目的 分析经微柱凝集技术进行交叉配血主侧相合、次侧不合的原因及输血疗效。方法 收集2021-01至2023-10在天津医科大学朱宪彝纪念医院498例进行交叉配血患者的数据,分析交叉配血主侧相合、次侧不合的原因,对直接抗人球蛋白试验(DAT)阳性患者进行DAT分型检测、二磷酸氯喹放散试验,分析阳性原因。结果 498例患者进行交叉配血累计1115次,检测出主侧相合、次侧不合共计446次(40%),次侧不合中检测出DAT阳性433次,占97.1%,DAT阳性分型以单纯IgG型为主共416次,占96.1%;IgG+C3d混合型15次,占3.5%,单纯C3d型2次,占0.4%,二磷酸氯喹放散试验后患者的红细胞放散液抗体筛查试验结果均为阴性,60例DAT阳性导致的主侧相合、次侧不合患者进行输血治疗选择输注悬浮红细胞,输血后血红蛋白(Hb)、红细胞(RBC)、血细胞比容(HCT)值均增加且符合理论预期值,总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)均在正常范围,无统计学差异(P>0.05),无溶血性输血反应发生,输注有效。结论 DAT阳性是导致本院输血治疗患者交叉配血主侧相合、次侧不合的主要原因,输注悬浮红细胞安全有效。

Objective To analyze the causes and therapeutic effect of cross-matching blood by microcolumn agglutination. Methods The data of 498 patients with cross-matched blood were collected from Zhuxian Yi Memorial Hospital of Tianjin Medical University from January 2021 to October 2023, and the causes of main side compatibility and secondary side inconsistency of cross-matched blood were analyzed. Patients with positive direct antiglobulin test (DAT) were tested for DAT typing and chloroquine diphosphate release test to analyze the positive causes. Results A total of 1115 times of cross-matching were performed in 498 patients, and 446 times (40%) were detected. A total of 433 times (97.1%) were detected as DAT positive in the secondary mismatch, and 416 times (96.1%) were mainly monoclonal IgG types. IgG+C3d mixed type was 15 times, accounting for 3.5%, and simple C3d type was 2 times, accounting for 0.4%. After chloroquine diphosphate release test, the antibody screening test results of red blood cell release fluid of patients were negative. 60 patients with major side compatibility and secondary side incompatibility caused by DAT positive were transfused and transfused suspended red blood cells were selected. After transfusion, the values of hemoglobin (Hb), red blood cells (RBC) and hemocytocyte volume (HCT) were increased and in line with theoretical expectations. Total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) were all within the normal range, with no statistical difference (P>0.05). No hemolytic transfusion reaction occurred, and infusion was effective. Conclusions DAT positive is the main cause of main side compatibility and secondary side incompatibility in patients treated with blood transfusion. Transfusion of suspended red blood cells is safe and effective.