C H U Y E N eg: Hpl NOHI KHOA HQC HUYgT HQC • TRUYgN M A U T O A N Q U 6 C 2012 TAI U|U THAM KHAO:
1. s i Tnmg Phin, Nguyin Chf Tuyin, Ph«m Tuin Duomg, S8 Mfnh Tuin, Bdi Th| Mai An, Nguyin Bie Thuin vi cing sv (1999), Hifu qui cia cufc vfn dfng hlin mdu vd sdn xuit cdc chi phim mdu, Y hpc Viit Nam 232, trang 1 - 8.
2. D S Trung Phin (2000), An todn truyin m<i«, NXBYhocHiNOi.
3. Kiiu Thj Thanh (2004), Tinh hinh sti dpng mdu tpl cdc khoa ldm sdng - Bfnh
Vlfn Bpch Mai (2000 - 2003), Lu|n vSnlit nghidp Bic si Y khoa, D?i hgc Y HiN^L . Nguyin Th| Bich Thuy, Tinh hlnh rt
dpng mdu tpi khoa ldm sing bfnh mau, Vlfn Huyil hpc • Truyin miu TWHtfikg 4/2005 - 3/2006, Luiln vin tot nghijp Ci nhin Icy thuit Y hpc, D?i hpc Y Hi N^i.
. Nguyin Anh Tri vi CS (2008), guy * ' truyin mdu 2007 vi cic vdn ban jiy phpm phip quy. Nhi xuit bin Y hgc.
NGHliN Cliu K ^ QUA SiiNG LQC VA HNH DANH KHANG TH^ BAT 1HU6NG or B|NH NHAN BENH MAU TAI VliN HUYfr HOC imiYEN M A U TRUN6 U I M ( 2 0 0 » ^ ^
T6(W TAT:
Bit vin <9i: Hiu hit b$nh nhin bj binh miu vio viin diiu trj diu ducrc truyin miu nhiiu lin, d i c6 dupe nhOng biin phip hl>u hiiu v i han chi cic tai biin truyin miu, thi/c hiin truyin miu c6 hiiu ipc cho nhOng binh nhin niy thi viic nghiin ci>u tJ i i v i die diim KTBT * binh nhan binh miu i i rit cin thiit Mpc tliu:
'Nghiin cdu tf li vi die diim KTBT & binh nhin bi binh miu tpl Win HHTMTU (2009 - 2011): Dil tm/ng: 2.293 binh nhin bj binh miu tuii til 7-91 tuAi dupe vio viin diiu trj ti>
12/2009- 4/2011. Phuvng phip: Si> dgng kJ geicard trin h i thing may tv ding Hemos SP il v4i b i panel h6ng ciu sing Igc v i dinh danh KTBT dugc sin xuit tgi Viin HHTMTU d i phit hijn KTBT cho bjnh nhan binh miu. Kit qui:
' Viin Huyil hpc - Tmyin miu Tmng irang
" Bp min Huyit hpc - Tmyin miu, Trudng Dpi hpc Y Hi Nil Phin blin khoa hgc: TS Truvng Cing Duin
Biii Thj Mai An*, VO Thj Tii Anh"
B i phit hlin ducTC 130 BN trong s i 2.293 BN o) KTBT chiim ty l i l i 5,7%; TJ l i KTBT gip cao nhit b h i nhim miu Rh:46,5% (Khing Itii E 29.2%; khing t h i c: 15,2%; khing thi C: 0.6%), rii din khing t h i Ml' cua h i MNS (34%); GJp vdi ty l i thip hon * cic h i nhim miu Ki*l, Duffy, P, Lewis; Ty l i KTBT * nO cao hon 4 nam (Nam: 4.8%; NO': 6,7%),; Ty IC KTBT c i liin quan din s i lin truyin miu (Du*i 5 lin: 2,4; TPiik 10 lin: 6.4% y i trin 10 lin: 10,8%); Binh nhin : RLST c i tJ l i KTBT cao nhit K l f lufn: T}l«
KTBT * binh nhin bj b$nh miu l i 5,7%; Tj * • KTBT gip cao nhit * h i nhim miu Rh (46.5«), ' rii din h i MNS (khing t h i Mi": 34%); T} » KTBT c i liin quan din gidi v i s i lin tniyin mSi; : Ty l i KTBT gip cao nhit i> nhim binh nhSn • RLST v i Thalasssemia.
