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临床输血与检验

临床输血与检验 ›› 2021, Vol. 23 ›› Issue (4): 455-458.DOI: 10.3969/j.issn.1671-2587.2021.04.010

• 临床输血 • 上一篇    下一篇

AIHA患者血型血清学特征及输注悬浮红细胞疗效分析

邸艳辉, 管行, 寇立舵, 白薇, 王新华   

  1. 100049 北京市,航天中心医院
  • 收稿日期:2020-08-05 发布日期:2021-08-18
  • 通讯作者: 王新华,女,主任技师,博士,主要从事临床输血方面研究,（E-mail）wangxinhua721@163.com。
  • 作者简介:邸艳辉（1969-）,女,北京人,主管技师,学士,主要从事临床输血方面研究,（E-mail）yh111666@sohu.com。

Serological Characteristics of Blood Group and Efficacy of Suspended Red Blood Cells Transfusion in Patients with Autoimmune Hemolytic Anemia

DI Yan-hui, GUAN Hang, KOU Li-duo, et al   

  1. Department of Blood Transfusion , Aerospace Center Hospital,Beijing 100049
  • Received:2020-08-05 Published:2021-08-18

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摘要： 目的 探讨分析自身免疫性溶血性贫血（AIHA）患者血型血清学特征及采用悬浮红细胞输注方式治疗效果及应用价值。方法 选取我院2014年1月~2019年12月住院治疗的56例自身免疫性溶血性贫血患者,回顾性分析56例患者血型血清学特征,并分析直接抗人球蛋白试验（DAT）阳性分型、凝集强度与溶血和贫血程度关系。对56例患者分为A组8例（药物治疗）,B组18例（输注洗涤红细胞）,C组30例（输注悬浮红细胞）。将3组临床疗效及治疗前后红细胞（RBC）计数、血红蛋白（Hb）水平、网织红细胞百分比（Ret）、总胆红素（TBIL）水平变化进行比较。比较3组临床症状缓解及不良反应发生情况。结果 56例患者,抗-IgG型自身抗体34例（60.71%）,抗-C3d型自身抗体5例（8.93%）,抗-IgG+C3d型复合自身抗体17例（30.36%）。其中单纯型（IgG、C3d）与复合型（IgG+ C3d）的溶血参数相比,有显著性差异（P<0.05）。56例患者DAT结果均为阳性（凝集强度W+-4+）,自身抗体和DAT凝集强度与溶血和贫血呈正相关（P<0.05）。治疗后Ret、TBIL均显著降低,RBC、Hb均显著提高,差异具有统计学意义（P<0.05）。治疗前以及治疗后3组患者RBC、Hb、Ret、TBIL比较差异无统计学意义（P>0.05）。治疗后A组治疗总有效率（87.5%）、B组治疗总有效率（94.4%）、C组治疗总有效率（100%）,3组比较临床症状完全有效率及部分有效率差异无统计学意义（P>0.05）。结论 AIHA患者自身抗体和DAT凝集强度越强溶血程度越严重,而贫血程度也随之加重。临床上应用悬浮红细胞输注方式对AIHA患者进行治疗,效果确切,能明显改善实验室检查指标及改善患者缺氧症状,并具有安全有效性,无不良反应发生,具有临床重要意义,可在临床上广泛推广与运用。

关键词: AIHA, 血型血清学, 悬浮红细胞, 输血疗效, 输血安全性

Abstract: Objective To analyze the serological characteristics of blood group in patients with autoimmune hemolytic anemia (AIHA) and the therapeutic effect and applications of suspended red blood cells (SRBCs). Methods Fifty-six patients with AIHA hospitalized in our hospital from January 2014 to December 2019 were selected. The serological characteristics of blood group in 56 patients were analyzed retrospectively. The association between positive direct antiglobulin test (DAT), agglutination strength and hemolytic intensity and degree of anemia were analyzed. Patients were divided into three groups: group A (8 cases, with drug), group B (18 cases, with washed RBCs) and group C (30 cases, with SRBCs). The treatment effect and the changes of RBCs, hemoglobin (Hb), reticulocyte (Ret) and total bilirubin (TBIL) were compared before and after treatment. The clinical symptoms and adverse reactions were compared among the three groups. Result Among 56 patients,34 (60.71%) were anti-IgG autoantibodies, 5 (8.93%) anti-C3d autoantibodies and 17 (30.36%) anti- IgG+ C3d mixed autoantibodies. There was significant difference in hemolytic parameters between simple type (IgG, C3d) and complex type (IgG+ C3d) (P<0.05). Fifty-six patients had positive DAT (agglutination strength W + - 4+). Autoantibodies and DAT agglutination strength were positively correlated with hemolysis and anemia (P<0.05). After treatment, Ret% and TBIL were significantly decreased, and RBC and Hb were significantly increased (P<0.05). There was no significant difference in RBC, Hb, Ret and TBIL among the three groups before and after treatment (P>0.05). Based on the total effective rate in group A (87.5%), group B (94.4%), and group C (100%) after treatment, there was no significant difference in the effective rate of complete and partial of clinical symptoms among the three groups (P>0.05). Conclusion The stronger the agglutination intensity of DAT and autoantibody in AIHA patients, the more severity of hemolysis and anemia. AIHA patients treated with SRBCs had definite effect, which could obviously improve lab tests index and improve the patient's anoxia symptom. It has safety, no adverse reactions, and has clinical significance. It is worth popularizing and suitable for clinic.

Key words: AIHA, Blood group serology, Suspended red blood cells, Transfusion efficacy, Transfusion safety

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