輸血醫(yī)學介紹-文庫吧
2024-09-27 10:17 本頁面
【正文】 nign cold autoantibody except in Oh ABO antibodies 輸血前檢查 —實作說明 ?ABO血型檢查 ?不規(guī)則抗體篩檢 ?交叉試驗 試管立即離心 ABO typing 血庫專用離心機 15秒 凝集作用 凝集作用 + + 判讀 4+ 4+ 3+ 2+ 1+ 0 目前血庫作業(yè)是將血球凝集作用分作四種強度 Reverse typing Forward typing Forward typing: 病人血球 +抗 A, 抗 B血清 Reverse typing:病人血清 (漿 )+A1,B紅血球 目的 :提供再確認的工作，特別是有 ABO discrepancy 時之避免血型錯誤。 Forward typing problems (Ag on cell) Reverse typing problems (antibodies in serum) Unexpected reactions ?Acquired B ?Cold autoantibodies ?Cell heavily coated with warm autoantibodies ?Mistransfusion ?Rouleauxformation ?Roomtemperature alloantibodies: antiM, N, P1 ?Cold autoantibodies ?Passively ABO antibodies Unexpected negative reactions ?A, B subgroups ?Antigen depression due to leukemia state ?Age of patient ?Hypoglobulinemia ?immunosupression Some causes of ABO discrepancy Zeta potential 在鹽水相， RBC 間距在 510A左右，不利於 IgG跨細胞形成橋引 —所以 Ig G之不規(guī)則抗體大多無法在鹽水相檢出凝集作用。 Phase 1 Reaction AgAb binding Binding characteristics ?Temperature ?pH ?Time of incubation Enhancement methods ? Neutralize zeta potential (Low ionic strength solution, Polyethylene glycol) ?Temperature ?Time of incubation Phases of hemagglutination Phase 2 Reaction Aggregation Bridging factors ?Antigendensity ?Antigen accessibility ?Ab concentration ?Types of Ab Enhancement methods ?Centrifugation ?Proteolytic enzyme ?Albumin ?Polycations (polybrene) ?AHG Phases of hemagglutination Enhancement solution LISS (low ionic strength Solution) 15% albumin Technique used in detection irregular antibodies The use of enhancement solution during incubation Enzyme (ficin, papain) to expose some antigens. Technique used to detect irregular antibodies Use enzymetreated RBCs instead of the regular RBCs Antiglobulin (AHG) AntiHuman globulin: AntiIgG, AntiC3d, Polyspecific: AntiIgG+AntiC3d (mixed) Monospecific: AntiIgG 抗球蛋白試驗 :antihuman globulin test The recent introduction of ―Gel test‖ as routine Blood bank methods. 不規(guī)則抗體篩檢 ? 病人血清與二至三組已定型之血球反應(yīng) ? 檢測方式： ? 傳統(tǒng)之 AHG檢驗 ? 臺灣普遍使用之 manual polybrene ? 對於 cold reactive antibodies 敏感 ? 無法檢測出 Kell系統(tǒng)抗體 (如 antiK) ? 對於某些不規(guī)則抗體之敏感度仍不足 ? 速度快，三分鐘完成檢查 ? Gel test (AHG法之應(yīng)用 ) ? 最適當?shù)淖鳂I(yè)應(yīng)是 1)檢出有臨床意義的抗體， 2)避開無意義的冷型抗體 ， 3)檢驗時間及時符合臨床要求。 抗體篩檢作業(yè) Screening cells Rh K e l l D u f f y K id d L e w is MN S P 特殊 D C E c e K k Fy a Fy b JK a JK b Le a Le b S s M N P1 Mi a I +
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