Y H p c VigT NAM T H A N G 8 - s t f B A C BlgT/2012 ABSTRACT:
STUDY ON RESULTS OF IRREGULAR ANTIBODY SCREENING AND IDENTIFICATION IN THE PATIENTS
HAVE BLOOD DISORDER DISEASES Almost inpatients who are suffer from blood disoder diseases are transfused many times.
Study on irregular antibodies' ratio and characteristic in ttiese patients is necessary to have effective methods to reduce transfusion reactions then perform effective transfusion to these patient. Objectives: Study on irregular antibody ratio and characteristic in patients vt/ho were suffer from blood disoder diseases in NiHBT from 2009 to 2 0 1 1 , Materials: 2.293 patients vi/ho were treated in NIHBT from December 2009 to April 2 0 1 1 , patients' age from 7 to 91 years old. Methods: Using gelcard method on Hemos SPII automachine system with screening cell and panel cell which were made in NIHBT to detect patients' irregular antibodies.
{Results: We found out 130 patients have Irregular antibodies among 2.293 patients (made up 5.7%). The highest irregular antibodies ratio was found in Rh blood group system: 46,5%
, (Anti-E 29.2%: anb-c: 15.2%; anti-C: 0.6%), anti- [ Mi* of MNS blood group system made up 34%,
Kidd's antibodies. D u f f ' s antibodies, P's antibodies and Lewis's antit^odies made up lower ratio, Inegular antibody ratio in woman patients is 'higher than man patients (man: 4,8%, woman:
6,7%). Irregular antibody ratio related to transfusion times (less than 5 times: 2.4%; from 5
"to 10 times: 6,4%; more than 10 times: 10,8%).
^JlJtyelodysplastic syndrome patients have the niighest in-egular antibody ratio. Conclusions:
'irregular antibody ratio of patients who were
• suffer from blood disoder diseases is 5,7%. The 'highest irregular antibodies ratio was found in Rh
•biood group system: 46,5%, anti-Mi" of MNS 'biood group system made up 34%. Irregular 'antibody ratio related to sex and transfusion times. The highest irregular antibodies ratio was found in myelodysplastic syndrome patients and flialassaemia patients.
I. OiBiT V £ N o i :
Miu rat quan tn?ng vk chn thik cho cuOc s6ng, nhdr c6 m6u mk nhi^u ngain b?nh da dirgrc curu s6ng. Mdu quan tr(?ng nhu v^y nhung khi truydn mdu cflng c6 thi gSy ra nhthig tai biin nghifim trpng niu khfing th\rc hi§n vk ddm bdo nhftng nguyfin tdc vh an todn truyin mdu [1], [5]. H^u hit b|nh nhdn bi b?nh mdu vdo vi^n diiu tri diu dugrc truyin mdu nhiiu l4n, de c6 Augc nhttng bi?n phdp httu hi$u vd h^n chi cdc tai biin truyen mdu, thvrc hi§n truyin mdu c6 hifu l\rc cho nhttng b^nh nhan ndy thi vi$c nghiSn curu ty 1$ vd d$c diim KTBT 6 b?nh nhdn b$nh mdu Id r^t c ^ thilt. Do v$y dl tdi dugc th\rc hi?n vdi M^c tieu: "Nghien cieu ty 1$ va 3gc diim KTBT a b$nh nhdn 6/ b$nh mdu tai Vi^n HHTMTU (2009-201 ly
II. £»6l TU0NG VA PHUDNG PHAP NGHIEN COU:
2.1. Doi tirgng nghiin cihi: 2293 b|nh nhan bj b?nh mdu, ttt 07 -91 tuoi dupe vdo vi?n diSu tri tai cdc Khoa B?nh mdu, Vi6n Huylt hpc - Truyen mdu Trung uong ttt thdng 12/2009 din thang 04/2011. Bao g6m 1442 BN la xe mi (LXM), 189 BN Thalassaemia, 172 BN U Lympho khong Hodgkin (U lympho), 73 BN Da u tuy xuorng (DUTX), 60 BN Rfii l o ^ sinh tuy (RLST), 53 BN tdng tilu cdu tien phdt (TTCTP) vd 304 BN bj cdc b?nh mdu khdc.
