The Analysis of Antibody Distribution and Factors Influencing the Efficacy of Blood Transfusion in Patients with Unexpected Red Cell Blood Antibodies
Objective: To analyze the distribution of unexpected red blood cell (RBC) antibodies and explore the factors that influence transfusion efficacy in patients with positive unexpected antibodies. Methods: A retrospective review of 161 cases of positive unexpected antibodies recorded in our hospital from January 2022 to December 2025 was performed. Clinical data were collected. We first analyzed the proportion of various types of unexpected RBC antibodies. Patients were divided into two groups, including an ineffective group and an effective group (partially effective, effective), according to transfusion efficacy, and the influencing factors that led to the ineffectiveness of RBC transfusion were explored. Results: Unexpected antibodies accounted for 77.02%, with Rh blood group system antibodies (34.78%) being the most common, followed by MNS blood group system antibodies (28.57%); anti-E (31.06%) accounted for the highest proportion of monospecific antibodies, followed by anti-M (18.63%). Ineffective RBC transfusion accounted for 12.10%. The average transfusion of 1 U RBCs per kilogram of body weight increased the median hemoglobin to 5.65 g/L. The therapeutic effect of RBC transfusion was related to the patient’s gender, presence of Rh blood group system antibodies, autoimmune history, pregnancy history, immune/targeted drug use history, and tumor history (p < 0.05). Rh blood group system antibodies and pre-transfusion hemoglobin levels are independent risk factors for ineffective RBC transfusion. The risk of ineffective RBC transfusion in patients with Rh blood group system antibodies is 7.68 times that of patients without (OR: 7.68, 95%; CI: 1.54–38.31); the risk of patients with pre-transfusion hemoglobin between 40 g/L and 70 g/L (excluding 40 g/L) causing ineffective transfusion is 0.03 times that of ≤ 40 g/L (OR: 0.03, 95%; CI: 0.00–0.33) (OR: 0.03, 95%; CI: 0.01–0.15), the risk of pre-transfusion hemoglobin > 70 g/L causing ineffective transfusion is 0.16 times that of ≤ 40 g/L (OR: 0.16, 95%; CI: 0.03–0.98). Conclusions: Rh blood group system antibodies are the most common, and anti-E is the most common monospecific antibody. Unexpected antibodies affect the efficacy of RBC transfusion, and Rh blood group system antibodies are an important risk factor for ineffective RBC transfusion. The hemoglobin level before transfusion is also a factor that affects the efficacy of RBC transfusion.
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