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目的:探讨适用于新生儿的输血前检验方法及输血策略。方法:收集20例诊断为ABO-HDN的患儿的血清及红细胞放散液,并随机取5份ABO同型红细胞制剂的血样同时用凝聚胺技术及微柱凝胶技术进行主侧交叉配血,评估2种配血方法结果之间的差异性,以及与直抗试验的相关性。结果:①在100次交叉配血中,微柱凝胶技术中血清及放散液出现不合为74次及62次,凝聚胺技术中血清及放散液出现不合为3次及5次,而联合所有血清及放散液出现不合79次;未出现1例配血为凝聚胺阳性而微柱凝胶阴性。②除了凝聚胺技术对患儿血清交叉配血外,直抗阳性的患儿血清及放散液交叉配血不合率均高于直抗阴性患儿(P<0.05)。③2种方法在患儿血清(Kappa=0.021,P=0.297)及放散液(Kappa=0.063,P=0.072)交叉配血结果一致性无统计学意义,凝聚胺技术的灵敏度明显较低。结论:新生儿输血前检验增加直接抗球蛋白试验十分必要,微柱凝胶抗球蛋白技术更适宜新生儿交叉配血,最适的输血策略应为尽可能先进行溶血病的诊断来合理选择同型或相容性输血。
Objective: To explore the transfusion test method and transfusion strategy suitable for neonates. Methods: Serum and erythrocyte discharge of 20 children diagnosed as ABO-HDN were collected. Five blood samples of ABO-type erythrocyte preparations were randomly collected. Blood samples of primary ABA were collected by poly-amine technique and micro-column gel technique. The difference between the two methods of dispensing blood and the correlation with the direct anti-test. Results: ① In 100 cross-matching blood, microcolumn gel technology and the discrepancy of serum and discharge appeared 74 times and 62 times, the poly-amine technology, serum and discharge appeared in 3 and 5 times, and the combination of all Serum and diffusor appeared substandard 79 times; did not appear in 1 case with blood polybrene positive and microcolumn gel negative. ② In addition to polybrene technology serum cross-matching with children, children with direct anti-positive serum and discharge of blood cross-mismatched were higher than the direct anti-negative children (P <0.05). ③ There was no significant difference between the two methods in the cross matching of blood in children with serum (Kappa = 0.021, P = 0.297) and exudate (Kappa = 0.063, P = 0.072). The sensitivity of polybrene technique was significantly lower. Conclusion: It is very necessary to increase the direct antiglobulin test before the transfusion test in newborns. The microcolumn gel antiglobulin technology is more suitable for neonatal cross matching. The optimal transfusion strategy should be to choose the hemolytic disease diagnosis as far as possible Homologous or compatible transfusions.