CHUYGN Bi: Hpl NOHj KHOA HQC HUYgT HQC • TRUYgN MAU TOAN QUfiC 2012
NGHllN Cliu CHKT LirgMG BO PANEL HdNG CAU DjNH DANH KHANG T H I BAT THlTCfNG DlTdC SAN Wfo
TAI VI|N H U Y I T HQC TRUV£N M A U TRUNG UtrNG
T 6 M TAT:
Oft v i n d i : Sin xuit h6ng ciu panel djnh danh khdng thf bit thudng (KTBT) cd chit lugng cao, mang tinh dfc thii cda ngudi Vlft Nam tgi Vifn Huyft hoc - Tnjyin miu Trung uong (HHTMTU) df cung cip cho cic bfnh vlfn v i trung tim truyfn miu Idn trong c i nude trifn khai xit nghifm djnh danh KTBT cho bfnh nhin (BN) v i ngudi hlfn miu (NHM) df cd thi lua chgn nhOng don vj miu hda hgp nhdm miu tmyin cho binh nhin l i rit cin thiit. Mgc tliu:
Nghiin ciru chit lupmg bd panel hdng ciu dinh danh KTBT duprc sin xuit tpi Viin HHTMTU.
Bdi tvgmg nghiin ci>u 5 bd panel hdng ciu dinh danh KTBT thufc 6 Id khdo nhau dugc sin xuit tgi Win HHTMTU tU thing 12 nim 2009 dfn thing 05 nim 2010 vd 01 bd panel hdng ciu dinh danh KTBT cua TTTMQG ChO thfp dd Thii Lan (Ld sin xuit thing 1/2010). Phuwng phip nghiin cdu. Md t i cit ngang, tifn ciru. Su- dgng kJ thuft dng nghifm va gelcanJ df dinh gii muc dd ngung kit cda cio KN nhdm miu vd nghiim phip Coombs true tiip (DAT), su quan sit bing mit thudng d i dinh gii su tan miu v i do ndng dd hdng ciu bing miy dfm tf bio tg ddng Kit qui: C i 10 hdng ciu cOa 05 bf panel hdng ciu dinh danh KTBT thudc 5 Id sin xuit trdn dfu cho kit qui nghifm phip Coombs trgc tiip i m tinh;
tinh KN cOa cdc h i nhdm miu: Rh. Lewis, Kidd.
MNS, Mia. P v i Duffy vin gio dugc mipc dd ngung kit ti> 3+ din 4+; Ndng dd hing ciu 6n djnii tir 3-5% v i khdng cd hidn tugng tan miu tgi cic thdi diem ngay sau pha, sau 2 tuin, 4 tuin bio quin v i sip dgng; Kit qui dinh danh KTBT
* Wf n Huyit hpc - Truyin miu Tmng uang Phin bifn khoa hgc: GS.TSKH Dd Trung Phin
Nguyin Anh Tri*, Biii Thj Mai An*, Hoing Th| Thanh Nga*, VO Dih: Bbik'
phil hgp vdi kit qui djnh danh cua bf panel hing ciu dugc sdn xuit tgi TTTMQG Chd tijp dd Thil Lan. K i t lufn: Bf hdng ciu panel d|nli danh KTBT dugc sin xuit tai Vifn HHTMTU \ti cd chit lugng ddm bdo v i dugc su dung df tri^
khai xdt nghifm d(nh danh KTBT tgi cic bfnh vifn v i ca sd truyin mdu.
ABSTRACT:
STUDY ON QUALITY OF IDENTIFYING Cat PANEL IN NATIONAL INSTITUTE OF HEMATOLOGY AND BLOOD TRANSFUSION
Produce sets of klentlfying cell panel with high quality and specific of Viehiamese in NIHBT is necessary to supply big hospitals and big transfusion centres in Vietnam to identify inegular antibody for blood donors and patients then selecting matched blood units to transfuse fbr patients Objective: Study on quality ol Identifying cell panel in NIHBT. Materials: 6 lots of identifying cell panel which were made in NIHBT from December 2009 to May 2010 and I set of identifying cell panel which was made HI National Blood Centre Thai Red Cross Societ)^|!
January 2010. Methods: cross-sectional sun/ey.
Using tube technique and gelcard techniquejo assess agglutination of biood group antigens direct Coombs test, hemolysis observation ar measure red cell concentration by automachine.