2.2. Phuong phap nghi€n cihi:
- Mo td cat ngang, ket hpp cd h6i cttu vd tien cttu.
- Stt dyng kjf thu^t gelcard trSn h^ thfing mdy t\r d^ng Hemos SP II de sdng lpc va djnh danh KTBT.
- Stt dyng panel hong cau sdng lpc vd djnh danh KTBT cua Vi?n HHTMTU dl phdt hi?n va dinh danh KTBT.
C H U Y B N oi: Hpl NOH| KHOA HpC HUYgT HpC - T R U Y S N M A U T O A N Q U 6 C 2012 III. K i r QuA N O H I E N C O U :
3,1. Ty If khing thi bit thirdng it bfnh nhla b| b$nh miu Bint I. TV ii KTBT d bjnh nhto bj btnh miu
niu
86 mlu nghltn zim S4 mlu du^nfl linh T»lt(%)
2293 5,7
Trong si 2293 bjnh nhta bj b$nh miu iugc tiin hinh sing Igc KTBT c6 130 bjnh nhan c6 kit qui xjt nghijm KTBT ducmg tinh cho ty I j li 5,7 %.
3.2. D$c diim khing th4 b^t t h u ^ g g^p it bjnh nhin bf bjnh m i u c6 kit qui sbg If c KTBT dw<mg tinh
Bing 2. Kit qui djnh danh khing thi but thuimg
H$ nh6m m i u Rh MNS Kidd Duffy P L&wls
Tin khing thi Khing thi E Kh^ng Ihi c Khang thi C KhSng thi Ml' KhSng I h i j k ' Khing thi Jk"
Khing thi Fvb Khing thi PI Khing thi Lea Khing thi Leb
n 42 24 1 49 1 6
5 9 5 2 1
T* l i % 29.2 16 2 0,6 340 3.8 32 5.7 3.2 1.3 06
n 67 49 11 9 5 3
TylS%
4S,9 34,0 7,0 6,3 3,5 2,1 Ket qui djnh danh KTBT d bing 2 cho thay KTBT cua hj nh6m miu Rh chiem ty le cao nhat (46,5 %), sau do li din hj MNS (34 %), Ty 1 j KTBT thupc hj nh6m miu Kidd la 7,6%, hj Duffy 6,3 %, khing the PI li 3,5 %, KTBT thupc hj nhdm miu Lewis li thip nh4t (2,1
%). Kit qua bang 2 cDng cho thay khing thi Mia ciia hj nh6m miu IVINS gip vdi ty Ij cao nhit (34%), sau do la khing thi E. khing thi c cua hj nhim miu Rh v6i thii tvr: 29,2% »|
15,2%. Cic KTBT ciia mpt so hj nhim miu khic gip vdi ty Ij thap hon (tft 2,1% din 5,7%). • Bing 3. Phta bo ty I j KTBT theo gitSri tinh
GI6>I Nam No- ting
S i miu NC 1263 1030 2293
S i miu (*) 61 69 130
Ty l i (%) 4.8 6.7 5.7
P
>005 Ket qui d btag 3 cho thiy ty Ij KTBT gjp d ntt la 6,7 % vi nam la 4,8 % ty Ij xuat hien KTBT d nhom bjnh nhta nO- cao hem bjnh nhta nam, tuy nhiin chua thiy cd sv khic biet ci y nghia thing ke vdi p> 0,05.
ig4. fhinbdty It kh N h i m b i n h \<i RLST Thalassaemia TTCTP B i n h m i u khSc Lo x i mi U Lympho Da u tuv xwonq Tong
ing the bat Ihirttng t S i miu NC
60 189
53 304 1442 172 73 2293
teo chin doan lim sane S6 duKyng tinh
10 26 7 19 61 6 2 130
Tv l i % 16.7 13.8 13.2 6.3 4.2 2.9 2,7 57
W V m W w
t
486
Y HQC VigT NAM T H A N O 8 - S 6 B A C BlgTf2012
Kit qui d btag 4 cho thiy nhdm bjnh nhta roi logn sinh tiy cd t^ I j xuit hijn KTBT cao hat (16,7%), sau dd din nhdm Thalassaemia (13,8%), Ttag tilu ciu tiin phit (13,2 %). T^ Ij LTBT thap nhit d nhdm bjnh Da u tiy xuong (2,7 %).
