Bäckman Sari, Ångerman-Haasmaa Susanne, Jousi Milla, Siitonen Sanna, Salmela Katja
Meilahti Hospital Blood Bank, Department of Clinical Chemistry, Helsinki University Hospital Laboratory (HUSLAB), and the Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
Transfusion. 2018 Jun;58(6):1372-1376. doi: 10.1111/trf.14557. Epub 2018 Mar 1.
Blood transfusion through the intraosseous route is gaining popularity in emergency medicine. Pretransfusion peripheral blood (PB) samples are usually not available in these patients, leading to discrepancies in blood group typing and a possible delay in transferring to group-specific blood products. The aim of this study was to assess the feasibility of ABO and D typing and red blood cell alloantibody screening in marrow (BM) samples.
Direct and reverse ABO typing, D typing, and a two-cell alloantibody screen were performed in EDTA-anticoagulated BM samples with standard manual column agglutination techniques. EDTA-anticoagulated PB samples were used as controls.
The mean age of the study subjects (n = 71) was 47 years (range, 1-82 years). All ABO groups and both D+ and D- types were represented. In all subjects, concordant results were observed for all analyses in BM and PB samples. In 15 (21%) of the samples, a discrepancy of one reaction strength step (1+) was observed in at least one of the analyses (Cohen's weighted κ = 0.993); this did not affect interpretation of the results.
Blood group typing and alloantibody screening are feasible in BM samples, providing proof-of-concept that intraosseous samples for blood group serologic analyses can be collected from emergency patients before intraosseous blood transfusion. This will enable a timely transfer to group-specific blood products and enable conservation of the valuable universal-donor blood products.
通过骨内途径输血在急诊医学中越来越普遍。这些患者通常无法获得输血前的外周血（PB）样本，导致血型鉴定出现差异，并可能延迟输注特定血型的血液制品。本研究的目的是评估骨髓（BM）样本中ABO和D血型鉴定以及红细胞同种抗体筛查的可行性。
采用标准手工柱凝集技术，对乙二胺四乙酸（EDTA）抗凝的BM样本进行直接和反向ABO血型鉴定、D血型鉴定以及双细胞同种抗体筛查。以EDTA抗凝的PB样本作为对照。
研究对象（n = 71）的平均年龄为47岁（范围为1 - 82岁）。涵盖了所有ABO血型组以及D+和D-两种类型。在所有受试者中，BM样本和PB样本的所有分析结果均一致。在15份（21%）样本中，至少一项分析中观察到一个反应强度等级（1+）的差异（Cohen加权κ = 0.993）；这并不影响结果的解读。
骨髓样本中的血型鉴定和同种抗体筛查是可行的，这为在骨内输血前从急诊患者采集用于血型血清学分析的骨内样本提供了概念验证。这将有助于及时输注特定血型的血液制品，并节约宝贵的通用供血者血液制品。