Results: all sets of identifying cell panel's DAT are negative, agglutination of antigens of some btood group systems: Rh, Lewis, Kidd, MNS, Mia and Duffy maintain from 3+ to 4+. Red cell
Y HQC V l f t NAM THANG 8 • S6 BAC BI6T/2012 x)ncentration maintains from 3 to 5 percent and
lot hemolysis immediately after produce, piesen/ation after 2 weeks and 4 weeks. Results of Irregular antibodies identification test by using NIHBT's identifying cell panel is suitale with results of Irregular antibodies identification test by using National Blood Centre Thai Red Cross Society's identifying cell panel. Conclusions:
Sets of identifying ceil panel which were made in NIHBT are high quality to deploy irregular antibodies identification test in hospitals and Iransftision centres.
I.DATVXNOI:
Truyin mdu la mgt phuong phdp diiu tri hi ttg dfc bift, ngodi nhitng hifu qud to ldm da dugc khing dinh, truyin miu cflng c6 thi gSy ra cdc tai biin truyen mdu nghifm trgng neu cdc quy tic an toan truyen mdu khong dugc thvrc hifn [1], [3]. Ngay nay nhu ciu trayin mdu ngay cang nhiiu, bfnh nhin khong chi dugc truyen mdu mft lin ma dugc trayin mau rit nliieu lin ttong suit qud ttinh diiu trj. Chinh vi vay, vifc sinh ra KTBT sau moi lin bfnh nhan dugc truyin mau la khd tranh khoi. San xuat hong cau panel dinh danh khdng thi bit thucmg (KTBT) co chit liigng cao, mang tinh dac thu ciia ngudri Vift Nam tai Vien Huyit hgc - Truyen miu Trung mmg di cung cip cho cdc bfnh vifn vi trung tam tmyen mdu Ion ttong ca nuoc trien khai xet nghifm dinh danh KTBT cho bfnh nhan (BN) va ngudri hiin mau (NHM) di c6 thi l\ra chpn nhirng don vi mau hda hgp nhdm mau ttuyen cho bfnh nhan la rit can thiit [3].
Chiing toi tiin hanh di tii nay nhim mgc tiSu: "Nghien ciru chdt lupng bp panel hing ciu dinh danh KTBT duac sdn xudt tpl Vifn Huyit hpc Truyin mdu Trung uang '(HHTMTU)"
II. edi TUQNG VA PHUONG PHAP NGHllN COU:
2.1. D i i tirgrng nghien ciru:
• Cic bf hing ciu panel sdng lgc KTBT dugc sin xuit tgi Vifn HHTMTU tir thdng 12 nim 2009 din thdng 05 nim 2010.
Hing ciu panel djnh danh KTBT gim 05 16 nhu sau;
- L6 si 1: So 16; SL00509; L6 si 2: Si 16; SLOOl 10; L6 so 3: Si 16; SL00210; L6 si 4: Si 16: SL00310; L6 si 5; Si 16: SL00410.
• Bg panel HC djnh danh KTBT cua TTTMQG Cho thfp d6 Thii Lan thufc 16 dugc sin xuit thdng 1/2010.
• Gelcard cd khing huyit thanh chuin di xic d)nh cic khdng nguyen cua hf Hh, Kell, Kidd, Lewis, Duffy ciia hing DiaMed va anti Mia ciia TTTMQG ChO thfp dd Thdi Lan.
2.2. Phuorng phap nghien cuu:
- Sir dgng kJ thuft dng nghifm vd gelcard di dinh gid miic dg ngung ket cda cdc KN nhom mau va nghiem phap Coombs trgc tiip; Quan sat bdng mdt thuomg di dinh gid su tan mau; Do ning dg hing ciu bing miy dem te bao tu dfng.
- Cdch thirc kiim tta; lay ngau nhidn 5 bg hing ciu panel dinh danh KTBT cua 5 16 hing cau panel khac nhau dugc sdn xuit tai Vifn HHTMTU tit thing 12 nam 2009 din thdng 05 nim 2010.
- Sir dgng kj^ thuft gelcard de so sdnh ket qua djnh danh KTBT gitta panel hong ciu sing lgc cua TTTMQG Chtt thap dd Thai Lan vi cita Vifn.
III. KiT QuA NGHIEN CCfU:
3.L Kiim tra chat lugng vi df tan mdu, hematocrit, DAT, tinh khdng nguyen hf Rh, Lewis, Mia, MN, P ciia panel hong cau dinh danh KTBT sau 2 tuin, 4 tuan su dung va bao quan.