Bam S. Phta bi t^ 1 j KTBT theo s6 lan truyin miu S6 lin truyin miu
Dydi 5 lin TCr 5 i i n 10 lin Trin 10 lin Ting
S i miu NC 1165 412 716 2293
Dvrong tinh 28 25 77 130
T!>li(%) 2.4 6.1 10.8
5.7
P
<O05
Kit qui btag 4 cho thiy bjnh nhta chua truyin miu vi truyin dudi 5 Ian t^ Ij g$p KTBT khi thap (2,4 %), nhdm bjnh nhta truyin miu tir 5 din 10 lin vi trin 10 lin cd ty Ij gSp ICTBT cao hon (6,1 % vi 10,8 %). Cao nhit li nhdm bjnh nhta truyin miu tren 10 lin.
IV, BAN L U $ N :
4.1. Ty Ij khing thi b£t thuimg ir bjnh nhiin bj bjnh miu
Kit qua d btag 1 cho thiy ty I j KTBT d bjnh nhta bj bjnh mau trong nghien ciiu ciia ching toi li 5,7 %. Kit qui nghien ciiu cua chung tii thip hem so vdi cac tic gii Bii Thj Mai An nim 1994 (13,04 %), Trin Thj Thu Ha -1999 (12,7%), Nguyen Thj Thanh Mai - 2000 (27,4%) va cd svr khac bijt niy cd y nghia thing ke vdi p< 0,05. Kit qui cua chiing toi thip hon nhiiu so vdi cac tic gia tita la do tit ci cic nghiin cihi diu thvrc hijn vio thdi diim tnrdc nim 2006, la thdi diim chira ra ddi "Quy chi truyin miu" va xet nghiem phta ing hoa hgip cd sd dvmg khtag iglobulin nguoi chua dirpc thvrc hijn mjt each ithirdng quy, cdn hijn nay tai Vijn HHTMTU, chung toi di thvrc hijn thudng quy xet nghiem nay cho 100% bjnh nhta ma ditcrc chi dinh truyin miu, xet nghijm stag JQC KTBT cung dupe thurc hijn mpt cich 'thirdng quy vi ichi bjnh nhta cd KTBT thi 'dupe Ivra chpn don vi miu hda hpp nhdm 'mau dl huyin [1], [2], [4], [5]. Tuy nhien kit 'qua ty Ij KTBT d bjnh nhta bj bjnh mau .Wg nghien cilu cOa chiing toi lai cao hon so Mk qua nghien ciiu cua mpt si tic gii nude
ngoii nhu Chae SL (1998) vi Ma Su Xuan (2003) vi svr khic bijt niy cflng cd ^ nghia thdng ke vdi p< 0,05, diiu niy cd thi dupe ly giii la cic tic gii tren thvrc hijn nghien cdu d dii tupng bjnh nhta nhta miu ndi chung, trong khi chung toi nghien cilu tren dii tupng bjnh nhta bj bjnh miu, cic bjnh nhta niy phin ldn li di dupe truyin miu nhiiu lin nen nguy ca phat sinh khtag thi bit thudng la rit cao. Ngoii ra, t^ii cac nude nay an tota truyin miu dupe thvrc hijn sdm hon va nghiem ngit hon [6], [7],
4.2. Dac diim khing the bit thvcmg or bjnh nhan bj bjnh miu
Kit qua dinh danh KTBT d btag 2 cho thiy KTBT hj nhdm mau Rh gap vdi ty Ij cao nhit (46,5 %), khtag thi Mia cila hj MNS gip vdi ty Ij khi cao (34 %), cic khtag thi hj nhdm miu Kidd, Duffy, P, Lewis gip vdi ty Ij thip hon (chi tir 2,1 % din 7,6 %).
Nhta xet tren eua chtag toi eung phu hpp vdi nhta xet cua tic gia Trin Thi Thu Hi (1999) vi tic gii Tran Vta Be (1994), tie gii Ma Su Xuan (2003) cung dua ra nhta xet KTBT cua hj Rh li gip nhiiu nhit (65 %) sau dd din Mi', Kidd, Duff'y, Lewis [2], [4], [7].
