疑难配血病例输血策略研究及输血疗效分析OA

Objective To analyze the etiologic distribution of difficult crossmatching and the characteristics of red blood cell antibodies,to summarize compatible transfusion strategies based on serological abnormalities,and to evaluate red blood cell transfusion efficacy and changes in bilirubin levels before and after transfusion.Methods A retrospective analysis was conducted on difficult crossmatching cases handled by the Department of Blood Transfusion of our hospital from January 2024 to December 2025.Cases that met the criteria for difficult crossmatching determination and had complete data were included in the analysis of the causes and antibody distribution.Patients who completed red blood cell transfusion and had complete hemoglobin(Hb)data before and within 24 hours after transfusion were included in the exploratory subgroup analysis of transfusion efficacy;among them,those who also had total bilirubin and indirect bilirubin data before and after the corre-sponding transfusion event were included in the bilirubin analysis.According to the main serological abnormal manifestations before transfusion and the actual compatible transfusion management pathways,the cases included in the exploratory sub-group analysis were divided into three groups:the alloantibody-related difficult crossmatching group,the autoantibody-related or autoantibody combined with alloantibody-related difficult crossmatching group,and the ABO blood group identification abnormality-related difficult crossmatching group.The Hb levels before and after transfusion,the Hb increase after transfu-sion of each unit of red blood cells,and the changes in bilirubin levels before and after transfusion were compared among the groups.Results A total of 322 difficult crossmatching cases met the predefined criteria,of which 287 were included in the analysis of causes and antibody distribution.There were 183 cases of alloantibody-related difficult crossmatching(63.76%),54 cases related to inconsistency between ABO forward and reverse typing(18.82%),44 cases related to au-toantibodies(15.33%),and 6 cases related to interference from anti-CD38 monoclonal antibody drugs(2.09%).Among the 183 alloantibody-related cases,79 cases had only a single alloantibody detected,among which antibodies of the Rh blood group system accounted for 49.37%(39/79).Among single alloantibodies,anti-E was detected most frequently,with 35 cases(44.30%),followed by anti-M with 19 cases(24.05%)and anti-Lea with 13 cases(16.46%).A total of 109 cases were included in the exploratory subgroup analysis of transfusion efficacy,including 76 cases in the alloantibody-related difficult crossmatching group,17 cases in the autoantibody-related or autoantibody combined with alloantibody-relat-ed difficult crossmatching group,and 16 cases in the ABO blood group identification abnormality-related difficult crossmatching group.The sex distribution and history of previous transfusion differed between cases included in and not in-cluded in this analysis.The Hb levels after transfusion in all three groups were higher than those before transfusion,and the differences were statistically significant(P<0.05).The Hb increase per unit of red blood cells did not differ significantly a-mong the three groups(P=0.086).Among 73 cases with paired total and indirect bilirubin data corresponding to the trans-fusion events,the comparison of changes in total bilirubin among the three groups showed no statistically significant differ-ence(P=0.864),and the comparison of changes in indirect bilirubin among the three groups also showed no statistically significant difference(P=0.914).Conclusion Alloantibody-related factors were the main causes of difficult crossmatch-ing in this study.Among single alloantibodies,Rh blood group system antibodies,especially anti-E,were relatively com-mon.In the included exploratory subgroup,after individualized compatible transfusion based on the causes of difficult crossmatching,antibody specificities,and crossmatching results,Hb levels were higher after transfusion than before transfu-sion in all three groups.Within the scope of this study,the magnitude of bilirubin changes did not differ significantly among the different types of difficult crossmatching.