冷式抗体保有患者への輸血用血液の選択時に冷式抗体を無視することの当否

摘要

In patients with cold-reactive antibodies (CRAbs) undergoing transfusion no consensus has yet been reached as to whether or not the corresponding antigen-negative red blood cells (RBC) should be selected.In our hospital, we routinely perform unexpected antibody screening tests by the saline method (S), bromelin technique (Br) and indirect anti-globulin testing (IAT). Of 401 unexpected antibodies detected between January 1995 and June 1996, 263 (66%) were CRAbs. Of these 213 CRAbs (81.0%) were not reactive in IAT with IgG-specific antisera (lAT-IgG) or at 37deg. Among patients with CRAbs, 172 were corss-matched with Br at 37degC regardless of CRAbs. Of these, 27 were transfused with 255 units of RBC compatible with the corresponding antigens; and 11 patients with anti-Le~a, 16 with anti-Le~b, 10 with anti-Pi and 1 with anti-M were transfused 25,181, 47 and 2 units of antigen-positive RBC, respectively. None of these patients exhibited incresed levels of antibodies or developed transfusion reactions.Over the past six and a half years, further more, 17 other cold-reactive anti-Le~a-positive patients given Le(a + ) RBC were followed to examine antibody levels, and 71 cold-reactive anti-Le~a-positive patients transfused with Le(a + ) RBC were observed with respect to clinical course without monitoring of antibody titers. None of these patients showed any increase in antibody values or transfusion reactions.We conclude that antibodies non-reactive at 37degC and/or lAT-IgG are of no clinical significance and can be ignored in transfusion testing.