Kit qua bing 3 cho thiy ty le xuit hijn KTBT d ntt cao hom d nam. Kit qua cua
C H U Y S N Bi: Hpl NQH| KHOA HpC HUYfeT H(?C • TRUYgN M A U T O A N Q U 6 C 2012
ching tdi phi hpp vdi nhta xit cCia cic tic gii Bii Thj Mai An (1994), Trin Thj Thu Hi (1999), NguyJn Thj Thanh Mai (2000) vi Xiang Dong (2003) [1], [3], [4], [8]. Sd dl ci kit qui ti^n li vl d nfi gidi, ngoii vijc truyin miu, trong qui trlnh chCra di cQng ci thi xuit hijn KTBT do bit ding nhdm miu ngoii hj ABO giOa m( vi con.
Kit qui d btag 4 cho thiy nhdm bjnh nhta rii lojn sinh tily cd ti Ij KTBT cao nhit (16,7 %), sau dd din nhdm bjnh nhta thalassaemia (13,8 %). Diy li hai nhdm bjnh nhta thudng xuyjn phii truyin khii hing ciu trong qui trlnh diiu trj vi hiu hit hp di dupe truyin miu trjn 10 lin. Khi ntag sinh miln djch phvi thuic nhiiu vio si lin truyin miu vi khotag cich giiia cic lin truyin, nhta xit niy cua chtag tdi cflng phu hpp vdi n h ^ xit cua tic gii Trin Vta Bi (1998) li si lin truyin miu ctag nhiiu, khotag cich ctag liu thi CO hii sinh KTBT ctag cao [2].
Kit qui btag 5 cho thiy nhflng bjnh nhta truyin miu dudi 5 lan cd ty 1 j KTBT li 2,4 %. Ty Ij KTBT d nhdm truyin miu tii 5 din 10 lin la 6,1 %, trong khi nhflng bjnh nhta di truyin miu tren 10 lin cd ty Ij li 10,8 %. Nhta xit ciia chtag tdi tuong tvr nhta xit cua cie tic gii Bui Thj Mai An, Trin Thj Thu Hi [1], [3]. Diiu niy chiing td la bjnh nhta ctag truyin miu nhieu lin thi ctag tiip xic nhiiu vdi khtag nguyin nhdm miu cua ngudi cho thi sS ctag ttag khi ntag xuit hijn KTBT [4]. Stag lpc KTBT cho nhung dii tupng niy trudc mii lin Uuyin mau li rat cin thiit de h^m chi nguy co tai biin truyin miu do bat ding miln djch.
V. KiT L U A N :
Qua sing lpc KTBT cho 2293 bjnh nhta bj bjnh miu tsii Vijn Huylt hpc - Truyen miu TW, chung tdi rut ra mpt si kit luta sau:
1. T^ I j KTBT d bjnh nhta bj bjnh mSn li 5,7 %.
2. Die diim KTBT d bjnh nhta bj bjnh rata Ty Ij KTBT gip cao nhit d hj nhiim miu Rh (46,5%). rii din hj MNS (khing thi Mia; 34%);
T^ Ij bjnh nhta cd KTBT d nS cao hom d nam (nO li 6,7% nam li 4,8%);
Tji I j KTBT d nhdm bjnh rii loan sinh tiy li cao nhit (16,7%);
Ty 1 j bjnh nhta cd KTBT cao nhit 6 nhdm truyin miu tiin 10 lin (10,8%) vi giim theo si lin truyin.
T A I u f u THAM K H A O :
1. Bui Thj Mai An, Bych Khinh Hdi, Nguyin Thj Y Ling, Nguyin Trifu Vin, Di Trung Phin, Khdng thi bit thucmg a ngudi cho mau va nhfn mdu nhiiu ldn a Vlfn Huyit hpc - Tniyin m|;
Trung uang, Y hpc Vijt Nam, 1995, si 9, tr. 5-39.
2. Trin Vin Bi, Miin dich huyil hpc w truyin mdu. Lam stag huylt hpc, 1998, tr.
312-350.
3. Tran Thj Thu Hi, Nghiin ciiu KTBTH hing cdu a bfnh nhdn nhfn mau nhieu ldn, Luta vta tit nghi jp th^c s^ y hgc, 1999, tr. 25-30.
