由于不恰当地使用预热和吸附技术导致抗-Vel血型抗体的误鉴定。

Storry J R, Mallory D

American Red Cross National Reference Laboratory for Blood Group Seroloa, 15601 Crabbs Branch Way, Rockville, MD 20855, USA.

Immunohematology. 1994;10(3):83-6.

Two units of red blood cells (RBCs) were ordered for a 44-year-old Caucasian woman with renal failure and cancer. Pretransfnsion testing performed at the regional reference laboratory had revealed the presence of an antibody reactive with all cells at the indirect antiglobulin test but apparently nonreactive by a prewarmed IAT. The patient's RBCs were direct antiglobulin test negative. Adsorption of the serum with rabbit erythrocyte stroma or with allogeneic RBCs at 4 degrees C reduced the reactivity at the IAT. The patient was transfused with two units of washed RBCs and died 6 to 8 hours later. Retrospective testing in our laboratory detected anti-Vel in both pretransfusion and posttransfusion samples. The pretransfnsion serum was hemolytic when tested io LISS or with papain-treated RBCs. Weak reactivity (I+) was observed at the IAT. EDTA-treated serum (to prevent C'-mediated hemolysis) was strongly reactive (3+s) with Vel+ RBCs but compatible with 10 examples of Vel- RBCs. Adsorptions with rabbit RBCs did not affect reactivity. Pretransfnsion RBCs were nonreactive with three examples of anti- Vel at the IAT. The posttranshision serum was grossly hemolyzed and anti-Vel was demonstrable, although weaker than in the pre- transfusion sample. The antibody was subclassed as IgG1 and IgG3. In this case, the use of a prewarming technique precluded detection of hemolysis caused by the antibody prior to the IAT. This case stresses the importance of antibody identification and the correct use of such techniques as prewarming and adsorptions.

为一名44岁患有肾衰竭和癌症的白人女性订购了两单位红细胞。在区域参考实验室进行的输血前检测发现，有一种抗体在间接抗球蛋白试验中与所有细胞发生反应，但在预热间接抗球蛋白试验中显然无反应。患者的红细胞直接抗球蛋白试验呈阴性。用兔红细胞基质或在4℃下用同种异体红细胞吸附血清可降低间接抗球蛋白试验的反应性。给患者输注了两单位洗涤过的红细胞，患者在6至8小时后死亡。我们实验室的回顾性检测在输血前和输血后样本中均检测到抗-Vel抗体。输血前血清在低离子强度盐溶液（LISS）中或与木瓜蛋白酶处理的红细胞检测时具有溶血作用。在间接抗球蛋白试验中观察到弱反应性（I+）。乙二胺四乙酸（EDTA）处理的血清（以防止补体介导的溶血）与Vel+红细胞强烈反应（3+s），但与10例Vel-红细胞相容。用兔红细胞吸附不影响反应性。输血前红细胞在间接抗球蛋白试验中与三例抗-Vel无反应。输血后血清严重溶血，抗-Vel抗体可检测到，尽管比输血前样本中的弱。该抗体被分类为IgG1和IgG3。在这种情况下，使用预热技术无法在间接抗球蛋白试验之前检测到由抗体引起的溶血。该病例强调了抗体鉴定以及正确使用预热和吸附等技术的重要性。