血型(2)——Rh血型系统

2010年11月25日 | 标签:

Rh血型

还是那个发现ABO血型系统的兰德斯泰纳医生在1940年发现了Rh血型,要知道这时候的兰德斯泰纳可是在10年前成了诺贝尔奖得主,但他仍然静心于血型研究,而不像我们的那位物理学家得奖后到处招摇,还在香港参加他的铜像揭幕,真让我受不了

兰德斯泰纳当时发现,人类红细胞表面不仅仅有A或B抗原,大多数人还有一个其它的抗原,这个抗原在全部印度恒河猴(Rhesus Macacus)的红细胞表面表达,于是就以恒河猴的英文单词的头两个字母Rh来表示。人类的红细胞表面根据是否携带Rh因子,分为两种类型:携带Rh因子的称Rh阳性,不携带Rh因子的称Rh阴性。看似简单,可这个发现使人类的血型分类变得复杂,比如虽然我们都是B型血,但我可能是携带Rh因子的B型血(简称B+),但你可能是不携带Rh因子的B型血(简称B-)

有意思的是Rh阳性的人和Rh阴性的人在各种族的分布差异显著。比如99.7%汉族人的红细胞表面都携带Rh因子(Rh阳性),而美洲土著印第安人几乎100%是Rh阴性血

随着Rh血型系统的发现,以前的ABO系统内的同型输血原则就要修改,同时需要Rh血型相同才能输血,但人们后来发现红细胞表面还存在其它的稀有血型系统,至今总计30多个,我们不可能在输血前给供血、受血的双方都定好各种血型再输血,那太麻烦,太费时间。于是一个简单的输血前实验就被建立,而且至今仍是各国医院输血前必做的实验:交叉配血实验,步骤如下:

1、输血前我们只给献血人血液和受血者的血液定“ABO”和“Rh”两种血型,因为它俩是最常见的血型系统。两个血型都相同就进入下述的主、副试验:

2、将供血人的红细胞+受血人的血清混合(主试验),目的是为了发现受血者血清中是否含有与供血者红细胞反应的抗体

3、将供血人的血清+受血人的红细胞混合(副试验),目的是为了发现供血者血清中是否有不合抗体

这个严谨的试验可以在无需鉴定其它稀有血型的前提下排除其它稀有血型对输血的干扰,只要我们观测主、副试验都无凝集现象,我们就认为输该血是安全的

但事实上,输血前,有极个别人的交叉配血试验就是无法通过,一般都是主试验无凝集,而副试验可能有轻度凝集。在多次更换不同供血者的血液都无法通过的话,如果病人急需输血,这种情形还是允许变通的:可适当少量输血 (不宜超过200ml),但输血时宜慢,并密切观察,如发生输血反应,应立即停止输注。因为机体可以耐受轻微溶血,毕竟救命要紧

而主侧试验发生凝集,其血绝对不可输入

Rh血型的发现不仅仅带来输血原则的改变,同时还给另一个困扰人类的特殊疾病:Rh溶血病,提供了解释

当然我在介绍Rh溶血病的同时还会介绍ABO溶血病,它们两者有类似之处,病因非常奇妙

今天就不谈了,否则知识点太多,接受起来会有困难。为了理解下一篇的内容,先给个思考题:

我的上一篇文章中称抗体是机体在抗原的刺激下产生的。那么,有没有人想过:在ABO血型系统中(A型血的血清中有抗B凝集素,B型血的血清中有抗A凝集素,O型人的血清既有抗A也有抗B的凝集素,AB型的血清中即无抗A也无抗B凝集素,凝集素可以理解为抗体),我们血液中的这个凝集素(抗体)不会生来就有的,它是怎么产生的?理应是在某种抗原物质的刺激下生成的,可我们又没输过异型血,这个抗原物质是什么?

这个问题困扰了医生很长时间,最终还是找到了答案

≈≈≈

我的下一篇文章将要解释:

(1) 为什么O型的妈妈怀了“A”型或“B”型的孩子就可能会发生溶血?为什么第一胎就可发病?而Rh溶血往往发生在第二胎?

(2) 为什么Rh阳性的血第一次进入Rh阴性的人的体内,Rh阴性的人(受血者)可能没事?而Rh阳性的人随便怎么接受Rh阴性的血都没事?而A型的人第一次输B型人的血就会发生严重的溶血?

另外,明天贴不了,因为又要上24小时班,后天下班还要折腾会儿老鼠,争取周日写出来

  1. YU
    2010年11月26日09:42

    学习了,谢谢费时费心。我是B+无疑,不可能是B—。

  2. 2010年11月26日12:05

    学习了

  3. Nana
    2010年11月26日12:08

    我曾经在剑里面写了一个帖子,王里奥,一个我认识十来年却不怎么联系的家伙回帖,A型血吧。
    我都晕彩了,血型和性格看来还是有一定的关系,我以前看过一本书,叫能见正比古的人写的,写了些什么我都不记得了,那时候连血型都不知道呢。
    等着看4。

  4. 会长胖
    2010年11月27日03:08

    作为一个听讲认真的同学,我把老师留的思考题思考过了,其实老师似乎已经给了提示,那个抗原物质,应该是来自……我先不说的,说了影响别的同学思考。:P

  5. long2
    2010年11月27日05:09

    我也知道能见正比古,他是b型血,写血型与性格的。

    关于老师的问题,我看了一眼会长胖,把目光深深地投向了印度恒河猴。。。

  6. yanhu
    2010年11月27日19:48

    @YU and 鱼

    向二位说声:Sorry

    记得有一天是“YU”留言,我故作聪明,回复时,把“YU”当作曾经留言的“鱼”

    “YU”事后还询问来着

    直到今天,我才知道此“YU”不是彼“鱼”

    但肯定都是女生

  7. yanhu
    2010年11月27日19:53

    @Nana

    小小的佩服一下妳的记忆力

    你说的那本《血型和性格》的书,我初中时看过,是个日本人写的,当时就觉得自己就特别像他在书中描述的那类B型人

    可我早忘了这个古怪名字的作者,直到今天妳突然提起

  8. yanhu
    2010年11月27日19:56

    @会长胖

    我感觉你猜得不对,也许我低估了你 :)

    因为它不是一个唯一的答案

    这个答案解释了为什么“ABO溶血”在第一胎就可发病,而“Rh溶血”第一胎基本不发病

  9. yanhu
    2010年11月27日20:01

    @long2

    答案同印度的恒猴没有关系

    其实很简单,只是我们不是从事这方面研究的,很难在专业领域发现和解决问题

    从心底,我非常佩服这些质疑和解决问题的人

    尤其是那些敢于质疑的人,是他们在推动知识体系的严谨

  10. YU
    2010年11月28日14:50

    @yanhu

    上次没错哦,真是同一个人。这次就不是,网络无极限,就当碰巧重名了呗。俺声明以后只用汉语拼音名字,免得把大夫绕晕:)

  11. 欣燃
    2010年11月28日18:28

    最差的那个学生交作业:
    因为我们都吃过血豆腐
    *_*

  12. yanhu
    2010年11月28日20:09

    @YU

    确实有点晕

    “YU”和“鱼”楼上楼下出现,还有此前的那段插曲,算是个小概率事件

    我一碰到小概率事件,就特别的High

  13. yanhu
    2010年11月28日20:12

    @欣燃

    把血豆腐都想出来了,真不容易

    你的答案还真有点沾边(书上说,我们的食物中就有类似A抗原和B抗原的物质,但没说是血豆腐),敬佩中……

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