输血患者排除抗筛假阴性的意义探讨

闫烨

doi:10.16766/j.cnki.issn.1674-4152.003212

输血患者排除抗筛假阴性的意义探讨

doi: 10.16766/j.cnki.issn.1674-4152.003212

闫烨

河南大学附属郑州颐和医院检验医学中心, 河南郑州 450018

基金项目:

河南省医学科技攻关项目 2018020701

详细信息

作者简介:
闫烨, E-mail: yy13783622960@163.com

中图分类号: R446.11 R457.13
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- 被引次数: 0
出版历程
- 收稿日期: 2022-07-20
- 网络出版日期: 2023-11-23

Significance of excluding anti-screening false negative in blood transfusion patients

YAN Ye

Laboratory Medicine Center, Zhengzhou Yihe Hospital, Zhengzhou, Henan 450018, China

摘要

摘要: 目的探讨对患者排除抗体筛选假阴性的意义，以减少输血不良反应的发生。方法选取郑州颐和医院2019年1月—2021年6月拟输血患者1 200例，先用抗人球蛋白检测卡进行不规则抗体筛查，实验结果阳性标本用谱细胞鉴定抗体特异性，将检出特异性抗体血浆用AB型血浆倍比稀释，选取谱细胞中相应纯合子抗原与杂合子抗原分别在盐水、凝聚胺、抗人球蛋白检测卡、木瓜酶介质中与稀释后血浆反应，以出现杂合子抗原反应阴性结果的血浆最高稀释度来评价纯合子抗原阳性细胞反应的凝集强度并测其效价；实验结果阴性标本分别再用不同实验方法和筛选细胞进行检测。结果用抗人球蛋白检测卡筛选出不规则抗体结果阳性标本进行抗体特异性鉴定，结果阴性标本加用盐水法、凝聚胺法，结果再阴性加用木瓜酶法检测，经谱细胞鉴定1 200例患者不规则抗体筛查阳性9例，检出率为0.75%，抗体筛选结果阴性检出假阴性2例，检出率为0.17%。结论对于有剂量效应的抗体尽量用纯合子细胞进行抗体检测，选择多种方法和不同抗原格局抗筛细胞联合应用排除抗筛假阴性出现，有效预防不规则抗体漏检，减少输血不良反应的发生。
- 抗体筛查 /
- 输血 /
- 纯合子 /
- 杂合子 /
- 低效价抗体
Abstract: Objective To investigate the importance of excluding false negative antibody screening in patients to reduce the incidence of adverse transfusion reactions. Methods Screening and identification of irregular antibodies in 1 200 patients who received blood transfusion form January 2019 to June 2021 in Zhengzhou Yihe Hospital; the specific antibody plasma was diluted with AB type plasma, and the corresponding homozygous antigens and heterozygous antigens in the spectrum cells were reacted with the diluted plasma in saline, polybrene, anti-human globulin test card and papain medium, respectively. The highest dilution of plasma with a negative result of heterozygous antigen reaction is used to evaluate the agglutination intensity of the homozygous antigen-positive cell reaction and to measure its titer. Results Anti-human globulin test cards were used to screen positive specimens with irregular antibody results for antibody specificity; negative samples were tested by the salt water method and the coagglutamine method; negative specimens were tested by the papain method. The positive rate of irregular antibody screening in 1 200 patients was 9 cases, the detection rate was 0.75%, and the negative antibody screening results were false negative in 2 cases. The detection rate is 0.17%. Conclusion For dose-dependent antibodies, try to use homozygous cells for antibody detection. Combined use of anti-screening cells with different antigen patterns and various methods to exclude false negatives from irregular antibody screening can prevent errors and reduce the likelihood of adverse transfusion reactions.
- Antibody screening /
- Blood transfusion /
- Homozygous /
- Heterozygous /
- Low potency antibody

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表 1 纯合子与杂合子抗体筛查情况(n=1 200)

Table 1. Screening for homozygous and heterozygous antibodies (n=1 200)

