溫型自體抗體陽性病患輸血管理模式

Algorithm for Management of Patients with Warm Autoantibodies in Taiwan

背景：溫型自體抗體會增加輸血前檢查複雜度，需要特別處理流程，包括多重吸附及完整的血型分析。我們參考台灣的血型抗原分佈頻率，提出簡化血型分析之溫型溶血性貧血病患的輸血管理模式，暨符合輸血安全，又能兼顧成本效率。研究設計和方法：參考本國居民的血型分佈頻率，當病人有溫型自體抗體，我們分析Rh及Kidd血型系統抗原分型，根據檢驗結果預防性發給抗原性相容血品。2014年8月至2015年7月，我們依照調整的輸血前檢驗，分析30名血型並依此策略配發血品。結果：30名患者中有13名患者在初發現具溫型自體抗體時，已產生異體抗體（43.3％）。24名有完整Rh及Kidd血型系統抗原分型，6名病人因經常輸注Rh相容血品，致Kidd血型無法分析。研究期間，30名病人共輸注702單位Rh及Kidd血型相容紅血球血品（2-116單位／患者，平均23.4單位／病人）（血品單位是依本地捐血中心的計量規定，為歐美單位的一半）。所有患者輸血治療後，血紅蛋白和血比容均有符合預期的提升。結論：我們制定適合本地溫型自體抗體陽性患者輸血前檢驗模式，提供本國較為重要關鍵次要血型相合的血品。這一套分析模式分析，簡化了檢驗流程，但仍足夠維持患者的輸血安全。

Background: Pre-transfusion testing for patients with warm autoantibodies represents a challenge and requires special procedures, including multiple absorptions and complete phenotyping. We advocate a local modified protocol that takes account of blood group antigen distributions of Taiwanese to streamline the pre-transfusion testing cost-effectively without compromising transfusion safety. Study design and methods: Given the blood group distribution frequency of local population, we perform phenotype study of Rh and Kidd antigens and provide Rh- and Kidd phenotype matched units for patients with warm autoantibodies. Thirty adult patients with warm autoantibodies (August 2014 to July 2015) were tested and received transfusions according to this modified policy. Results: Thirteen of 30 patients demonstrated preexisting alloantibodies (43.3%). Twenty-four patients were typed for Rh and Kidd antigens and received prophylactic antigen-matched units. Six patients whose Kidd blood phenotypes could not be determined due to frequent transfusions received Rh antigen-matched units. These 30 patients totally received 702 units of donor red cells (range 2-116 units/ patient, mean 23.4 units/ patient) during the study period (In Taiwan, one unit of red cells is derived from 250 mL whole blood, equal half western standard unit). All patients had expected post-transfusion increments in hemoglobin and hematocrit levels. Conclusion: We instituted a protocol for local patients with warm autoantibodies with limited phenotype- matched transfusion. Our algorithm simplified the pretransfusion work-up while maintain adequate transfusion safety for local patients.