Impact of direct anti-human globulin positive intensity on blood transfusion in critically ill patients

Gu Yuqing; Liu Yali; Sheng Jinnian; Xu Shaoguo; He Rui; Bian Maohong; Liu Miao; Zhang Yuxia

doi:10.3969/j.issn.1002-1949.2025.03.009

Abstract：Objective To compare the impact of different positive antibody intensities of direct anti-human globulin(DAT)on blood transfusion in critically ill patients.Methods Clinical data of 80 critically ill patients with positive DAT admitted to the Third People's Hospital of Hefei and the First Affiliated Hospital of Anhui Medical University from January 2015 to March 2024 were retrospectively collected.They were divided into an experimental group(n=40)and a control group(n=40)based on different blood transfusion products.The control group received washed red blood cells infusion,while the experimental group received suspended red blood cells infusion.The blood matching results of two groups in the patients with different DAT positive intensities,the clinical efficacy of red blood cell infusion with different DAT positive intensities,the differences in hemolytic indicators with different DAT positive intensities,and the correlation between DAT positive intensities and hemolysis were compared.Results There were statistically significant differences in the results of primary blood matching among the experimental group,the control group and the patients with different DAT positive intensity in the case of non-grouping(P＜0.05).There was a statistically significant difference in the results of secondary blood matching in the patients with different DAT positive intensity in the experimental group(P＜0.05).According to Kendall's tau-b correlation test,the intensity of DAT positivity was positively correlated with both primary and secondary blood matching results(r＞0,P＜0.05).Out of 80 patients,19 patients were positive for irregular screening,with 9 in the experimental group and 10 in the control group.There were statistically significant differences in the distribution of DAT positivity intensity among irregular antibody positive patients of the experimental group,the control group and non-grouping(P＜0.05).Kendall's tau-b correlation test showed a positive correlation between DAT positive intensity and irregular antibody screening(r＞0,P＜0.05).The comparison of infusion efficacy in the patients with DAT positive intensity 2+and below between two groups showed no statistically significant difference(P＞0.05).The infusion efficacy of DAT positive intensity 3+and above in the control group was significantly better than that in the experimental group with statistically significant differences(P＜0.05).The therapeutic effects of different DAT positive intensities infusion in the experimental group were compared with statistically significant differences(P＜0.05).The differences in red blood cell infusion volume among the patients with different DAT positive intensities in the experimental group was statistically significant(P＜0.05).According to Pearson correlation test,there was a negative correlation between DAT positive intensity 3+and above and red blood cell infusion volume(r＜0,P＜0.05).Before blood transfusion,there was no statistically significant difference in hemoglobin(Hb),red blood cells(RBC)and reticulocyte(Ret)among different DAT positive intensities in the experimental group(P＜0.05).However,total bilirubin(TBIL)showed an increasing trend in the patients with DAT positive intensities≤1+,2+,3+and 4+with statistically significant differences(P＜0.05).After blood transfusion,Hb and RBC increased compared to before blood transfusion at the same intensity,but Ret decreased in different DAT positive intensities with statistically significant differences(P＜0.05).There was no statistically significant difference in TBIL between before and after blood transfusion(P＞0.05).After blood transfusion,Hb and RBC showed a decreasing trend in the patients with DAT positive intensities≤1+,2+,3+and 4+,while TBIL showed an increasing trend in the patients with DAT positive intensities≤1+,2+,3+and 4+with statistically significant differences(P＜0.05).According to the correlation test,the positive intensity of DAT was positively correlated with TBIL before and after blood transfusion(r＞0,P＜0.05).Conclusions The positive intensity of DAT is correlated with primary and secondary blood matching.The stronger the positive intensity of DAT,the higher the risk of detecting irregular antibodies.DAT positive intensity 2+and below is not related to the effect of red blood cell infusion,but the infusion effect gradually deteriorates with DAT positive intensity 3+and above,and there is a negative correlation between DAT positive intensity and red blood cell infusion volume.The positive intensity of DAT is positively correlated with TBIL before and after blood transfusion.