基因突变的人群。本研究提示分子生物学方法可辅助鉴别血清学初筛为阴性的RhD变异体样本,联用分子生物学方法和血清学方法在准确鉴定血型、保障患者输血安全方面有重要意义。
基金Natural Science Foundation of Guizhou Province,China,No.397.
文摘BACKGROUND Allogeneic hematopoietic stem cell transplantation(Allo-HSCT)is currently the only viable method of curing patients with acute myeloid leukaemia.In 30%to 50%of patients,donors and recipients have some level of ABO blood group incompatibility.ABO blood group incompatibility can cause antibodies against the donor's red blood cells to persist in the recipient's body,resulting in a delay of several months in the recovery of red blood cells.A number of different treatments have been reported for post-transplant pure red cell aplastic anaemia(PRCA),such as plasmapheresis,donor lymphocyte infusions,anti-thymocyte globulin,rituximab and steroids.CASE SUMMARY A 41-year-old female diagnosed with acute myeloid leukaemia underwent peripheral blood allogeneic haematopoietic stem cell transplantation in November 2013 from an HLA matched unrelated donor.The donor was AB-positive and the recipient was O-positive.The patient was diagnosed with PRCA three months after receiving the donor stem cell transplant.After failing multiple lines of therapy,the patient applied for daratumumab.After receiving three doses of daratumumab,the patient developed a reticulocyte response and no longer required CONCLUSION The use of daratumumab anti-CD38 for the remove of plasma cells is safe and effective and may be tried for refractory patients with PRCA after undergoing allo-HSCT for ABO incompatibility.
文摘血液复苏是严重失血患者的关键急救措施。血液复苏液体的选用,经历了从全血到晶体液/胶体液、晶体液联合红细胞、等比例血液成分的演进过程。近20年来,采用低效价抗体O型全血(low titer group O whole blood,LTOWB)作为血液复苏的首选应急通用桥接复苏液,已发展成为大趋势。我们对全血在严重失血患者的应用历史和现状做一介绍,并提出我国采用LTOWB作为首选应急通用血液的进一步论证和验证研究建议。
