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临床输血与检验 ›› 2022, Vol. 24 ›› Issue (6): 716-720.DOI: 10.3969/j.issn.1671-2587.2022.06.007

• 临床输血 • 上一篇    下一篇

抗-M抗体影响血型鉴定及对临床输血的影响*

谢惠益, 周载鑫, 杨玥, 王星怡, 李津杞, 牟显尧, 顾海慧, 钱宝华   

  1. 200433 上海,海军军医大学第一附属医院
  • 收稿日期:2022-06-16 发布日期:2023-01-05
  • 通讯作者: 钱宝华,男,教授,主要从事临床输血、血液免疫方面研究,(E-mail)qianbh1963@163.com。
  • 作者简介:谢惠益(1976-),女,主要从事输血检验方面研究,(E-mail)59128156@qq.com。
  • 基金资助:
    *本课题受海军军医大学第一附属医院“234学科攀峰计划”(No.2020YXK036)、国家自然科学基金面上项目(No.81970165)资助

Analysis of the Influence of Anti-M Antibody on Blood Group Identification and Clinical Blood Transfusion

XIE Hui-yi, ZHOU Zai-xin, YANG Yue, et al   

  1. Department of Blood Transfusion, the First Affiliated Hospital of Naval Medical University, Shanghai 200433
  • Received:2022-06-16 Published:2023-01-05

摘要: 目的 通过探讨抗-M抗体对血型鉴定造成的干扰,分析提前发现此类抗体对输血相容性检测和临床输血的必要性,进而探讨O型红细胞在日常不规则抗体筛查中的重要性。方法 收集2019年1月~2021年12月在我院输血科首次进行血型鉴定,其中18例反定型鉴定中O型红细胞对照管为凝集最终确定为抗-M抗体影响血型的标本,通过抗人球蛋白实验等方法进行抗体鉴定,用吸收放散试验及2-巯基乙醇等方法消除不规则抗体的影响,并对处理后的红细胞和血清进行正反定型确认实验,通过盐水法、凝聚胺法和卡式抗人球法进行交叉配血实验。结果 这18例O型红细胞对照管为凝集的标本中,16例正反定型不符;2例O型标本全自动血型仪正反定型相合,但试管法复核反定型时发现O型红细胞对照管凝集,自身对照管阴性,提示存在ABO系统以外的不规则抗体。所有标本经抗体鉴定均检出抗-M抗体,在37℃或抗球蛋白阶段能发生反应的IgM+IgG抗体有11例,14例进行了交叉配血实验,其中4例患者输注了悬浮红细胞等血液成分,无一例发生输血不良反应。输血后疗效评价发现输注有效。结论 对于明确由抗-M类不规则抗体引起的正反定型不符或交叉配血不合的标本,血清经过吸收试验及2-巯基乙醇处理,可以消除不规则抗体带来的干扰,获得正确的实验结果,而在使用全自动血型仪鉴定血型中加入O型红细胞对照管则能提高抗-M类的冷反应性的盐水抗体的检测率。

关键词: 抗-M抗体, ABO血型鉴定, 正反定型不符, 交叉配血试验, 输血安全

Abstract: Objective To analyze the influence of anti-M antibody on blood transfusion compatibility test,the necessity of such antibodies for transfusion compatibility detection and clinical transfusion was found in advance, and then the importance of O cells in daily blood group identification was further explored. Methods The ABO typing discrepancy specimens were collected in the first blood group typing in the Department of Blood Transfusion of our hospital from January 2019 to December 2021, 18 of them were found to be anti-M positive by anti-human globulin test and other methods, and the influence of anti-M was eliminated by absorption-elution test and 2-mercaptoethanol. The red blood cells and serum after treatment were confirmed by forward and reverse typing, and cross-matching experiments were carried out by saline method, polybrene method and antiglobulin test. Results Among the 18 anti-M positive samples, 16 blood typing with discrepancy, antibodies were detected in reverse typing, 2 cases of type O specimens were not detected by automatic blood typing instrument, and O cells were found to be positive when the reverse type was rechecked by test tube method. After the anti typing of serum was rechecked by O cell absorption, the forward and reverse typing of all samples were consistent, and anti-M antibodies were detected in antibody identification. Cross matching test was carried out in 14 cases, of which 4 cases were infused with suspended red blood cells and other blood components, there was no adverse reaction of blood transfusion. The efficacy evaluation after blood transfusion found that the infusion was effective. Conclusion For the samples clearly caused by anti-M inconsistent match or cross blood incompatible, the interference caused by anti-M antibody can be eliminated and the correct experimental results can be obtained after the serum is treated with absorption test and 2-mercaptoethanol. However, the automatic blood group instrument alone is used to detect the blood group-deficient O cells with the cold-reactive saline antibodies to the anti-M class.

Key words: Anti-M antibody, ABO blood group determination discrepancy, Blood cross-matching test, Blood transfusion safety

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