| Objective1.Analyze the distribution of unexpected antibodies in tumor patients,and study the single factors and multiple factors that affect the production of unexpected antibodies in tumor patients based on the basic information and treatment of the patients,which can further guide clinical doctors and laboratory technicians to pay attention to high-risk factors and make comprehensive analysis and as early as possible to identify and confirm the patient’s possible allogenic antibodies,and then give positively treatment to reduce the adverse effects of blood transfusion caused by antigen-antibody reaction,and ensure the effectiveness and safety of clinical blood transfusion.2.Summarize the experimental results of unexpected antibody identification in cancer patients,search for problems and solutions in the process of antibody identification,and further improve the accuracy and sensitivity of unexpected antibody identification in cancer patients.3.According to the influencing factors and distribution characteristics of unexpected antibodies in tumor patients,combined with the daily clinical work process,carry out a reasonable and standardized process in the identification of unexpected antibodies in tumor patients,clarify the standardized content of unexpected antibody identification,and make rational choices and usage based on the characteristics of different experimental techniques.And strengthen the quality control of key points to further ensure the accuracy of antibody identification,thereby increase the detection rate of unexpected antibodies in cancer patients.4.According to the distribution characteristics of unexpected antibodies in cancer patients,establish a suitable matched antigen inventory management strategy to ensure the safety and timely blood transfusion of patients with allogenic antibody in emergency.Method1.Unexpected antibody detection in cancer patientsColumn agglutination technology was used to test ABO blood type and red blood cell antibody screening on blood samples of 48,369 tumor patients who underwent surgical blood preparation and routine blood transfusion at the Cancer Hospital of the Chinese Academy of Medical Sciences from January 2011 to October 2015.The results showed interference with reverse typing of ABO blood group and positive antibody screening,which has reminder unexpected antibodies,the standardized detection process of the unexpected antibody identification experiment for tumor patients was perform,which was established by the Department of Blood Transfusion,and refer to the AABB antibody identification guidelines for antibody identification.The results were used to analyze the distribution characteristics of unexpected antibodies in tumor patients.2.Consideration in the process of identifying unexpected antibodies in cancer patientsAccurate identification and confirmation of unexpected antibody identification is the key point and the most difficult point of the blood transfusion compatibility test.Through the study of the accidental antibody experimental process that has been identified,the shortcomings of the experimental process and improvement strategies are analyzed.This includes but is not limited to the following steps:judgment of abnormal results of routine experiments,experimental content and methods of auxiliary experiments,usage and analysis of screening cells and antibody serum,confirmation and analysis of medical history information,selection and confirmation of judgment criteria,review of difficult results and communication with the clinic and comparison the historical results.To the end,the quality control points for the identification of unexpected antibodies in tumor patients are determined.3.Standardized the identification experiments of unexpected antibody for tumor patients The antibody identification process involves related theoretical knowledge such as red blood cell antigen expression and antibody characteristics,selection of reagents and detection methods,experimental operations,judgment and interpretation of results,and complex antibody identification.Any problems in any of the above steps will affect the accuracy of antibody identification results and the timeliness of providing matched RBC for the clinic.For this reason,it is necessary to establish a quality control process to ensure that the reagents,instruments and methods meet the expected requirements.Detect ABO blood type and antibody screening on patients’ routine blood transfusion samples,and complete antibody identification experiments for patients suspected of having the allogenic antibodies,such as inconsistent blood type group positive and reverse type,positive results of antibody screening,etc.Comprehensive consideration needs to be given to the timely and accurate detection of alloantibodies present in patients in terms of quality management,sample management,reagent red blood cells,assay methods,media usage for enhancement,routine antibody identification,interpretation and interpretation of results,and complex antibody identification.Result1.Results unexpected antibody identification for tumor patientsABO blood group and erythrocyte antibody screening experiments were performed on 48,369 tumor patients.Among them,255 were unexpected antibody positive,with a positive rate of 0.53%;103 cases of male patients,accounting for 40.39%(103/255),with a positive rate of 0.41%(103/24945),152 cases of female patients,accounting for 59.61%(152/255),and the positive rate was 0.65%(152/23424).The distribution of unexpected