英国布里斯托输血协会的David J Anstee在最近一期《血液》杂志上发表文章，探讨了红细胞基因分型技术近年来的发展以及在输血实践中的应用。

　　近20年来，科学家们几乎确定了所有主要血型抗原的分子基础。这项研究极大促进了以DNA技术为基础的红细胞基因分型方法的发展。DNA技术在红细胞分型中最引人瞩目的应用是：对可能罹患新生儿溶血病的胎儿，在其母体内即能确定胎儿的血型。然而，在输血前检查中，分子生物学方法取代传统血清学方法并不会一蹴而就。对大多数受血者来说，并不需要除ABO和Rh血型以外的其它血型与供血者相配合。而对少数存在同种免疫风险的没有接受过输血的患者，虽然能从血型配合度扩大的血液中受益，但是这种检测并不完全可靠。即使某种方法能够鉴定出容易产生同种抗体的个体，也不能保证给这些病人提供血型完全配合的血液，因为这是由献血者的数量和种族来源决定的。但是，基于DNA技术的常规分型方法可以给那些易产生同种免疫，而且体内已经存在抗体的患者，比如镰刀形红细胞贫血病患者，提供最优适配的献血者的血液，而且这一方法已经得到了广泛应用。

　　相关研究论文发表在2009年5月1日的《血液》（blood）在线出版上。

　　原始出处：Blood: Prepublished online May 1， 2009;

　　Red cell genotyping and the future of pre-transfusion testing. David J Anstee.

　　Abstract

　　Over the past 20 years the molecular bases of almost all the major blood group antigens have been determined. This research has enabled development of DNA-based methods for determination of blood group genotype. The most notable application of these DNA-based methods has been for determination of fetal blood group in pregnancies where the fetus is at risk from Hemolytic Disease of the Fetus and Newborn (HDFN). The replacement of all conventional serological methods for pre-transfusion testing by molecular methods is not straightforward. For the majority of transfusion recipients matching beyond ABO and D type is unnecessary and the minority of untransfused patients at risk of alloimmunization who would benefit from more extensively blood group matched blood cannot be identified reliably. Even if a method to identify individuals most likely to make alloantibodies were available this would not of itself guarantee the provision of extensively phenotype matched blood for these patients because this is determined by the size and racial composition of blood donations available for transfusion. However， routine use of DNA-based extended phenotyping to provide optimally matched donations for patients with pre-existing antibodies or patients with a known predisposition to alloimmunization such as those with sickle cell disease， is widely employed.

（叶璐夷）