132例ABO血型正反定型不符患者的临床特点及相关影响因素分析

任爽; 林静; 李思远; 向代军; 张立文

doi:10.3969/j.issn.2095-5227.2021.04.007

132例ABO血型正反定型不符患者的临床特点及相关影响因素分析

Characteristics of patients with ABO typing discrepancy and potential influencing factors: An analysis of 132 cases

摘要

摘要:
背景影响ABO血型鉴定的因素较多，正确鉴定ABO血型对确保患者的安全输血至关重要。
目的分析ABO血型正反定型不符患者的临床特点及影响因素。
方法收集2017年1月- 2019年12月解放军总医院第一医学中心检验中心ABO血型正反定型不符患者的临床资料，血型正反定型一致作为对照组，分析ABO血型正反定型不一致患者的血型分布频率、临床特点和相关影响因素。
结果 ABO血型正反定型不一致患者132例，男性75例，女性57例，年龄3 ～ 84(50.3 ± 19.3)岁，有手术史89例(67.42%)，有输血史23例(17.42%)。对照组142例，男性79例，女性63例，年龄10 ~ 78(50.5 ± 15.55)岁，有手术史68例(47.88%)，有输血史2例(1.40%)。血型正反定型不一致患者中，B型59例(44.7%)，A型38例(28.8%)，AB型28例(21.2%)，O型7例(5.3%)。血型正反定型不一致在21个临床治疗科室中出现，血液内科21例(15.9%)，骨科15例(11.36%)，肝胆外科14例(10.6%)，普通外科11例(8.33%)，血管内外科11例(8.33%)，其他科室在5%以下。血型正反定型不一致组：低/弱亲和力抗体A占3.79%，低/弱亲和力抗体B占18.18%，弱A抗原占3.03%，弱B抗原占12.12%，造血干细胞移植占10.60%，不规则抗体占46.70%，亚型占3.79%，冷凝集占1.51%。血型正反定型不一致患者疾病主要包括血液病、肿瘤、消化道出血、肝胆炎症、心脏瓣膜病、低蛋白血症、肾病综合征、骨关节炎等。二元logistic回归显示，血液病、肿瘤，手术史和输血史与血型正反定型不一致相关。
结论血型鉴定时可能存在检测不出应有的ABO血型系统抗体，血液病、肿瘤、手术史和输血史是血型正反定型不一致的主要原因，应结合临床资料用血清学方法综合判断正确的血型。

Abstract:
Background There are various factors that affect the identification of ABO blood type, and correct identification of ABO blood type is very important for ensuring the safety of blood transfusion.
Objective To investigate the clinical features of ABO typing discrepancy and related influencing factors.
Methods From January 2017 to December 2019, clinical data and blood types were collected from the patients with ABO typing discrepancy who were tested in the medical laboratory center, the First Medical Center of Chinese PLA General Hospital, and the patients without ABO typing discrepancy were enrolled as controls. The distribution frequency of blood types, influencing factors, and clinical features were analyzed for the patients with ABO typing discrepancy.
Results A total of 132 patients with ABO typing discrepancy were enrolled, among whom there were 75 males and 57 females, with an average age of (50.3 ± 19.3) years (range, 3-84 years). Of all patients, 89 (67.42%) cases had a history of surgery and 23 (17.42%) cases had a history of blood transfusion. There were 142 patients in the control group (79 males and 63 females), aged 10-78 (50.5 ± 15.55) years, among whom 68 (47.88%) cases had a history of surgery and 2 (1.40%) cases had a history of blood transfusion. As for the blood types with discrepancy, 59 patients (44.7%) were type B, 38 (28.8%) were type A, 28 (21.2%) were type AB, and 7 (5.3%) were type O. The blood types with discrepancy were observed in 21 clinical departments, with 21 patients (15.9%) in department of hematology, 15 (11.36%) in department of bone surgery, 14 (10.6%) in department of hepatobiliary surgery, 11 (8.33%) in department of general surgery, and 11 (8.33%) in department of vascular medicine or vascular surgery, with a proportion of < 5% for other departments. For the patients with ABO typing discrepancy, low/weak affinity antibody A accounted for 3.79%, low/weak affinity antibody B accounted for 18.18%, weak A antigen accounted for 3.03%, weak B antigen accounted for 12.12%, hematopoietic stem cell transplantation accounted for 10.60%, irregular antibody accounted for 46.70%, subtype accounted for 3.79%, and cold agglutination accounted for 1.51%. The diseases of patients with ABO typing discrepancy mainly included blood diseases, tumors, gastrointestinal bleeding, hepatobiliary inflammation, valvular heart disease, hypoproteinemia, nephrotic syndrome, and osteoarthritis. The binary logistic regression analysis showed that blood diseases, tumors, history of surgery, and history of blood transfusion were associated with ABO typing discrepancy.
Conclusion It is possible that the antibody of ABO blood group system can not be detected during blood typing. Blood diseases, tumors, history of surgery, and history of blood transfusion are the main influencing factors for ABO typing discrepancy. Serological methods should be used in combination with clinical data to determine the correct blood type.

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