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醫學 1901

論正常人類血液的凝集現象

卡爾·蘭德施泰納

健康人的血液分屬不同、互不相容的種類——這正是輸血有時致命的原因。

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In depth · the introduction

幾個世紀以來,把一個人的血輸給另一個人,都是一場賭博——有時救人一命,有時奪人性命,直到維也納的一位年輕醫生發現:人類的血液分屬不同的種類,彼此並不相融。

核心想法

卡爾·蘭德施泰納注意到一件從沒有人當真的事:若把一名健康者血液裡的清亮液體(血清)與另一名健康者的紅血球混在一起,那些紅血球有時會成團凝結——有時卻不會。這取決於「誰」配上了「誰」。

他把 22 名健康者的血液兩兩相互測試,看出了一個清晰的格局:人們落入為數不多的幾個群。他稱之為 A、B 與 C(今天我們把 C 稱作 O 群)。你的血型,決定了你的身體會接納誰的血、又會攻擊誰的血。正是這一個洞見,讓今天的輸血成了尋常之事,而不再是一場與死神的擲幣賭博。

它是如何誕生的

到 1900 年,輸血背著一個可怕的名聲。有時病人康復了;有時他們的血凝結成團、人就死了,卻沒人知道為什麼。許多醫生以為,這種凝結是疾病的徵象。而在維也納一所病理研究所工作的蘭德施泰納,懷疑的卻是更離奇的事——健康人,彼此之間本就不同。

於是他做了那個事後看來理所當然的實驗:他和同事抽出自己的血,把每一份樣本與其餘每一份交叉相試。凝結並不是隨機的。它把所有人分進了為數不多的幾個類型,且服從一條工整的規則——而你自己的血,從不與自己凝結。他於 1901 年把它寫成了一篇三頁的論文。第四、也是最罕見的 AB 型,就在次年由他的兩位同事發現。

它為何重要

正是這一發現,讓輸血變得安全。一旦你能給供者和病人定型,你就能為他們配對——於是手術室、產房、戰地醫院,都以前所未有的方式變得可活下來。蘭德施泰納還準確地指出了另外兩項用途:在犯罪現場鑑定血跡,以及終於解釋了為何過去的輸血如此難以預料。他憑此在 1930 年贏得了諾貝爾獎。

一個可以想像的畫面

把每個紅血球想像成舉著一面彩旗:A 紅血球舉「A」旗,B 紅血球舉「B」旗,AB 紅血球兩面旗都舉,而 O 紅血球一面也不舉。你的免疫系統則像一名門衛,凡是認不出、不屬於「自家」的旗子,他都要攻擊。O 型的人沒見過任何旗子,所以他的門衛會同時攻擊 A 與 B——可他自己那不舉旗的紅血球,誰也不冒犯,這正是 O 型血能輸給任何人的緣由。AB 型的人兩面旗都見過,所以他的門衛對誰都放行。那些旗子,就是抗原;門衛的那些「積怨」,就是你血漿裡的抗體。

一張可互動的血型鑑定卡:選擇 O、A、B 或 AB 型,同樣的紅血球被滴入兩個孔——一孔為抗 A 血清,一孔為抗 B 血清。唯有紅血球帶有相配的抗原時,那一孔才會凝集,於是凝集的格局反過來讀出血型。

它的位置

蘭德施泰納站在免疫學走向實用的那個起點上。在他身後,是證明了疾病可以被馴服的巴斯德與科赫;在他前方,是 Rh 因子的發現(這也有他的一份功勞,在 1940 年)、現代血庫與器官移植——而這每一樣,都依賴於把供者與受者配對。在本館裡,你還可以讀到弗萊明所開啟的下一項救命之器——抗生素;二者一道,讓二十世紀的醫學變得可以活下來。

The original document
Original source text

開篇——健康人的血液彼此有別

Karl Landsteiner · Wiener klinische Wochenschrift 14 (1901): 1132–1134 · English translation
Some time ago I observed and reported that blood serum of normal human beings is often capable of agglutinating red blood corpuscles of other healthy individuals.
A real difference between my observations and Maragliano's is that in Maragliano's case the serum acts also on corpuscles which come from the same individual and that the reaction is obtained only with abnormal blood. My observations, however, show differences of a rather striking kind between blood serum and corpuscles of different apparently entirely healthy human beings.

凝集反應表

Tables I–III · sera of apparently healthy persons crossed against one another's corpuscles
About equal amounts of serum and approximately 5% blood suspension were mixed in 0.6% saline solution and observed in hanging drops or in test tubes (the plus sign denotes agglutination).
All 22 examined sera from healthy persons gave the reaction. The result obviously would have been different had I not used a number of different corpuscles for the test.
[ … ]

劃分為三個群

Landsteiner sorts the 22 sera into three regular classes — the groups later named A, B and O
In addition, however, a remarkable regularity appeared in the behavior of the 22 blood specimens examined. … in most cases the sera could be divided into three groups:
In several cases (group A) the serum reacted on the corpuscles of another group (B), but not on those of group A, whereas the A corpuscles are again influenced in the same manner by serum B. In the third group (C) the serum agglutinates the corpuscles of A and B, while the C corpuscles are not affected by sera of A and B.
In ordinary speech, it can be said that in these cases at least two different kinds of agglutinins are present: some in A, others in B and both together in C.

結尾——法醫與輸血

The described agglutination can also be produced with serum which has been dried and then dissolved. … Thus the reaction may possibly be suitable for forensic purposes of identification in some cases, or, better, for the detection of the nonidentity of blood specimens…
Finally, it must be mentioned that the reported observations allow us to explain the variable results in therapeutic transfusions of human blood.
Karl Landsteiner · Vienna · 1901