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C H U Y B N Bi: Hpl NOHj KHOA HQC H U Y E T HQC • TRUYEN M A U T O A N QUgc 2012
Bing 1. Kiim tra chit lugng v i df tan miu, hematocrit, DAT cua hing c i u panel bijg iu djnh danh KTBT ngay sau khi pha, sau pha 2 tuin v i 4 tuin
Panel hdnq ciu dlnh danh PQ tan miu NBHC (%) DAT
Am tinh (3/3 HC) Ldsdl (0,.0io) Khdng tan
(3/3 HC)
3-5 (3/3 HC)
Am tinh (3/3 HC) Ldsd2(0,.0,o) Khdng tan
(3/3 HC)
3-5 (3/3 HC) Ldsd3(0,.0,i,) Khdng tan
(3/3 HC)
3-5 (3/3 HC)
Am tinh (3/3 HC) Ldsd4(0,.0io) Khdng tan
(3/3 HC)
3-5 (3/3 HC)
Am tinh (3/3 HC) Am tinh (3/3 HC) Ld s i 5 ( 0 , . d o ) Khdng tan
(3/3 HC)
3-5 (3/3 HC) Kit qui A bdng 1 cho thiy: Cd 10 hing
ciu ciia 05 bf hing c i u panel dinh danh KTBT thufc 5 16 sdn xuit khdc nhau ngay sau khi pha, sau plia 2 tuin, sau pha 4 tuin diu kh6ng c6 biiu hifn tan mdu, ning df hing ciu i n djnh 3-5% vd nghifm pliip Coombs trgc tiip diu cho kit qud dm tinh.
Kit qud 6 bdng 2 dudi diy cho thiy:
Miic df ngung kit cdc khdng nguyfn nhdm mdu hf Rh, MNS (Mi*), Uvris, Kidd v i D u ^ ciia cd 10 hing ciu ciia 5 bf hing c i u panel dinh danh KTBT thufc 5 16 sdn xuit khic nhau diu cho kit qud duong tinh 4+ 6
thdi diim ngay sau khi ptia vd sau khi pha 2 tuin; Tinh khdng nguyfn ciia bf nhdm miu Rh, Kidd vd Dufly cua cd 10 hing ciu cia S bf hing c i u panel djnh danh KTBT thufc 5 16 sin xuit khdc nhau diu cho kit qud duong tinh 4+ sau khi pha 4 tuin. Sau 4 hiin Uo quin v i sii dgng tinh KN cua hf Mia (4/516), Lewis (5/5 16) c6 xu hudmg gidm, tuy nhiin mirc df ngimg kit van Id duomg tinh 3+ vi trfn th\ic t i thi cdc bg panel hong cau djnh danh KTBT ndy thi van dugc sir dyng tit Si phdt hifn KTBT.
Bing 2. Khdo sdt chit lugng v i tinh KN cua hf nhdra Rh, Kell, Kidd, Duffy, MNS cia panel HC djnh danh KTBT sau khi pha. sau pha 2 tuin v i 4 tuin
Ngay s a u pha Sau 2 t u i n Sau 4 t u i n
/ ? / I ( 0 , . 0 , o ) D u o n g tinh 4+ (5/6 Id) D u o n g Unh 4+ (5/5 Id) D u o n g tinh 4+ (5/516) i . o i v / s ( 0 , . 0 , o ) D u o n g Unh 4+ (5/6 Id) D u o n g tinh 4+ (5/5 Id) D u o n g tinh 3+ (5/516) K/d(/(0,.0,o) D u o n g tinh 4+ (5/5 Id) D u o n g tinh 4+ (5/5 Id) D u o n g tinh 4+ (5/516),
PI
MNS (Mi') {O, .0,„) D u o n g tinh 4+ (5/5 Id) D u o n g tinh 4+ (5/5 Id) D u o n g tinh 3+(4/6 »)' Duffy(0,.Oio) D u o n g tinh 4+ (5/5 Id) D u o n g tinh 4+ (5/5 Id) D u o n g tinh 4+(6/516) 3.2. So sdnh kit qud p h i t hifn KTBT ciia hf panel HC djnh danh KTBT dugc sin xuit t;i TTTMQG ChO' t h i p dd Thdi Lan v i Vifn HHTMTU
Bing 3. So sdnh kit qud phdt hifn KTBT ciia bg panel HC sing lgc KTBT dugc san xuat tgi TTTMQG Chtt thfp dd Thdi Lan yd Vifn HHTMTU
Panel HC d j n h d a n h K T B T 111 MUG CtiCr t h i o dd T h i i Lan V l i n HHTMTU
Tdng s6 272 272
D u o n g t i n h n 16 16
5,9
%
5,9
A m t i n h n 256 256
94,1
%
94,1
Y HQC VigT NAM T H A N G 8 • s g OAC BI6T/2012
Kit qud 6 bing 3 cho thiy; Ci panel HC dinh danh KTBT cua Trung tim truyin miu quic gia Chtt thfp dd Thdi Lan vi Vifn HHIMTU aiu phit hifn dugc 16 bfnh nhin CO KTBT cho tJr If la 5,9%.
