微柱凝胶法交叉配血次侧凝集原因剖析及临床意义.docVIP

微柱凝胶法交叉配血次侧凝集原因剖析及临床意义 　　[摘要]目的 分析?血前微柱凝胶法交叉配血次侧凝集的原因及意义，为临床安全输血提供参考。方法 统计2013年1月～2016年5月我院微柱凝胶法次侧交叉配血凝集患者，按照病种分组分析交叉配血次侧凝集的比例，次侧配血凝集率与输血次数、输血反应的相关性；采用抗人球蛋白试验、放散试验、抗体筛选鉴定、药物性抗体筛查及RBC形态结构分析等方法研究交叉配血次侧凝集的原因。结果 调查分析微柱凝胶卡交叉配血45 672人次，其中325例次侧配血凝集，凝集率为0.71%；次侧配血凝集主要病种为血液系统疾病、ICU重症及急诊抢救、烧伤等；血液病患者次侧配血凝集率与输血次数、输血反应率、输血效率等均成正相关性（P0.05）；次侧配血凝集原因主要有：患者红细胞形态结构变化、血浆蛋白影响、供者血清同种抗体、药物性抗体、加样量不当及技术因素等；由免疫因素与非免疫因素引起的次侧配血凝集原因的分类比较差异有统计学意义（P0.05）。结论 微柱凝胶法交叉配血次侧凝集的原因很多，非免疫因素导致交叉配血次侧凝集比例较高，输血反应与输注无效率较低；而免疫因素引起的次侧凝集比例低，但输注无效率高，且较易引起输血反应。 　　[关键词]交叉配血；次侧凝集；原因分析；临床意义 　　[中图分类号] R446.61 [文献标识码] A [文章编号] 1674-4721（2017）10（a）-0014-04 　　[Abstract]Objective To evaluate the agglulination reasons for the minor cross-matching，to provide reference for the safety of clinical blood transfusion.Methods Cases of patients with side crosss-matching agglulination were chosen from January 2013 to May 2016 in our hospital，according to the disease group，to investigate the correlation of the proportion of side cross-matching agglulination and the numbers of blood transfusion and the blood transfusion reaction.We had analysed the reasons of the side crossmatching agglulination by the antiglobulin test，antibodies identification，drug antibody screening and identification，and the size of RBC and morphology，combined with the clinical blood transfusion.Results 45 672 cases were investigated by micro-column gel way，ther were 325 cases side agglutination，the agglutination rate was 0.71%.The patients with side cross-matching agglulination mainly included haematology patients，ICU critical patients and emergency and burn patients.The agglulination rates of the haematology patients associated with the numbers of blood transfusions，there were positive correlation between the times of blood transfusion reaction and the times of blood transfusion（P0.05）.The reasons of side cross-matching agglulination mainly included，drugs antibodies，plasmas proteins，erythrocyte alloantibody of donor，the changes of the erythrocyte morpholo