目的 探究抗-M抗体影响血型鉴定及对临床输血的影响,分析不规则抗体筛查必要性,以期进一步提升临床输血的安全性及有效性。方法 分析2020年1月—2023年4月于蚌埠医学院第二附属医院输血科检查的100例O型红细胞对照管凝集患者样本资料,使用全自动血型仪微柱凝胶卡、反定型试管法对样本进行血型鉴定和抗体检查,使用抗人球蛋白实验检测抗体类型及特异性,并分析抗-M抗体在不同环境温度下的效性。结果 血型仪微柱凝胶法显示100例标本中存在正反定型不符89.00%,正反定型相符11.00%;反定型试管法复核显示100例标本A、B、O细胞管均为阳性,对照管均为阴性。对89例正反定型不符的样本予以分析,抗-M是最主要影响抗体,占比56.18%;IgM、IgG是最主要影响抗体类型;13例未鉴定出抗体特异性,占比14.61%。89例正反定型不符的样本中男25例、女64例;71例存在妊娠史或输血史,占比79.78%,其中的11例合并妊娠史和输血史。50例抗-M抗体标本在不同气温下呈现不同效价,在4 ℃、22 ℃下会出现凝集梯度;在37 ℃下,50例样本中反应强烈31例,占比62.00%,阴性19例,占比38.00%。结论 抗-M类不规则抗体是影响血型鉴定、威胁输血安全的主要因素,临床需加强输血前血型鉴定,明确抗-M抗体临床检测的意义,通过多种途径提升鉴定准确性,对合并高危险因素的患者更需要着重关注,保障输血安全。
目的 明确输血前各抗体的分布特点，探讨自身抗体和同种抗体在性别、年龄、输血史、妊娠史和不同疾病中的差异，并根据抗体血型血清学特性制定个体输血方案，以确保临床输血安全。方法 选取2021年6月—2024年8月在广东省第二人民医院输血科申请输注红细胞或手术备血的29 662例患者，采用低离子抗人球蛋白微柱凝胶法进行不规则抗体筛查，结果阳性的标本经科内讨论并送广州血液中心血型参比实验室进行抗体鉴定，通过统计血液中心回报结果分析各抗体的特异性。结果 29 662例患者标本中不规则抗体结果为阳性的有208例，阳性率为0.70%。同种抗体占比47.69%，Rh、MNS和Lewis红细胞血型系统共占同种抗体中的94.50%，其中常见意外抗体：抗-E占31.87%、抗-M占14.29%、抗-Mur占19.78%、抗-C占7.69%和抗-e占7.69%。同种抗体与自身抗体在性别、年龄、妊娠史等方面比较差异无统计学意义（P＞0.05）；在输血史及不同科室疾病等方面比较差异有统计学意义（P＜0.05）。结论 输血前进行输血相容性检测是必要的，应对拟申请红细胞的患者进行不规则抗体筛查，阳性者宜进行抗体鉴定，明确其抗体的特异性及临床意义，以确保临床输血安全。
Objective To clarify the distribution characteristics of each antibody before transfusion，to explore the differences between autoantibodies and homologous antibodies in gender，age，history of blood transfusion，history of pregnancy and different diseases，and to formulate individual transfusion protocols based on the serological characteristics of antibody blood groups to ensure the safety of clinical blood transfusion．Methods A total of 29 662 patients who applied for red blood cell transfusion or surgical blood preparation in the hospital from June 2021 to August 2024 were selected for irregular antibody screening by low-ion anti-human globulin microcolumn gel method．The samples with positive results were discussed within the department and sent to the Blood Type Reference Laboratory of Guangzhou Blood Center for antibody identification．The specificity of each antibody was analyzed by blood center reported results．Results Among 29 662 patients，208 were positive for irregular antibody，the positive rate was 0.70%．The alloantibodies accounted for 47.69%，Rh，MNS and Lewis erythrocyte blood group system accounted for 94.50% of alloantibodies，among which the common unexpected antibodies were anti-E 31.87%，anti-M 14.29%，anti-MUR 19.78%，anti-C 7.69% and anti-E 7.69%．There were no significant differences between alloantibodies and autoantibodies in gender，age and pregnancy history（P＞0.05）．There were statistically significant differences in blood transfusion history and diseases in different departments（P＜0.05）．Conclusions It is necessary to test the compatibility of blood transfusion before transfusion．Screening for irregular antibodies should be carried out in prospective transfusion patients，and antibody identification should be carried out in positive patients to clarify the specificity and clinical significance of their antibodies to ensure the safety of clinical transfusion．
