Kay Brian, Poisson Jessica L, Tuma Christopher W, Shulman Ira A
Los Angeles County + USC Medical Center and Keck School of Medicine of USC, Los Angeles, California.
Transfusion. 2016 Dec;56(12):2973-2979. doi: 10.1111/trf.13782. Epub 2016 Sep 5.
Kidd blood group antibodies are notorious for transient detection and hemolytic transfusion reactions. This report compares the rate of detection of anti-Jk when using gel column agglutination versus solid-phase red blood cell adherence (SPRCA) testing and documents the occurrence of hemolytic transfusion reactions in 17 recently transfused patients who developed anti-Jk that were detectable by SPRCA but were undetectable by gel.
Before April 20, 2011, the laboratory used gel column agglutination as the primary method for antibody screening and identification. From April 20, 2011, to August 12, 2013, SPRCA was adopted as the primary method for antibody screen with gel remaining the primary method for identification. SPRCA identification was also performed if sufficient sample was available. Medical records were reviewed for evidence of hemolytic reaction in patients whose anti-Jk was negative or inconclusive by gel, but clearly identifiable by SPRCA at the time the anti-Jk was first identified.
A total of 105 patients were discovered with anti-Jk from 88,478 SPRCA screens performed. In 32 patients, anti-Jk was initially discovered by SPRCA testing and concurrent gel testing was completely negative (n = 26) or inconclusive (n = 6). Seventeen of the 32 patients were recently transfused and of these six met criteria for delayed hemolytic transfusion reaction (DHTR), three had possible DHTRs, and eight had delayed serologic reactions; 13 of the transfused patients received Jk(a-) RBCs to avoid potential hemolysis.
SPRCA testing significantly increased the discovery of clinically significant anti-Jk and facilitated the earlier use of Jk(a-) RBCs to avoid hemolytic transfusion reactions.
基德血型抗体因检测结果短暂及溶血性输血反应而声名狼藉。本报告比较了使用凝胶柱凝集法与固相红细胞黏附（SPRCA）检测法检测抗Jk的比率，并记录了17例近期输血患者发生溶血性输血反应的情况，这些患者产生的抗Jk可通过SPRCA检测到，但凝胶法检测不到。
在2011年4月20日前，实验室采用凝胶柱凝集法作为抗体筛查和鉴定的主要方法。从2011年4月20日至2013年8月12日，采用SPRCA作为抗体筛查的主要方法，凝胶法仍作为鉴定的主要方法。如有足够样本，也会进行SPRCA鉴定。对那些抗Jk通过凝胶法检测为阴性或不确定，但在首次鉴定抗Jk时通过SPRCA可明确鉴定的患者的病历进行回顾，以寻找溶血反应的证据。
在进行的88478次SPRCA筛查中，共发现105例抗Jk患者。在32例患者中，抗Jk最初通过SPRCA检测发现，同时进行的凝胶检测完全为阴性（n = 26）或不确定（n = 6）。这32例患者中有17例近期接受过输血，其中6例符合迟发性溶血性输血反应（DHTR）标准，3例可能发生了DHTR，8例出现了迟发性血清学反应；13例输血患者输注了Jk(a-)红细胞以避免潜在溶血。
SPRCA检测显著提高了具有临床意义的抗Jk的发现率，并有助于更早地使用Jk(a-)红细胞以避免溶血性输血反应。
