Objective: To explore the serological characteristics of patients with autoimmune hemolytic anemia（AIHA） and analyze its clinical efficacy and safety of incompatible red blood cell transfusion.
Methods: Sixty AIHA patients admitted in our hospital from January 2014 to January 2018 were selected. The blood type serological characteristics of 60 patients were analyzed retrospectively. According to the type of autoantibody and the composition of different red blood cells, the efficacy and safety of erythrocyte infusions were evaluated respectively.
Results: The screen results of irregular antibody in 60 AIHA patients were positive, and the direct anti-human globulin test also was positive, including 8 cases of cold autoantibodies (13.33%), 49 cases of IgG warm autoantibodies (81.67%), and 3 cases of warm cold double autoantibodies (5%). The irregular anti-body identification test confirmed the existence of homoantiboby in 17 cases (28.33%). Out of 60 cases 34 received incompatible red blood cell (RBC) infusion for 108 time including ABO homotype non washing RBC (81 tirnes) and O type washing RBC (27 times). The infusion results showed that the total [JP2]effective rate was 57.41(62/108), total partial effective rate was 14.81% (16/108) and total ineffective rate was 27.78% (30/108).The infusion of ABO homotype non-washing RBC for 81 time showed that the effective rate was 58.02%[JP] (47/81) , partial effective rate was 12.35 (10/81) and ineffective rate was 29.67% (24/81); the infusion of O type washing RBC for 27 times showed that the effective rate was 55.56% (15/27), partial effective rate was 22.22% (6/27) and ineffective rate was 22.22% (6/27), there was no significant difference in effective rate between 2 kinds of infusion (P>0.05). The comparison of different antibody type infusion showed that in the infusion of IgM cold autoantiboay for 12 times, the effective rate was 41.67% (5/12), partial effective rate was 33.33% (4/12) and ineffective rate was 25% (3/12); in the infusion of IgG warm antoantibody for 93 times. The effective rate was 58.06% (54/93),partial effective rate was 12.90% (12/93) and ineffective rale was 29.04% (27/93), there was also no significant difference in effective rate between 2 kinds of infusion(P>0.05). However, in infusion of cold/warm double autoantibody for 3 times, the effective rate was 100% (3/3), moreover, the hemotytic reaction of infusion was not observed during the treatment .
Conclusion: The infusion of ABO homotype non-washing RBC and O type washing RBC both possess the high safely and efficacy for treatment of patients with AIHA, but the use of ABO homotype non-washing RBC can effectively avoid the excessive use of O type washing RBC.
题目: AIHA患者血型血清学特征及红细胞不相容输注的疗效.
目的: 探究自身免疫性溶血性贫血（autoimmune hemolytic anemia, AIHA）患者的血型血清学特征，分析红细胞不相容输注的疗效.
方法: 选取本院2014年1月-2018年1月我院收治的60例AIHA患者，回顾性分析60例患者的血型血清学特征，根据患者自身抗体类型及接受不同红细胞成分对红细胞不相容输注的疗效及安全性进行评价.
结果: 60例AIHA患者不规则抗体筛查结果均为阳性，且直接抗人球蛋白试验也均为阳性，其中单独IgM类冷自身抗体8例（13.33%），单独IgG类温自身抗体49例（81.67%），温冷双自身抗体3例（5.00%），不规则体鉴定试验证实存在同种抗体17例（28.33%）。60例AIHA患者中，34例接受了不相容红细胞输注共108次，输注次数的总有效率为57.4%（62/108），总部分有效率为14.81%（16/108），总无效率为27.78%（30/108）。81次输注ABO同型非洗涤红细胞中的有效率为58.02%（47/81），部分有效率为12.35%(10/81)，无效率为29.63%(24/81)；27次输注O型洗涤红细胞中的有效率为55.56%（15/27），部分有效率为22.22%（6/27），无效率为22.22%（6/27），2组治疗有效率相比差异无统计学意义（P＞0.05）。不同抗体类型输注疗效比较显示，输注IgM 类冷自身抗体的有效率为41.67%（5/12），部分有效率33.33%(4/12)，无效率25.00%(3/12)；输注IgG 类温自身抗体组的有效率58.06%（54/93），部分有效率12.90%(12/93)，无效率29.04%(27/93)，2组治疗有效率相比差异无统计学意义（P＞0.05）。温冷双自身抗体组的有效率为100%(3/3)。治疗过程中无患者发生溶血性输血反应.
结论: ABO同型非洗涤红细胞和O型洗涤红细胞输注应用于AIHA患者均具有较好的疗效，但ABO同型非洗涤红细胞可避免O型洗涤红细胞过度使用.