antibodies was the largest in the Rh system antibodies(69/27.06%),followed by Lewis system antibodies(67/26.27%),and MNSs system antibodies are also relatively common(62/24.31%);anti-M was the most(57/22.35%),followed by anti-Lea(49/19.22%)and anti-E(45/17.65%).There were 6 cases of anti-Wra,of which 4 cases coexisted with anti-E and 2 cases coexisted with anti-S;10 cases of autoantibodies(3.92%),each 1 case of self-anti-E,self-anti-D,and drug-based antibodies(0.39%);there were 2 cases(0.78%)with anti-HI antibodies and 27 cases(10.59%)with no specificity antibodies detected.2.Univariate analysis of unexpected antibody production in tumor patientsAccording to the patient’s clinical treatment information,including gender,age,ABO blood type,RhD blood type,history of blood transfusion,pregnancy history,tumor location,and whether the tumor has metastasized,a univariate analysis of unexpected antibody production was performed,and patients were divided into five groups based on age(<35,35-44),45-54,55-64,≥65),and divided into four groups based on the history of pregnancy(1,2,3,and>3).The tumor sites are divided into ten groups which including lung,esophagus,stomach,liver,colorectal,kidney,and ovary,uterus,lymphoma and other.After statistical analysis,the P values of the gender of the cancer patient(x2=12.8298),RhD blood type(x2=4.0175),history of blood transfusion(x2=15.3220),pregnancy history(x2=8.7533),tumor location(x2=24.5642)and whether it has metastasized(x2=10.3945)were all less than 0.05,and the difference was statistically significant.The above factors were related to the unexpected antibody production of tumor patients.3.Multivariate analysis of unexpected antibody production in tumor patientsWith the unexpected antibody positive of tumor patients as the dependent variable,a stepwise logistic regression analysis was performed.The inclusion and exclusion criteria of the variables were both P<0.05.After unconditional logistic multiple stepwise regression analysis,there were 7 factors that were statistically significant for unexpected antibody production in tumor patients,including female,RhD positive,history of blood transfusion,2 times of pregnancy,colorectal tumor,lymphoma and tumor metastasis(OR=1.462,2.999,1.994,1.667,1.811,2.788 and 3.484,respectively).Conclusion1.Anti-M was the most prevalent unexpected antibody in tumor patients,followed by anti-Lea and anti-E;Rh system antibody had the largest proportion,followed by Lewis system antibody and MNS system antibody.The detection ratio of anti-M and anti-Lea was higher than the detection ratio of the above-mentioned antibodies in the Chinese population reported in the literature;there were some cases where antibody specificity was not detected by standardized antibody identification,which needed to be further summarized and sorted in future work.2.Univariate analysis of the causes of unexpected antibody production in tumor patients was related to gender,RhD blood type,history of blood transfusion,pregnancy history,tumor location,and metastasis.Multivariate logistic regression analysis was related to female,RhD positive,history of blood transfusion,2 times of pregnancy,tumor metastasis,colorectal tumors and lymphomas.3.In the process of unexpected antibody detection of tumor patients,complete experimental operations and standardized records were the basis for accurate analysis,and effective clinical communication and medical history inquiry were very important for accurate identification and subsequent blood transfusion treatment.Double check and additional necessary experiments could further clarify the specificity of the allogenic antibody.Once the blood transfusion was completed,it would be more difficult to re-identify the previously unclear results.Accurate antibody identification and cross matching were two separate processes,random matching(blind matching)strategies should be used with caution in the clinical blood transfusion treatment process.The communication and the learning of uncommon antibodies would help to speed up the improvement of skills,and attention to unexpected results and details was the key factor in accuracy.4.The causes of unexpected antibodies in cancer patients and the nature of the antibodies were different.Antibody screening and antibody identification experiments should be carried out in a standardized process.This could improve the detection rate and accuracy of unexpected antibodies,and match the corresponding blood management system to improve blood transfusion safety and effectiveness.The development of standardized procedures for the detection of unexpected antibodies in cancer patients could improve the ability of laboratory personnel to recognize and confirm unexpected antibodies.The entire process required a complete management of people,machines,materials,methods,and environments.5.Comprehensive analysis based on the influence factors of antibody produce and distribution characteristics of unexpected antibodies in cancer patients,which could guide experimenters to fully consider the positive situation of unexpected antibodies that may be caused by immune stimulation,and improve the detection rate of antibodies and remind the department of blood transfusion to formulate scientific and reasonable inventory blood antigen screening strategies based on the distribution of the detected allogenic antibodies to quickly meet the requirements for the timeliness of clinical blood use for some cancer patients. |
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