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혈액은행 실무의 이해 (ABO 불일치 및 항체 선별검사 )

혈액은행 실무의 이해 (ABO 불일치 및 항체 선별검사 ). 아산재단 서울 아산병원 진단검사의학과 박 태 화. 목 차. ABO 식 혈액형 및 검사 방법. ABO discrepancy. 항체 선별 검사. 결 론. ABO 식 혈액형 및 검사방법. ABO System. Initially described by Karl Landsteiner in 1901. ABO antigens are found on red cells, platelets, and many circulating proteins.

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혈액은행 실무의 이해 (ABO 불일치 및 항체 선별검사 )

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  1. 혈액은행 실무의 이해(ABO 불일치 및 항체 선별검사) 아산재단 서울 아산병원 진단검사의학과박 태 화

  2. 목 차 • ABO식 혈액형 및 검사 방법 • ABO discrepancy • 항체선별 검사 • 결 론

  3. ABO식 혈액형 및 검사방법

  4. ABO System • Initially described by Karl Landsteiner in 1901. • ABO antigens are found on red cells, platelets, and many circulating proteins. • The ABO system contains four major ABO phenotypes:A,B,O and AB. [Karl Landsteiner]

  5. ISBT 분류에 의한 Blood Group System 29 Blood Group System 34 Gene loci 285 Antigens (2005)

  6. Plasma Plasma Plasma Plasma ABO Blood Groups

  7. Biochemical Bases of Blood Groups • The H antigen is precursor to the ABO blood group antigens. The H locus is located on chromosome 19. • The A and B antigens are defined by three-sugar-terminal epitopes on glycolipids and glycoproteins that require the synthesis of H antigen for their expression.

  8. Biochemical Bases of Blood Groups • Humans with A-type blood also contain an additional enzyme which adds N-Acetylgalactosamine to the H antigen.  • Humans with B-type blood contain another enzyme which adds Galactose to the H antigen.  • Group O individuals express only H antigen.

  9. Secret of ABO Blood Groups

  10. Antibodies of ABO Antigens

  11. Mechanism of Red Cell Agglutination

  12. Results in Tube method

  13. ABO 검사 방법 • 1. 검체Type • Plain Tube로 검체 채취 • 2. 주의사항 • 환자의 생명에 치명적인 결과를 초래할 수 있으므로 환자 및 검체의 확인이 매우 중요하다. • 3. 검사방법 • Cell typing • Serum typing • Rh typing 바코드 부착 혈액은행용 스티커

  14. ABO Typing &Result 1. Cell typing 2. Serum typing + +

  15. ABO discrepancy

  16. ABO discrepancy? • Cell typing 과 Serum typing의 결과가 각각 일치하지 않는 경우 • Cell typing과 Serum typing의 결과 판독 결과중 4+보다 작은 응집을 보이는 경우

  17. Problem sheet NT: Not Test

  18. Technical reasons • 시약을 잘못 넣은 경우 • 검사자가 잘못 읽은 경우 • 혈구, 혈청 비율이맞지 않은 경우 가장 많이 발생하며, 재 검사 후discrepancy 나타나면 환자의 혈구나 혈청 측 원인 때문에 일어나는 Real discrepancy 이다.

  19. ABO Discrepancy • Cell grouping • (false positive) • Acquired antigens (B, A) • Poly-agglutination • B (A) phenomenon • Post-transfusion of different BG. • DAT positive sample • (false negative) • Antigen expression decrease (e.g.:AML) • A subgroups (A3, Ax) • Due to technical or reagent error • Reverse serum typing • (false positive) • Cold agglutinin / antibodies • A1 antibodies, antibodies to used A1&B cells other than anti-A&B. • Auto-antibody • Fibrin • (false negative) • Babies • Old age • Hypo-agammaglobinaemia • Due to technical or reagent error

  20. A sub-groups

  21. Confirming Test of A or B subgroup • Anti-A, Anti-B , Anti-A1(Dolichos biflorus), Anti-H(Ulex europaeus) 와 피검 혈구와의 반응 • Adsorption & Elution Test • Saliva Test • Antibady Screening Test • A & B 유전자 전이효소 검출 • Genotyping • Family Study 등

  22. Subgroups of A & B Antigens • Subgroups of A antigens A2: A gene product 250,000/RBC vs. 1,000,000/RBC Anti-A1(serum or Dolichos Biflorus Seed) A1: Positive, A2: Negative A2 B: 22-35%에서 검출 Subgroups weaker than A2: A3, Ax, Ael, Am • Subgroups of B antigens Very rare, B3, Bx, Bm (Dolichos Biflorus )

  23. A & B sub-groups 감별 Anti-H(Ulex europaeus seed) A or BSubtypes: Positive A1: Negative Strength of agglutination : O> A2>B> A1 (Ulex europaeus )

  24. ABO 혈액형 아형들의 반응 양상 mf = mixed-field agglutination

  25. A & B sub-groups 감별 • Mixed-field agglutination • 1. Following out-of-group red cell transfusion(group O->group A) • 2. Leukemia • 3. ABO subgroups(A3 or B3) (Mixed-field agglutination)

  26. 항체 선별 검사

  27. Type of Antibody • 예기항체(Expected Antibody) - ABO 항체(Anti-A, Anti-B) • 비예기항체(Unexpected Antibody) - 한국인의 빈도는 0.2~1.2% - 생성원인(Pregnancy, Transfusion, Event unknown) • 자가항체(Auto Antibody)

  28. Indications: For detection of irregular antibodies (non-ABO) Pre-transfusion tests Antenatal screening Donor units HDN(hemolytic disease of the newborn) Antibody Screening, WHY?

  29. Antibody Screening Importance in transfusion • This test detects if a recipient has a clinically significant antibody, so a donor unit that lacks the corresponding antigen would be selected for X-Matching and transfusion.

  30. Antibody Screening

  31. 비예기항체 선별 검사 및 동정 검사 • 선별 및 동정혈구를 Micro-Tube에 50㎕씩 분주 2. 각 Micro Tube에 환자 혈청 25㎕씩 분주 3. 37℃에서 15분 Incubation 4.Centrifugation 10분 (910rpm) 5. 결과판독

  32. 비예기항체 선별 검사 및 동정 검사 Interpretation of reactivity with gel column agglutination assay

  33. Antibody Identification

  34. 주요 혈액형 항체의 빈도

  35. 결론 나의 작은 실수 하나도 환자에게는 치명적일 수 있다. 조심 또조심

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