目的：探讨自身免疫性溶血性贫血患者的临床输血前检测对血液选择及输注疗效的重要性。方法：对2例自身免疫性溶血性贫血患儿进行血型鉴定、不规则抗体筛查、交叉配血,并评估输血疗效。结果：2例标本的血型鉴定反定型中,均表现为O型红细胞凝集,抗体筛查均为阳性。根据抗体鉴定反应格局,一例标本含类抗-C抗体,另一例标本抗体性质不明。予输注适宜洗涤红细胞悬液后,患者病情得到改善,输血疗效评价为有效。结论：自身免疫性溶血性贫血患者体内不规则抗体比较复杂,应根据抗体性质尽量选择无相关抗原的血液输注。如自身抗体显示Rh血型等相关特异性时,应选择缺乏此抗原的红细胞悬液输注;如自身抗体性质不明,则应选择多份ABO血型相同的血液做配合性试验,采用患者血清与献血者红细胞反应最弱的血液;若患者直接抗球蛋白试验阳性,特别是抗C3d阳性,可对献血者血液进行洗涤处理后予以输注,避免献血者血液中残留的补体成分引起患者溶血。

Objective: To explore the importance of pre-transfusion detection and blood selection for therapeutic efficacy in autoimmune hemolytic anemia. Methods: Blood group identification,irregular antibody screening and cross-ma-tching were performed with DG Gel confirmcards, Neutral cards, Coombs cards and WADiana/8XT Compact Analyzer (Diagnostic Gri-fols, S.A). Thetransfusion efficacy was assessed. Results: Both samples from the 2 patients showed agglutination of O cell and positive antibody screening test. The mimicking anti-C was identified in one sample based on the response pattern of panel cells, and autoantibody of another sample was not clearly identified. The health condition of both patients was improved after transfusing with red blood cells and the transfusion therapy was effective. Conclusions: In patients with autoimmune hemolytic anemia, the irregular antibodies were rather complex, therefore the blood cells without associa-ted antigen should be selected for transfusion according to the character of antibody. If the autoantibody showed mimicking Rh blood group characteristics, blood cells without the associated antigen were selected for transfusion. If the autoantibody was not clearly identified, blood cells with the same ABO blood group should be selected for the compatible test and that with the weakest reaction was chosen from multiple donors. If direct antiglobulin test was positive, especially the anti-C3d positive, donor's blood should be washed before transfusion to avoid hemolysis caused by the residual complement.