Lamba Divjot S, Mittal Kshitija, Sood Tanvi, Bedi Ravneet Kaur, Kaur Paramjit, Kaur Gagandeep
Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India.
Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India.
Transfus Apher Sci. 2014 Oct;51(2):132-3. doi: 10.1016/j.transci.2014.08.025. Epub 2014 Sep 28.
Life-long red blood cell (RBC) transfusions remain the main treatment for severe thalassemia. We hereby report a case of anti S and anti Lu(a) in a β-thalassemia major patient detected incidentally on antibody screening. The patient was a known case of β-thalassemia major and was on regular blood transfusion every 3 weeks from the institute from the age of 6 months. Subsequently, on one occasion, patient's crossmatch was compatible despite positive antibody screen using microcolumn gel technique. Autocontrol and direct antiglobulin test were negative on microcolumn gel. Anti S and anti Lu(a) antibodies were identified. Blood unit found compatible was negative for S and Lu(a) antigens. Antibody titers were 1:1 for both anti S and anti Lu(a) in AHG phase using tube technique and antibodies were of IgG type. Blood unit was transfused uneventfully to the patient. Donors were traced back (last three donations) and called for repeat blood sample testing for S and Lu(a) antigen. Two out of three donors were found to be S antigen positive and one out of these two was Lu(a) antigen positive. Anti S and anti Lu(a) antibodies were again identified on patient's subsequent visit for transfusion. The present case re-emphasize the importance of antibody screening at each visit in earlier detection of antibodies in multi transfused patients. Encouraging patients to receive transfusion from one center and dedicating donors could reduce alloimmunization rate but larger studies are required.
终身红细胞（RBC）输血仍是重型地中海贫血的主要治疗方法。我们在此报告一例在抗体筛查时偶然发现的重型β地中海贫血患者体内存在抗 - S和抗 - Lu(a)抗体的病例。该患者为已知的重型β地中海贫血病例，自6个月大起每3周从该机构接受一次定期输血。随后，有一次，尽管使用微柱凝胶技术进行抗体筛查呈阳性，但患者的交叉配血仍相匹配。微柱凝胶上的自身对照和直接抗球蛋白试验均为阴性。抗 - S和抗 - Lu(a)抗体被鉴定出来。发现相匹配的血液单位中S和Lu(a)抗原呈阴性。使用试管技术在抗人球蛋白（AHG）阶段抗 - S和抗 - Lu(a)的抗体效价均为1:1，且抗体为IgG型。该血液单位顺利输给了患者。对献血者进行追溯（最近三次献血），并要求再次采集血液样本检测S和Lu(a)抗原。发现三名献血者中有两名S抗原呈阳性，其中这两名中的一名Lu(a)抗原呈阳性。在患者随后的输血就诊中再次鉴定出抗 - S和抗 - Lu(a)抗体。本病例再次强调了在每次就诊时进行抗体筛查对于早期检测多次输血患者体内抗体的重要性。鼓励患者从一个中心接受输血并指定献血者可以降低同种免疫率，但还需要更大规模的研究。