IV. BAN L U $ N ;
Kit qui bing 1 vi 2 cho thiy cd 10 hong ciu cda 5 bf hing ciu panel djnh danh khtag thi bit thudng thufc 5 16 sin xuit khdc nhau diu c6 ning d§ hing ciu tir 3-5%, nghifm phip Coombs trgc tiip im tinh vi khong c6 biiu hifn tan mdu. Miic dg ngung kit cia mft so Ichdng nguyen nhdm mdu ngoii hf ABO dgt t i 3+ din 4+ 6 thdri diim 'ngay sau khi pha, sau khi pha 2 tuin vi 4 'tuan. Cac kit qud tten cho thiy panel hong ciu dugc sdn xuit tai Vifn HHTMTU li cd
•chit lugng tit vi in dinh trong suit qud ttinh
•baoquan [2], [4].
' Kit qui bang 3 cho thiy ci panel HC Idinh danh KTBT ciia Trung tam truyin mdu quic gia Chtt thfp do Thai Lan va Vifn HHTMTU diu phdt hifn dugc 16 bfnh nhan CO KTBT ttong ting si 272 bfnh nhin dugc 'tiSn hanh xet nghifm cho ti If 5.9%. Kit qud ,ti€n cho thiy chit lugng cua bg panel hong loiu djnh danh KTBT cua Vifn HHTMTU
•sin xuat hrong duong vdri chit lugng cua bf fpanel hing ciu djnh danh KTBT do Trung jtSm ttuyin mdu quic gia Chii thap do Thai jLansanxuit [2].
j ' Ben canh do, bing bg panel hing cau -dinh danh KTBT dugc san xuit tai Vien 'HHTMTU, chiing t6i da dinh danh 4 mau ngoai kiim do Trung tam Truyin mau Chtt fMp dd Thai Lan gui sang ttong 2 dgt ngo?ii , Idim, chiing toi da lam xet nghifm chinh xdc ' va kit qua cua chiing toi da dugc Trung tim
; tmyin mau Chtt thfp do Thai Lan danh gia 1 tit cao (Excellent) [5]. San phim cua chiing
t6i cflng da dugc Vifn Kiim itinh quic gia vie xin vi sinh phim Y ti, Bf Y ti kiim tta vi dd cip giiy phip luu hinh cho 3 16 sin phim panel HC djnh danh KTBT sin xuit tai Vifn (L6 00208; L6 DD 00810 vd L6 DD 01310) vdi cdc si ding k;?: Si 019808/SP-NC;
03110/SPCD-DK vd 00211/ SPCD -DK).
V. Kiir LU$N:
Qua kit qud nghidn cdu vi bdn luan trdn, chiing t6i nit ra kit luin sau;
Bg panel hing ciu djnh danh KTBT dugc sin xuit t?ii Vifn Huyit hgc Truyin miu ttung uomg c6 chit lugng dim bdo ttong suit qud ttinh sir dgng vd bio quin;
- Kh6ng c6 biiu hifn tan mau tai thdi diim sau khi pha, sau 2 tuin, 4 tuin bio quan vd stt dgng.
- Kit qui nghifm phdp Coombs ttirc tiip im tinh tai thdi diim sau klii pha, sau 2 tuan, 4 tuin bao qudn va stt dung.
- Ning do hong ciu in djnh tu 3-5% tai thcii diim sau khi pha, sau 2 tuin, 4 tuin bao qudn vd sir dgng.
- Tinh khdng nguyen mgt so he nhom mdu Rh, Kell, Kidd, IVlNS (Mia), Lewis van gitt dugc miic do ngung kit 4+ tai thdri diim sau khi pha, sau 2 tuin.
- Tinh khang nguydn cua hf nhom mdu MNS (Mia), Lewis sau 4 tain bio quan va stt dung CO xu hudmg giam, nhung van dat mttc dg ngung kit 3-I-.
