Liumbruno Giancarlo Maria, Tognaccini Adriana, Bonini Rosaria, Curciarello Giuseppe, Masini Isio, Ringressi Alvaro, Tornabene Francesco, Vanacore Renato
Servizio di Immunoematologia e Medicina Trasfusionale Livorno, Italy.
Blood Transfus. 2008 Jul;6(3):156-62. doi: 10.2450/2008.0046-07.
The aim of this study was to conduct a Regional survey to determine the policies and ways of performing the direct antiglobulin test in pre-transfusion screening, the approach used in cases giving positive results with this test and the technical and operative modalities for choosing blood for transfusion in cases of autoimmune haemolytic anaemia.
A questionnaire, containing ten multiple-choice questions, was sent to all the transfusion centres in the Region of Tuscany.
The data from all 40 regional centres were analysed. Direct antiglobulin tests and autocontrols were not regularly used in pre-transfusion screening. The direct antiglobulin test was predominantly reserved for suspected cases of autoimmune haemolytic anaemia. Sixty percent of the laboratories characterised the specificity of samples that were positive for IgG and complement by the direct antiglobulin test, 45% that were positive for IgM, 35% also for IgA, and 13% also for subclasses of IgG. Elution studies were reserved (in 18% of laboratories) for those cases in which it was expected that transfusion therapy would be used. In cases of autoimmune haemolytic anaemia, autologous/allogeneic adsorption was carried out in 27% of the structures (the use of proteolytic enzymes is predominant, followed by the "ZZAP" reagent--a mixture of dithiothreitol and an enzyme) and the dilution method in 20%; transfusion of red blood cells with a phenotype extensively compatible (c, C, D, E, e, K, Jka, Jkb, Fya, Fyb, S, s) with that of the recipient is practised in 17% of the centres, while transfusion of units of "least incompatible" red blood cells was reported by 95% of the centres, but in 88% this is preceded by at least one of the above mentioned immunohaematological investigations.
The organisation of a network of Services of Immunohaematology and Transfusion Medicine can be exploited to overcome some technical and operative limitations of peripheral, dependent Transfusion Sections. The results of this study reveal which immunohaematology laboratory is endowed with the greatest potential and which could, therefore, become the regional reference centre. This investigation could lay the basis for defining behavioural algorithms and recommendations on the issues considered.
本研究的目的是进行一项区域调查，以确定在输血前筛查中进行直接抗球蛋白试验的政策和方法、该试验结果呈阳性时所采用的方法，以及自身免疫性溶血性贫血病例中选择输血用血的技术和操作方式。
向托斯卡纳地区的所有输血中心发送了一份包含十个多项选择题的问卷。
对所有40个区域中心的数据进行了分析。直接抗球蛋白试验和自身对照在输血前筛查中未得到常规使用。直接抗球蛋白试验主要用于疑似自身免疫性溶血性贫血病例。60%的实验室对直接抗球蛋白试验中IgG和补体呈阳性的样本进行特异性鉴定，45%对IgM呈阳性的样本进行鉴定，35%对IgA呈阳性的样本进行鉴定，13%对IgG亚类呈阳性的样本进行鉴定。洗脱研究（在18%的实验室中）仅用于预期将采用输血治疗的病例。在自身免疫性溶血性贫血病例中，27%的机构采用自体/异体吸附法（主要使用蛋白水解酶，其次是“ZZAP”试剂——二硫苏糖醇和一种酶的混合物），20%采用稀释法；17%的中心输注与受血者血型广泛相容（c、C、D、E、e、K、Jka、Jkb、Fya、Fyb、S、s）的红细胞，而95%的中心报告输注“最不相容性最小”的红细胞单位，但其中88%在输注前至少进行了上述免疫血液学检查中的一项。
可利用免疫血液学和输血医学服务网络的组织来克服周边附属输血科室的一些技术和操作限制。本研究结果揭示了哪个免疫血液学实验室具有最大潜力，因此可能成为区域参考中心。这项调查可为确定所考虑问题的行为算法和建议奠定基础。
