Leger R M, Garratty G
American Red Cross Blood Services, Southern California Region, Los Angeles 90006, USA.
Transfusion. 1999 Jan;39(1):11-6. doi: 10.1046/j.1537-2995.1999.39199116889.x.
In pretransfusion testing of patients whose sera contain autoantibodies reacting optimally at 37 degrees C, it must be determined whether alloantibodies are also present. Two approaches, testing a 1-in-5 dilution of patients' sera and the adsorption of sera in the presence of polyethylene glycol (PEG), have been proposed as alternatives to the time-consuming approach of adsorbing sera with ficin- or ZZAP-treated red cells (RBCs). The three approaches were compared.
Patients' sera containing warm autoantibodies, with and without alloantibodies, were retested 1) after dilution (1-in-5) and 2) after adsorption with allogeneic RBCs in the presence of PEG. Results were compared to those after adsorption with ZZAP-treated allogeneic RBCs.
Dilution (1-in-5): Twenty-seven of 119 sera (7/26 [27%] with and 20/93 [22%] without alloantibodies) did not react; one example each of alloanti-D, -E, -e, -Fy(a), and -Jk(a), and two examples of anti-Jk(b) were not detected at a dilution of 1 in 5. Alloantibodies were identified in 5 (19%) of 26 1-in-5 diluted sera containing alloantibodies; 87 (73%) of 119 sera still reacted with all cells and would have required further workup. PEG adsorption: Thirty-nine sera were tested after parallel PEG and ZZAP adsorptions. The PEG adsorptions required a total of 55 aliquots of adsorbing cells and 13.75 hours, whereas ZZAP adsorptions required 61 aliquots and 30.5 hours. All alloantibodies (anti-D [3], -C [2], -c [1], -E [4], -K [2], -Fy(a) [1], -Jk(a) [2], -Jk(b) [1]) reacted in the adsorbed serum-PEG mixtures at a strength equal to or greater than that in the ZZAP-adsorbed sera.
Although the 1-in-5 dilution approach is convenient, only 22 percent of warm autoantibodies without alloantibodies were nonreactive, and 27 percent of alloantibodies of potential clinical significance were not detected. PEG adsorption appears to give similar results to those of ZZAP adsorption, but it has the advantages of eliminating the cost and time of prior treatment of the allogeneic adsorbing cells and of a reduction of at least a 50 percent in adsorption time.
在对血清中含有在37℃时反应最佳的自身抗体的患者进行输血前检测时，必须确定是否也存在同种抗体。已提出两种方法，即检测患者血清的1:5稀释液和在聚乙二醇（PEG）存在下对血清进行吸附，作为用 ficin 或 ZZAP 处理的红细胞（RBC）吸附血清这种耗时方法的替代方法。对这三种方法进行了比较。
对含有温自身抗体、有或没有同种抗体的患者血清进行重新检测，1）在稀释（1:5）后，以及2）在PEG存在下用同种异体RBC吸附后。将结果与用ZZAP处理的同种异体RBC吸附后的结果进行比较。
稀释（1:5）：119份血清中有27份（有同种抗体的26份中的7份[27%]和没有同种抗体的93份中的20份[22%]）没有反应；在1:5稀释时未检测到同种抗 -D、-E、-e、-Fy(a)和 -Jk(a)各1例，以及抗 -Jk(b) 2例。在26份含有同种抗体的1:5稀释血清中，有5份（19%）鉴定出了同种抗体；119份血清中有87份（73%）仍与所有细胞发生反应，需要进一步检查。PEG吸附：在平行进行PEG和ZZAP吸附后对39份血清进行了检测。PEG吸附总共需要55份吸附细胞和13.75小时，而ZZAP吸附需要61份吸附细胞和30.5小时。所有同种抗体（抗 -D [3]、-C [2]、-c [1]、-E [4]、-K [2]、-Fy(a) [1]、-Jk(a) [2]、-Jk(b) [1]）在吸附的血清 -PEG混合物中的反应强度等于或大于在ZZAP吸附血清中的反应强度。
虽然1:5稀释法很方便，但没有同种抗体的温自身抗体中只有22%无反应，且27%具有潜在临床意义的同种抗体未被检测到。PEG吸附似乎能给出与ZZAP吸附相似的结果，但它具有消除同种吸附细胞预处理成本和时间以及吸附时间至少减少50%的优点。
