輸血醫(yī)學(xué)介紹-全文預(yù)覽
【正文】 analogues, Hodgkin’s disease and congenital immune deficiency. ? All intrauterine transfusions ? All granulocyte concentrates. Guideline form blood transfusion services of the United Kingdom 輸血案件 (19992020) 輸血風(fēng)險(xiǎn) 事件類別 件數(shù) ABO 抗體 A RBCs→O pt B/AB RBCs →O pt A/AB RBCs →B pt B RBCs →A pt O plasma →A/AB B plasma →AB 80 26 12 6 6 1 小計(jì) 131 不規(guī)則抗體 AntiK AntiEKP1 AntiJka+Jkb+JK3 AntiJKb AntiFya 5 1 1 1 1 小計(jì) 9 19761985 FDA統(tǒng)計(jì)輸血死亡案例 —與抗體有關(guān)者 本地輸血醫(yī)療糾紛 ABO血型 discrepancy不敢發(fā)血 ? 51歲女姓病人，於淩晨零點(diǎn)十五分前往某區(qū)域醫(yī)院急診，主訴在外自行服用傷風(fēng)藥劑後全身無(wú)力，畏寒，口乾，想吐。西方人報(bào)告中以 HPA1a 抗體為主 (又名 antiplA1)，多發(fā)生於 HPA1a陰性且 HLADR3*0101之?huà)D人。 Fisher Short notations % white % Asian CDe R1 41 70 Cde R 39 3 cDE R2 14 21 cDe R0 3 3 cdE r‖ 1 rare Cde r’ 1 2 CDE Rz rare 1 CdE ry rare rare Rh haplotypes nomencaltures Phenotype Phenotype frequency RBC Ag Serum Ab P1 75% P1, P, Pk None P2 25% P, Pk *AntiP1 P1k Very rare P1, Pk AntiP P2k Very rare Pk AntiP p Very rare None AntiPP1Pk (antiTja) *AntiP1 : frequently seen as naturally occurring antibodies, Clinically insignificant cold reactive antibodies. P blood group system PolyagglutinationT activation (T antigen) ? Red cells agglutinate when exposed to normal sera ? In normal status: sialic acid and other residue will cover antigenic structure within red cell membrane (cryptantigens) ? Polyagglutination: in disease status, . bacterial infections, partial desialation of the red cell membrane due to the microbial neuraminase activity. Polyagglutinationdetection by plant lectins Arachis hypogaes Glycine soja Salvia Sclarea Salvia horminum Griffonia simpliafolbia Vicia cretica T + + Tn + + + Tk + + Th + + Tx + Cad + + (花生水 ) 血小板抗原抗體系統(tǒng) 血小板表面之抗原可以分成以下 兩類 ? 第一類： 組織型抗原 ：與其他組織均有之抗原，例如HLA, ABO抗原。 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(xì)胞形成橋引 —所以
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