- Kit qui sang lgc KTBT vol hai bg panel hong ciu sang lgc KTBT cua TTTMQG Chtt thfp do Thai Lan va cua chiing t6i diu cho kit qua nhu nhau vi deu da phat hifn dugc 16 bfnh nhan c6 KTBT ttong ting si 272 benh nhan dugc tiin hanh xet nghiem cho ti If 5.9%.
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CHUYfeN Bi: Hpl NOH| KHOA HQC HUVe'T HQC - TRUYgN MAU TOAN QUO'C 2012
TA( LI|U THAM KHAO:
L Biii Th| Mai An (2004), Cdc bifn phdp bio dim an toin truyin mdu, Mft si chuyin di Huyit hgc - Truyin miu Ifp I.
NXB Y hgc, tr.230-237.
2. Bdo cdo ting hgp kit qud nghifn clhi khoa hgc cfng nghf dy dn "Hoin thifn quy trinh sdn xuit, bdo quin vd cung cip panel hing cdu cho cdc ca sd cung cip mdu trong todn quic di ndng cao chit lupng dich vp truyin mdu".
3. Quy chi truyin miu - 2007 vi mflsitft bin quy phpm phip luft vi truyin Nguyin Anh Tri, Phgm Quang Vinh, xuit bin Y hgc, 2008, tt. 36.
4. Guide lo Ihe pre paralion, use andqiuOtf asurance of blood components, 1 th edition, pp. 182-189
5. Patravee Soisangwan (2010), REQAS in BGS VTN Project Summary Report, WHO Document.
NGHIEN Cliu K H A N G N G U Y I N , K I I U H I N H CUA H | NHdM NlAU KELL, DUFFY VA MNS dl NHMTN 0 ^ XAY D ^ G NGAN H A N G M A U H I ^ M
Bili Thj Mai An*, Nguyin Anh Trf*, Tran Nggc Qui
T6M
ikv.
Bft van de: Nghiin cUu khing nguyin (KN) v i kiiu hlnh (KH) ciia hf nhdm miu Kell, Duffy.
MNS df xiy dung ngin hing miu hiim tgi Vifn HHTMTU l i rit quan tnjng v i cin thiit d i dim bio cung cip du, kip thdi mdu hjfm cho nhOng bfnh nhin (BN) cin truyin miu hifm; BN cin truyin miu hda hop nhdm miu. Mpc tliu:
'Nghiin cdu KN vi KH cda hi nhdm miu Kell, Duffy vi MNS 6 NHMTN di xiy dpng ngin hing miu hiim tpi Viin HHTMTLT. Dfi tupmg: 1.550 NHMTN dugc xic dinh KN S. s; KN Mi" ciia hf MNS (1290 ngudi); KN K k cua hf Kell (1166 ngudi); KN M, N cua h i MNS (1166 ngudi); KN Fy", Fy' cua hf Duffy (1165 ngudi); Phmmg phip: SO dgng kf thuft gelcard df xic djnh cic KN ciia hf nhdm miu Kell. MNS v i Duffy cho NHMTN. Kit qui: Ty If KN v i KH cua h i Kell: K
• Vlin Huyit hpc - Tmyin miu Tmng uong Phan bifn khoa hgc: GS.TSKH € d Trung Phin
(0%), k (100%), K-k+ (100%); H i Duffy Fy*
(99%) v i Fy''(14.8). Fy(a^fb+); 14,1%, Fy(atH 84,9%. Fy(a-b-f): 0.9% v i Fy(a-b-): 0,09%. H{
MNS: M (80.9%), N (63%), S (5.5%), s (100»).
Ml" (8,9%), S-s-f (94.6%). S-i-s-i- (5.5%). S-ts-vS S-s- (0%); M*N* (46,4%), U*N- (34.5%), M-N*
(16,6%) v i M-N- (2,5%). Kit lufn: NHMTN c6 KN K. KH K-k-. K-i-k- (0%) ciia hf Kell, Fy(a*) cOa hf Duffy (0,09%), S-fs- (0%) vd S-s- (0%) ciia hf MNS l i cic KN v i KH hifm v i rit hi^n gip. nhOng NHMTN niy dugc lira chgn, lir van df tham gia vio ngin hing miu hifm tai Vi$n HHTMTU.
ABSTRACT:
Study on antigens and phenotypes of Kelt Duffy, MNS blood group systems to built rare blood bank in NIHBT is veiy important anS
