脐带血移植后并发自身免疫性溶血性贫血及迟发性输血反应一例分析*

doi:10.3969/j.issn.1671-2587.2025.06.014

临床输血与检验 ›› 2025, Vol. 27 ›› Issue (6): 835-841.DOI: 10.3969/j.issn.1671-2587.2025.06.014

脐带血移植后并发自身免疫性溶血性贫血及迟发性输血反应一例分析^*

马婷¹, 范亮峰², 李婧薇³, 孙杨¹, 杨江存¹, 向东²

¹陕西省人民医院输血科,陕西西安 710068;
²上海市血液中心,上海 200000;
³四川省人民医院输血科,四川成都 610072

收稿日期:2024-12-11 出版日期:2025-12-20 发布日期:2025-12-24
通讯作者: 向东,主要从事免疫血液学研究,E-mail：xiangdong@sbc.org.cn。共同通信作者：杨江存,主要从事临床输血研究,E-mail：yjc65@sina.com。
作者简介:马婷,主要从事临床输血方面研究,E-mail：527766458@qq.com。
基金资助:
^*本项目受陕西省人民医院科技发展孵化基金项目（No.2022-28）资助

A Case Analysis of Autoimmune Hemolytic Anemia and Delayed Hemolytic Transfusion Reaction after Umbilical Cord Blood Transplantation

MA Ting¹, FAN Liangfeng², LI Jingwei³, SUN Yang¹, YANG Jiangcun¹, XIANG Dong²

¹Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi 710068;
²Shanghai Blood Center, Shanghai 200000;
³Department of Transfusion Medicine, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072

Received:2024-12-11 Online:2025-12-20 Published:2025-12-24

摘要/Abstract

摘要： 目的探讨一例脐带血移植后并发自身免疫性溶血性贫血（AIHA）的患者发生配血困难情况下,如何合理运用血清学实验技术实现安全输血。方法对患者血液样本进行直接抗球蛋白试验、抗体鉴定试验、吸收试验、酸放散试验、抗体效价、微柱凝集法交叉配血实验等。结果患者血型为B型Lu^a抗原阴性,多次输注红细胞后发生溶血危象。血清及放散液中均检出IgG型抗Ec及抗-Lu^a。通过实验确定发生了因抗-Ec导致的迟发性溶血性输血反应。规避特异性抗体后患者Hb显著回升,流式细胞术结果显示随着配合性红细胞输注后,患者体内致敏抗原细胞占比逐渐下降。结论抗-E、c引起的迟发性溶血性输血反应可以加重自免溶贫患者贫血,甚至导致溶血危险发生。选择合适的血清学技术方法,可以发现难以确认的特异性抗体,对临床输血安全具有重要意义。

关键词: 脐带血移植, 抗-Ec, 抗-Lu^a, 迟发性溶血性输血反应, 自身免疫性溶血性贫血

Abstract: Objective To investigate the rational application of serological techniques in ensuring safe transfusion for a patient with autoimmune hemolytic anemia (AIHA) following umbilical cord blood transplantation in cases of incompatibility crossmatch. Methods A series of tests, including direct antiglobulin test (DAT), antibody identification test, absorption test, acid elution test, antibody titer measurement, and microcolumn agglutination cross-matching test, were performed on the patient's blood samples. Results The patient's blood type was identified as type B and Lu^a antigen was negativity. A Hemolytic crisis occurred after multiple transfusions of red blood cells. IgG-type anti-Ec and anti-Lu^a antibodies were detected in both serum and exudate samples. Tests showed a delayed hemolytic transfusion reaction (DHTR) caused by anti-Ec. Following compatible red blood cells transfusions, the patient's hemoglobin levels showed a significantly improvement, and flow cytometry results indicated a gradual decrease in the proportion of antigen-sensitized cells in the patient's blood. Conclusion DHTR induced by anti-Ec can exacerbate anemia in AIHA patients and may pose a significant risk of hemolysis. The appropriate selection and application of serological techniques can facilitate the identification of clinically significant antibodies, which is crucial for ensuring the transfusion safety.

Key words: Umbilical cord blood transplantation, Anti-Ec, Anti-Lu^a, Delayed hemolytic transfusion reaction Autoimmune hemolytic anemia

中图分类号:

R457.1

马婷, 范亮峰, 李婧薇, 孙杨, 杨江存, 向东. 脐带血移植后并发自身免疫性溶血性贫血及迟发性输血反应一例分析^*[J]. 临床输血与检验, 2025, 27(6): 835-841.

MA Ting, FAN Liangfeng, LI Jingwei, SUN Yang, YANG Jiangcun, XIANG Dong. A Case Analysis of Autoimmune Hemolytic Anemia and Delayed Hemolytic Transfusion Reaction after Umbilical Cord Blood Transplantation[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2025, 27(6): 835-841.

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脐带血移植后并发自身免疫性溶血性贫血及迟发性输血反应一例分析^*

A Case Analysis of Autoimmune Hemolytic Anemia and Delayed Hemolytic Transfusion Reaction after Umbilical Cord Blood Transplantation

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