Shulman I A
Blood Bank, Los Angeles County-University of Southern California Medical Center 90033.
Arch Pathol Lab Med. 1990 Apr;114(4):412-4.
The major crossmatch must include an anti-human globulin test, unless the transfusion recipient has no apparent significant unexpected antibodies, in which case the use of only an immediate spin crossmatch method is considered acceptable. However, a minority of laboratories utilize only an immediate spin crossmatch as their routine major crossmatch, possibly because contemporary antibody screening tests occasionally miss detecting some unexpected antibodies, and these missed antibodies are more often detected by the anti-human globulin crossmatch than by the immediate spin crossmatch. In the present study, 20 hospitals were surveyed to determine how often an acute hemolytic transfusion reaction would occur when only an immediate spin crossmatch was used as the major crossmatch method. During the study period, 1.3 million immediate spin crossmatches were performed, and five patients experienced acute overt hemolytic transfusion reactions that were believed to be caused by antibodies that were missed by both the antibody screening test and immediate spin crossmatch (one hemolytic event per 250,000 immediate spin crossmatches). The implicated antibodies were anti-Jka, anti-Wra, anti-C, anti-c, and anti-Kpa. These survey data demonstrate that the routine crossmatching of blood using an immediate spin crossmatch may rarely result in an acute hemolytic transfusion reaction if the antibody screening cells used during pretransfusion compatibility testing fail to detect some clinically significant red blood cell antibodies.
主交叉配血必须包括抗人球蛋白试验，除非输血受者没有明显的意外抗体，在这种情况下，仅使用立即离心交叉配血法被认为是可以接受的。然而，少数实验室仅将立即离心交叉配血作为常规主交叉配血方法，这可能是因为当代抗体筛查试验偶尔会漏检一些意外抗体，而且这些漏检的抗体通过抗人球蛋白交叉配血比立即离心交叉配血更常被检测到。在本研究中，对20家医院进行了调查，以确定仅将立即离心交叉配血作为主交叉配血方法时，急性溶血性输血反应的发生频率。在研究期间，共进行了130万次立即离心交叉配血，有5名患者发生了急性明显溶血性输血反应，据信是由抗体筛查试验和立即离心交叉配血均漏检的抗体引起的（每25万次立即离心交叉配血发生1次溶血事件）。涉及的抗体为抗Jka、抗Wra、抗C、抗c和抗Kpa。这些调查数据表明，如果输血前相容性检测中使用的抗体筛查细胞未能检测到一些具有临床意义的红细胞抗体，那么使用立即离心交叉配血进行血液常规交叉配血很少会导致急性溶血性输血反应。