4. Nguyin Thj Thanh Mai, Nghiin cmcic khdng thi bdt thuomg khang hdng can o mft si ddl tupng tpi Bfnh vifn Nhi TW, Luta ta tiln sjr sinh hpc, 2005, tr. 11 - 20.
5. Quy chi truyin miu - 2007 va mfl d van bin quy phpm phdp luft vi truya miu, Nguyin Anh Tri, Pham Quang Vinh, Nhi xuit bta Y hpc, 2008, tr. 36.
6. Chae SL, Bang KH, Chang EA, Chi YJ, An evaluation of gel test for irregul0 antibody screening, Korean J blood trunsfiis, 1998,9 (1), pp. 31 - 35.
Y HQC VigT NAM THANG B - S6 P^C BlgT/2012
7. Ma Su Xuan, Liu Jing Han, Li Xi Jin, Luo Qun, Chen Min Cai, Wang Hai Jen, Micro column gel indirect anti globulin Technique for screening and
\-..identification of irregular antibody, Journal of Experimental Hematology, 2003,11 (2), 194.
. Xiang Dong, Zhang Xiongmin, Wang Jianlian (2003), Analysis of irregular RBC antibodies in 220 patients frpm Shanghai^ Journal of clinical Transfusion and Laboratory Medicine, 2003, pp. 2.
NGHIEN cuu K ^ QUA X £ T NGMlM HdA HOP cd SUTDUNG KHANG GLOBUUN m B i m NHAN BEW M l ^ TO VllN HUVn HOC 11WEN M A U imiNG UIMG ^
Dft vfn df: Xit nghiim hia hpp (XNHH) cd s i dgng khing globulin d i dupe thuc hiin Xp\
Viin HHTMTU tip nim 2007 de dim bio skf hda hgp v i nhim mta h i hing ciu git^a ngudi cho vi ngudi nhin, nhim ning cao chit lupng an toSn tniyin miu v i mat miin djch, Ching tdi tiin tMr\ i i tdi niy nhim ddnh gii kit qui cua xit nghiim nSy trong vijc bio aim an to4n truyin mSu. Mpc tiiu: 'Nghiin cdu kit qui xit nghipm lids hpp c6 sd dpng khing globulin ngudi (AHG) i binh nhin bi binh miu tpi Win HHTMTU (2009 -2010): Dfi tuprng: 668 BN bi bjnh m4u Uirgro trayin KHC (1814 lupt BN) tCf 01/10/2009 ain 31/03/2010 Phuvng phip: Su dgng kJ ' gelcard trin h i thing miy tp ding Hemos SP II ' «l thgc hiin XNHH c i su dgng AHG cho binh
nllSn dupe truyen mta. Kit qui: Trong s6 668 i BN bi binh miu dupe truyin KHC c i 58 BN c i 1 XNHH c i SLP dgng AHG duong tinh cho tj l i \i
• 8,8%. Ty l i XNHH c6 sO dgng AHG duong tinh i nam l i 5,6%; nO: 11,5%, ty i j XNHH c i su' dmg AHG duong cr nhim bjnh nhin RLST ii
Bili Thj Mai An*, Nguyen Anh Hung**
19,6%, nhim binh nhin c6 nhim mdu A c i t^ l i XNHH c6 s i dgng AHG duong tinh \i cao nhit (9,3%). Kit lufn: T9 l i binh nhin dupe tmyin mau c i XNHH c i si> dgng AHG duong tinh l i 8,8%; ty l i i binh nhin nO cao hon binh nhin nam (11,6% va 5,6%), nhim binh nhan Thalasssemia vS nhO-ng binh nhSn c i nhim mau A c i ty l i XNHH c i si} dgng AHG duong tinh cao nhit (19,6% va 9,3%).
ABSTRACT:
STUDY ON RESULTS OF COMPABILITY TEST IN AHG PHASE IN THE PATIENTS HAVE BLOOD DISORDER DISEASES IN NIHBT
Cross-matching in AHG phase has perfomned in National Institute of Hematology and Blood Transfusion (NIHBT) since 2007 to ensure compatibility about red blood cell blood group systems bebween patient and donor in order to improve transfusion safety quality and.
We carry out this reseach to assess results of this test in ensuring of transfusion safety.
Objects: "Study on result of compabllity test in
* WSn Huyit hpc - Truyin miu Trung uong, " Bd min Huyit hpc Truyin miu
489
