Schonewille Henk, van Zijl Annette M, Wijermans Pierre W
Department of Hematology, Hospital Leyenburg, The Hague, The Netherlands.
Transfusion. 2003 Jul;43(7):939-44. doi: 10.1046/j.1537-2995.2003.t01-1-00435.x.
It is common practice to perform an antiglobulin cross-match only when unexpected RBC alloantibodies are present, to detect antibodies against additional RBC antigens. In this study, the incidence of unexpected antibodies to low-incidence antigens (Ab-LIA) over a period of 23 years was investigated.
Records of RBC antibodies and the accompanying transfusion history from 1978 through 2000 was retrospectively examined. Complete cross-matches were performed for all RBC transfusions before 1991. As of 1991, the type-and-screen policy was applied. To study the incidence of anti-Wra, a prospective study was conducted on sera from 462 patients sent to the transfusion laboratory and 486 blood donors.
The records of 1795 patients containing 2257 RBC antibodies were examined. In 89 patients, a total of 94 Ab-LIAs was found. Anti-Wra was the most frequently encountered Ab-LIA. Thirty-nine patients had Ab-LIA in combination with other antibodies, 20 of which were autoantibodies. Eighty percent of these Ab-LIA were found at the first positive antibody screening test. Fifty-one solitary Ab-LIA were found in 50 patients, 37 during antibody screening tests, and 14 after positive complete cross-matches conducted before 1991. After an RBC antibody was detected, 664 patients received a total of 7792 RBC transfusions. Since the introduction of the type-and-screen policy, only one anti-Wra has been discovered during complete cross-matching. No transfusion reactions due to Ab-LIA were reported during the study period. In the prospective study, 12.3 percent of patients and 4.3 percent of blood donors had anti-Wra.
Although Ab-LIAs are found coincidentally in the sera of only 2 to 3 percent of patients with other RBC antibodies, they are formed often. Because we found no difference in serologic incompatibility, due to Ab-LIAs, between patients with and without other blood group antibodies, we conclude that blood can be transfused safely to patients without performing a complete cross-match.
仅在存在意外红细胞同种抗体时进行抗球蛋白交叉配血以检测针对其他红细胞抗原的抗体，这是常见的做法。在本研究中，调查了23年间针对低频率抗原的意外抗体（Ab-LIA）的发生率。
回顾性检查了1978年至2000年的红细胞抗体记录及相关输血史。1991年以前的所有红细胞输血均进行了完全交叉配血。自1991年起，采用血型鉴定和筛查策略。为研究抗Wra的发生率，对送至输血实验室的462例患者和486名献血者的血清进行了一项前瞻性研究。
检查了1795例患者的记录，其中包含2257种红细胞抗体。在89例患者中，共发现94种Ab-LIA。抗Wra是最常遇到的Ab-LIA。39例患者的Ab-LIA与其他抗体同时存在，其中20种为自身抗体。这些Ab-LIA中的80%在首次阳性抗体筛查试验中被发现。在50例患者中发现了51种单独的Ab-LIA，37种在抗体筛查试验期间发现，14种在1991年以前进行的阳性完全交叉配血后发现。在检测到红细胞抗体后，664例患者共接受了7792次红细胞输血。自采用血型鉴定和筛查策略以来，在完全交叉配血过程中仅发现了1例抗Wra。在研究期间未报告因Ab-LIA引起的输血反应。在前瞻性研究中，12.3%的患者和4.3%的献血者有抗Wra。
虽然在仅有2%至3%的伴有其他红细胞抗体的患者血清中偶然发现Ab-LIA，但它们经常形成。由于我们发现有无其他血型抗体的患者因Ab-LIA导致的血清学不相容性并无差异，因此我们得出结论，无需进行完全交叉配血即可安全地为患者输血。