抗体	方法	杂合子/纯合子	血清稀释倍数					效价	积分
抗体	方法	杂合子/纯合子	原液	1∶2	1∶4	1∶8	1∶16	效价	积分
抗-D	凝聚胺法	杂合子	1+	0	0	0	0	1	5
		纯合子	1+	±	0	0	0	1	7
	抗人球蛋白检测卡	杂合子	1+	±	0	0	0	1	7
		纯合子	2+	1+	0	0	0	2	13
抗-E	凝聚胺法	杂合子	1+	0	0	0	0	1	5
		纯合子	2+	1+	±	0	0	2	15
	抗人球蛋白检测卡	杂合子	1+	1+	0	0	0	2	10
		纯合子	2+	1+	1+	0	0	4	18
	木瓜酶试验	杂合子	2+	1+	±	0	0	2	15
		纯合子	3+	2+	1+	±	0	4	25
抗-Jk^a	抗人球蛋白检测卡	杂合子	1+	±	0	0	0	1	7
		纯合子	2+	2+	1+	±	0	4	23
抗-M	盐水法	杂合子	1+	±	0	0	0	1	7
		纯合子	1+	1+	±	0	0	2	12
	凝聚胺法(2-me)	杂合子	1+	±	0	0	0	1	7
		纯合子	2+	1+	±	0	0	2	15
	抗人球蛋白检测卡(2-me)	杂合子	1+	1+	0	0	0	2	10
		纯合子	2+	1+	1+	±	0	4	20
抗-Le^a	凝聚胺法	杂合子	1+	±	0	0	0	1	7
		纯合子	2+	1+	±	0	0	2	15
	抗人球蛋白检测卡	杂合子	2+	1+	0	0	0	2	13
		纯合子	3+	2+	2+	1+	0	8	31

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表 2 低效价抗体漏检导致抗筛假阴性

Table 2. Missing detection of low-titer antibodies leads to anti-screening false negatives

抗体	原液	1∶2	1∶4	1∶8	1∶16
Le^a	1+	0	0	0	0
Le^a	1+	0	0	0	0
抗-M	2+	0	0	0	0

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表 3 抗体筛选细胞试剂1检测结果(生产批号20171001)

Table 3. Results of antibody screening cell reagent 1 test (Production Lot No. 20171001)

序号	Rh-hr					Kidd		MNSs				Duffy		Kell		Lewis		P	结果
序号	D	C	E	c	e	Jk^a	Jk^b	M	N	S	s	Fy^a	Fy^b	K	k	Le^a	Le^b	p1	盐水	凝聚胺	抗人球蛋白
1	+	+	0	0	+	+	0	+	+	0	+	+	0	0	+	0	+	0	0	0	0
2	+	0	+	+	0	+	+	+	+	0	+	+	0	0	+	+	0	+	0	0	0
3	+	+	+	+	+	+	+	0	+	0	+	+	+	0	+	0	+	0	0	0	0
注：+为阳性，0为阴性。

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表 4 抗体筛选细胞试剂2检测结果(生产批号20177039)

Table 4. Results of antibody screening cell reagent 2 test (Production Lot No. 20177039)

序号	Rh-hr					Kidd		MNSs				Duffy		Lewis		P	结果
序号	D	C	E	c	e	Jk^a	Jk^b	M	N	S	s	Fy^a	Fy^b	Le^a	Le^b	p1	盐水	凝聚胺	抗人球蛋白
1	+	0	+	+	0	+	0	+	+	+	+	+	0	0	+	0	0	0	0
2	+	+	0	0	+	+	+	0	+	0	+	+	0	+	+	+	0	0	+
3	+	+	+	+	+	+	+	+	+	0	+	+	0	0	+	0	0	0	0
注：+为阳性，0为阴性。

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表 5 抗体筛选细胞3木瓜酶法检测结果(生产批号20177043)

Table 5. Results of antibody screening cell 3 papain assay (Production Lot No. 20177043)

序号	Rh-hr					Kidd		MNSs				Duffy		Lewis		P	结果
序号	D	C	E	c	e	Jk^a	Jk^b	M	N	S	s	Fy^a	Fy^b	Le^a	Le^b	p1	盐水	凝聚胺	抗人球蛋白	木瓜酶	阴性对照	阳性对照
1	+	0	+	+	0	+	+	0	+	0	+	+	0	+	+	0	0	0	0	+	0	+
2	+	+	0	0	+	0	+	+	+	+	+	+	0	0	+	0	0	0	0	0	0	0
3	+	+	+	+	+	+	+	+	0	0	+	+	0	0	+	+	0	0	0	0	0	0
注：+为阳性，0为阴性。

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