Jovanović Radmila, Bujandrić Nevenka, Lisulov Slobodanka, Bogdanović Sanja
Srp Arh Celok Lek. 2011 Jul-Aug;139(7-8):518-22. doi: 10.2298/sarh1108518j.
Transfusion management of patients who are alloimmunized against high-prevalence erythrocyte antigens is often problematic. Strategy management depends, not only on the specific clinical circumstances of the patient, but also on the acceptable time frame. In patients without clinically significant antibody incompatible transfusion it may be less harmful than delaying medical intervention.
We report a 57-year-old female from Libya, blood group O, RhD-positive, who was treated at the Institute of Cardiovascular Diseases of Vojvodina. At the Blood Transfusion Institute of Vojvodina, during pretransfusion testing an IgG alloantibody of unknown specificity was determined. A total of 200 blood units (O, RhD-positive) were crossmatched, but positive reactions indicating that the donor units were incompatible for that specific patient. By testing the patient's family members in Tripoli, six compatible blood units were found and applied during and after surgery. Due to the deterioration of the patient's condition a rapid transfusion was required; however cross-match compatible blood was not available. After a biological cross-match to predict the clinical significance of this antibody, 12 units of erythrocytes with the lowest positive cross-match reactions, were transfused to the patient without any adverse effects. Good tolerance of the units suggested that the present antibodies were not clinically significant. Later on, a rare alloantibody directed to the high frequency Gerbich blood group antigens was identified by the Foundation Central Laboratory, Blood Transfusion Service in Bern, Switzerland.
In cases of emergency patients with alloantibodies against high frequency Gerbich, when autologous or compatible alogenous transfusion is unavailable, blood with the lowest positive cross-match reaction could be transfused if the biological cross-match is negative. Formation of a national register of donors with rare blood groups and their connection with international registers is of crucial significance in the management of patients requiring antigen negative blood otherwise unavailable from routine blood banks.
对于对高流行率红细胞抗原产生同种免疫的患者，输血管理往往存在问题。策略管理不仅取决于患者的具体临床情况，还取决于可接受的时间框架。对于没有临床显著抗体不相容输血的患者，输血可能比延迟医疗干预危害更小。
我们报告了一名来自利比亚的57岁女性，血型为O型，RhD阳性，在伏伊伏丁那心血管疾病研究所接受治疗。在伏伊伏丁那输血研究所进行输血前检测时，发现了一种特异性未知的IgG同种抗体。共交叉配型了200单位血液（O型，RhD阳性），但出现阳性反应，表明供体单位与该特定患者不相容。通过检测患者在的黎波里的家庭成员，找到了6单位相容血液，并在手术期间及术后使用。由于患者病情恶化，需要快速输血；然而，没有交叉配型相容的血液。在进行生物学交叉配型以预测该抗体的临床意义后，给患者输注了12单位交叉配型反应阳性率最低的红细胞，未出现任何不良反应。这些单位的良好耐受性表明目前的抗体无临床意义。后来，瑞士伯尔尼输血服务中心中央实验室鉴定出一种针对高频格尔比希血型抗原的罕见同种抗体。
对于紧急情况下对高频格尔比希血型产生同种抗体的患者，当无法获得自体或相容异体输血时，如果生物学交叉配型为阴性，可以输注交叉配型反应阳性率最低的血液。建立稀有血型献血者国家登记册并将其与国际登记册相连，对于管理需要抗原阴性血液而常规血库无法提供的患者至关重要。
