同种特异性自身抗体的血清学特点分析及输血策略的探讨

doi:10.16150/j.1671-2870.2023.05.008

摘要/Abstract

摘要：

目的：分析罕见的抗-Ce特异性自身抗体血清学特点，探讨输血相关自身抗体的检测方法和输血策略，为临床存在自身抗体的患者提供输血治疗参考。方法：对1例产生罕见抗Ce特异性自身抗体的患者进行ABO血型鉴定、Rh血型分型、Coombs试验及抗体鉴定试验、酸放散试验等血清学分析；采用序列特异性引物引导的PCR反应（polymerase chain reaction-sequence specific primer，PCR-SSP) 方法对其Rh血型基因分型进行鉴定，规避抗-Ce特异性进行红细胞交叉配血。对患者输注前、后血红蛋白进行检测分析。结果：血清学结果表明该，患者血型为AB型，RhD阳性，Rh分型为CcEe，直接抗人球试验和抗体筛选试验均为阳性。抗体鉴定结果显示该患者血浆中和红细胞上均含有抗-Ce特异性抗体，而基因分析结果表明该患者Rh分型为CcEe。2次交叉配血结果均为阴性，每次输注红细胞ABO血型为AB型，Rh分型为ccDEE型2U；2次输注后患者血红蛋白分别从48 g/L、58 g/L上升至60 g/L和88 g/L。结论：罕见情况下，在抗体鉴定过程中，自身抗体可以表现出非全凝集情况，显示有强弱凝集差异格局的同种抗体特征。红细胞输注原则是当血浆中含有此种抗体时应规避抗体特异性，选择交叉配血相合红细胞输注，待抗体减弱或消失后，再给予Rh同型且配血相合的红细胞进行输注。

关键词: 自身抗体, 同种抗体, 抗Ce抗体, 输血治疗

Abstract:

Objective: To explore the detection methods and transfusion strategies of autoantibodies with specificity against Rh blood group system to provide timely and effective transfusion treatment for those patients. Methods: A case of a patient with autoantibodies with anti-Ce specificity was studied through serological tests, including ABO and Rh blood group identification, Coombs tests, antibody identification test and acid elution test. PCR-SSP was carried out to identify the Rh phenotype. The cross-matching test should avoid the specificity of anti-Ce autoantibody. The hemoglobin was measured pre- and post- the transfusion. Results: The results of the serological tests showed the blood group of the patient was AB type, RhD positive, and Rh blood group was CcEe before transfusion Direct antiglobulin test (DAT), and indirect antiglobulin test (IAT) were positive. According to the identification of antibodies, there were autoantibodies with anti-Ce specificity in the patient’s serum. The Rh antigen phenotyping was C⁺, c⁺, E⁺, e⁺ through the gene analysis. The results of the cross-matching were negative and the blood group of the red blood cell were AB, ccDEE. The hemoglobin of the patient increased from 48 g/L to 60 g/L and 58 g/L to 88 g/L rapidly after transfusion. Conclusions: In rare cases, autoantibodies can also show the characteristics of the complete antibodies rather than the pattern which could be agglutination with all the red blood cells for antibodies identification but there were strength differences. During blood transfusion treatment for those patients, we should try to avoid the specificity of autoantibodies, and carry out cross matching test before transfusion. After the titter of the autoantibodies decreased or disappeared, homotypic red blood cells for transfusion could be carried out.

Key words: Autoantibody, Alloantibody, Anti-Ce antibody, Treatment with transfusion

中图分类号:

R457.1

雷航, 王中英, 谢军华, 龚国琴, 向东, 蔡晓红, 邹纬. 同种特异性自身抗体的血清学特点分析及输血策略的探讨[J]. 诊断学理论与实践, 2023, 22(05): 466-471.

LEI Hang, WANG Zhongying, XIE Junhua, GONG Guoqin, XIANG Dong, CAI Xiaohong, ZOU Wei. Analysis of the serological characteristics and transfusion strategy of the autoantibody with specificity[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(05): 466-471.

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Detection time	Forward typing		Reverse typing		Rh typing					Direct antiglobulin test
Detection time	-A	-B	Ac	Bc	-D	-E	-e	-C	-c	抗-IgG，C3	抗IgG	抗C3
Emergency	4+	4+	0	0	4+	4+	4+	4+	4+	2+	2+	0
Hospitalization	4+	4+	0	0	4+	4+	2+mf	2+mf	4+	2+	2+	0

	D	C	E	c	e	f	C^w	V	K	k	kp^a	kp^b	Js^a	Js^b	Fy^a	Fy^b	Jk^a	Jk^b	Xg^a	Le^a	Le^b	S	s	M	N	P1	Lu^a	Lu^b	PS
Ⅰ	+	+	0	0	+	0	0	0	0	+	0	+	/	+	+	0	+	+	+	0	+	0	+	0	+	0	0	+	2+
Ⅱ	+	0	+	+	0	0	0	0	0	+	0	+	/	+	0	+	0	+	+	+	0	+	0	+	0	+	0	+	0
Ⅲ	0	0	0	+	+	+	0	0	+	+	0	+	/	+	+	+	+	0	+	0	+	0	+	+	+	+s	0	+	2+
自身																													1+s

细胞编号	Rh					KELL		Duffy		Kidd		MNSs				P1	Lewis		PS	放散液
细胞编号	D	C	c	E	e	K	k	Fy^a	Fy^b	Jk^a	Jk^b	M	N	S	s	P1	Le^a	Le^b	PS	放散液
1	+	+	0	0	+	+	+	+	0	0	+	0	+	0	+	+	+	0	4+	4+
2	+	0	+	+	0	0	+	0	+	0	+	+	+	+	+	+	0	+	0	0
3	+	0	+	+	0	0	+	+	0	+	+	+	0	+	0	+	0	+	0	0
4	+	0	+	+	0	0	+	+	+	+	0	+	+	0	+	+	+	0	0	0
5	0	+	+	0	+	0	+	+	0	+	+	+	0	+	+	+	0	+	4+	4+
6	0	0	+	+	+	0	+	+	0	+	+	+	+	+	+	+	0	+	1+	2+
7	0	0	+	0	+	0	+	+	0	0	+	0	+	+	+	+	+	0	3+	3+
8	0	0	+	0	+	0	+	0	+	+	0	+	+	+	0	+	+	0	3+	3+
9	0	0	+	0	+	+	+	+	+	+	0	0	+	0	+	0	0	+	3+	3+
10	+	+	+	+	+	0	+	+	+	0	+	+	0	0	+	0	+	+	3+	3+
11	+	0	+	+	0	0	+	+	0	+	+	+	+	0	+	0	0	0	1+	2+
12	0	0	+	0	+	0	+	+	0	0	+	+	+	0	+	+	+	0	2+	3+
13	+	+	+	+	+	0	+	+	+	0	+	+	0	0	+	+	0	+	3+	3+
14	+	+	+	+	+	0	+	+	0	+	+	0	+	0	+	+	0	+	3+	3+
15	+	+	0	0	+	0	+	+	+	+	+	+	+	+	+	+	0	+	3+	3+
16	+	+	+	+	+	0	+	+	+	+	+	+	+	+	0	0	0	+	3+	3+
自身																			3+