Solves P, de la Rubia J, Arriaga F, Cervera J, Arnao M, Carpio N, Marty M L
Servicio de Hematología y Hemoterapia, Hospital Universitario La Fe, Valencia.
Sangre (Barc). 1997 Feb;42(1):25-9.
To analyze the different immunohematologic studies required to identify anti-red cell antibodies directed against high incidence antigens and comment the best tranfusion management.
Five patients with suspected anti-red cell alloantibodies directed against high frequency antigens are reported. After a positive antibody screening test (AST), an agglutination test with a commercial panel of 24 red cells was performed. Red cells were treated with proteolytic enzymes and AET to try to identify the circulating antibody. However, it was necessary to send the samples to reference laboratories for definitive identification. In order to evaluate the haemolytic potential of the antibody serum samples were treated with DTT and immunoglobulin subtype was studied with the capillary agglutination test. Finally, we analyze the half life of Cr51 labelled red cells. To obtain compatible blood for transfusion, autologous transfusion and cross-match with blood from direct relatives were performed.
AST was positive in every case. A decrease in the agglutination test was observed after ficin treatment in two patients, and an increase in the remaining. The treatment of red cells with ZZAP and AET resulted in a decrease of agglutination in three cases and an increase in the remaining two. Specificity of the antibodies was as follows: anti-Cellano (two cases), anti-Ku (one case) and anti-Yta (two cases). Anti-Kell antibodies were IgG1 and anti-Cartwright antibodies were IgG4. One patient was transfused with autologous blood alone, another patient received compatible blood from direct relatives. A third patient was transfused both with autologous and allogeneic compatible blood. The fourth patient did not need red cell transfusion and, finally the last patient had to be transfused with incompatible blood but no postransfusion haemolysis was observed.
In patients with anti-red cell antibodies against high-frequency antigens, red blood cells treatment with proteolytic enzymes (ZZAP, ficin) and AET are useful techniques to approach to their identification. Beside this, the study of type and subtype of Ig are necessary to know the haemolytic activity of the antibody. Regarding the transfusional management, autologous transfusion, crossmatch with blood from direct relatives and cryopreservation of compatible blood are the most adequate attitudes to cover future needs.
分析鉴定针对高频抗原的抗红细胞抗体所需的不同免疫血液学研究，并对最佳输血管理进行评论。
报告了5例疑似针对高频抗原的抗红细胞同种抗体患者。在抗体筛查试验（AST）呈阳性后，用包含24种红细胞的商业细胞板进行凝集试验。红细胞用蛋白水解酶和AET处理，试图鉴定循环抗体。然而，有必要将样本送至参考实验室进行最终鉴定。为了评估抗体的溶血潜力，血清样本用DTT处理，并用毛细管凝集试验研究免疫球蛋白亚型。最后，我们分析了铬51标记红细胞的半衰期。为获得相容的输血用血，进行了自体输血以及与直系亲属血液的交叉配血。
所有病例的AST均为阳性。两名患者经胰蛋白酶处理后凝集试验减弱，其余患者凝集试验增强。用ZZAP和AET处理红细胞后，三例患者的凝集反应减弱，其余两例增强。抗体的特异性如下：抗Cellano（2例）、抗Ku（1例）和抗Yta（2例）。抗Kell抗体为IgG1，抗Cartwright抗体为IgG4。一名患者仅输注了自体血，另一名患者接受了来自直系亲属的相容血液。第三名患者同时输注了自体和异体相容血液。第四名患者不需要红细胞输血，最后一名患者不得不输注不相容血液，但未观察到输血后溶血。
对于针对高频抗原的抗红细胞抗体患者，用蛋白水解酶（ZZAP、胰蛋白酶）和AET处理红细胞是有助于鉴定抗体的有用技术。除此之外，研究Ig的类型和亚型对于了解抗体的溶血活性是必要的。关于输血管理，自体输血、与直系亲属血液交叉配血以及保存相容血液以备未来之需是最恰当的做法。
