In order to ensure the safety and effectiveness of blood transfusion, the patient's irregular antibodies need to be screened before transfusion to allow the patient to intake the blood that is matched. weak antibodies that
leak low-efficiency price can lead to ineffective blood infusions and even a hemolytic transfusion response.
the laboratory encountered a case of irregular antibodies produced by multiple blood transfusions, reported as follows.
1 Materials and Methods 1. 1 Study subjects and data of children, female, 9 years old, have no history of blood transfusion, suspected drug-induced anemia, blood type identified as type A, RhD impotence.
was admitted to hospital on May 11, 2017 with 12 blood transfusions within 15 d and the effect of blood transfusions was not good.
the laboratory was commissioned by the hospital to cross-match blood, the 12th blood transfusion before the detection of anti-E antibodies, retrospective testing of the process of the production of the antibody, analysis of its effects on blood transfusion.
1. 2 Main Reagents and Instruments Screening Cells and Spectrum Cells Are Purchased from Holland Sanquin Corporation, Anti-Human Globulin Cards from Bio-Rad Corporation of the United States, Coaelectric amine, Polyethylene glycol (polyethylene glycol, PEG) test agent purchased from Changchun Bode Company, acid release reagents purchased from Zhuhai BesossTechnology Technology Company, papayase powder, anti-E, anti-E, C, anti-C are all purchased from Shanghai.
KA-2200 centrifuge (Kubota Corporation, Japan), reagent incubators and centrifuges, digital lysatary thermostats, adjustable fluid transfer (Bio-Rad Corporation, USA).
1. 3 Irregular antibody identification saline method, condensation amine method, microcolumn coagulation method (microcolumn gel test, MGT) 3 commonly used blood type serological test methods and acid dispersion test are operated according to the reagent instructions, directly against human globulin test using MGT.
1. 4 PEG-MGT adds 100 sl patient plasma, 200 ?L PEG reagents, and 50 ?L 2% to 5% red blood cells to the test tube, and is washed 4 times in salt water after 37 degrees C temperature 15 min, formulated to a suitable concentration of suspension.
because of the test tube anti-human globulin method in this test PEG after the cell coagulation strength is very weak, in order to facilitate interpretation, the processed cells will be assigned to a suitable concentration of suspension, add IgG mono-antigel card and centrifugation, record the condensation strength.
1. 5 Enzyme-MGT uses a 2-step enzyme method to combine the filtered cells and spectroscopic cells with salt water 3 times to a concentration of 2% to 3%, add an equal amount of papaya protease, and 3 times washed with salt water 3 times after temperature-breeding at 37 degrees C.
due to test tube anti-human ball method to detect the red blood cells after paracetamas treatment and patient plasma coagulation strength is too weak to interpret, the enzyme treatment of red cells formulated into a 1% concentration of low-ion suspension, added anti-IgG-C3d gel card, and then added to the patient's plasma, 37 degrees C after temperature-fed centrifugal centrifugal, record the concentration strength.
2 Result 2. 1 Direct anti-human globulin test see Table 1.
the patient's red blood cell direct anti-human globulin test was 2 plus, the second was 1 plus, the 3rd and 4th was w-plus, and the sample direct anti-human globulin test before the 5th to 12th transfusion was all negative.
2. 2 Antibody Screening Anti-sieve saline method, polyamine method, MGT are negative, because the patient directly anti-human globulin test positive, in order to avoid autoantibody interference without PEG-MGT and enzyme-MGT test.
pre-transfusion anti-sieve salinal, coagulation, MGT, PEG-MGT, and enzyme-MGT are all negative.
the 9th pre-transfusion enzyme-MGT detection of irregular antibodies, the 12th pre-transfusion enzyme-MGT and PEG-MGT both detected irregular antibodies, spectral cell patterns are consistent with anti-E antibodies (not listed in the spectrum cell pattern table), the patient Rh is CCDee.
previous anti-sieve fruit see table 1.
, the first and 12th blood transfusion pre-sieve saline method is negative at room temperature, 2 times serum 4 degrees C temperature 10 min after-sieve cells and self-control are coagulated and the intensity is 3 plus, both containself-cold antibodies.
2. 3 Antibody Properties The enzyme-MGT method tests the anti-sieve to negative after the serum of patients treated with 2-Me for 30 min before the 12th transfusion, confirming that the actual anti-E antibody is IgM.
2. 4 Acid dispersion test Patient samples before the 1st and 12th blood transfusion were tested for acid dispersion, the 1st red blood cell dispersion was not detected with specific antibodies, and the 12th red blood cell dispersal solution was detected by enzyme-MGT method.
2. 5 Effect sororts on the effectiveness of blood transfusion The hemoglobin amount varies with the number of days, figure 1.
combined with Figure 1 and Table 1 found that anti-E antibodies were detected from day 13 and blood without E antigens was infusions on day 6, 12, and 15 days, all of which increased hemoglobin.
and the 5th, 9th, 10th, and 14th days only infusions of blood containing E antigens failed to raise hemoglobin levels.
3 Discusses saline, coagulation, MGT, and enzyme methods are common irregular antibody screening methods, and the condensation amine method, MGT, and enzyme methods are not statistically significant for detecting common IgG-type antibodies in Rh systems, while IgM antibodies are usually screened by saline methods, and some IgM antibodies can be detected by MGT.
this case weak IgM anti-E antibodies accompanied by autocold antibodies, room temperature saline negative, 4 degrees C saline method due to cold antibodies no method to identify specific antibodies, PEG-test tube anti-human globulin method (PEGIAT) and enzyme-test tube anti-human globulin method (enzyme-IAT) also because the condensation strength is too weak to interpret.
the use of enzyme-MGT, patient direct resistance to yin, 37 degrees C temperature control cold antibody interference, the use of a variety of anti-human globulin gel card to detect plasma, with higher sensitivity and intuitive results, for the identification of weak IgM type irregular antibodies provides an optional method.
to avoid the interference of complement C3 binding autoantibodies, PEGMGT uses IgG mono-anti-card, which in this case weak antibody detection process is less sensitive than enzyme-MGT.
infusion of blood with corresponding antigens in patients in this study, hemoglobin levels were raised, and blood containing the corresponding antigens could not raise hemoglobin levels, proving that the antigen had clinical significance.
the occurrence of irregular antibodies in the recipients is closely related to the number of blood transfusions, when the number of blood transfusions is greater than 6 times, the frequency of irregular antibodies can reach 89. 7%  。
the most common irregular antibody in Our country is anti-E antisomes, in this study patients 15 d blood transfusion 12 times, infusion ineffective, identified to produce anti-E antibodies.
can detect E antigens, infusion E-like or compatible blood, reduce the probability of irregular antibodies produced by multiple recipients, reduce the frequency of infusion invalidity and blood transfusion reaction, thereby improving the safety and effectiveness of blood transfusion.