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医学 1901

论正常人类血液的凝集现象

卡尔·兰德施泰纳

健康人的血液分属不同、互不相容的种类——这正是输血有时致命的原因。

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In depth · the introduction

几个世纪以来,把一个人的血输给另一个人,都是一场赌博——有时救人一命,有时夺人性命,直到维也纳的一位年轻医生发现:人类的血液分属不同的种类,彼此并不相融。

核心想法

卡尔·兰德施泰纳注意到一件从没有人当真的事:若把一名健康者血液里的清亮液体(血清)与另一名健康者的红细胞混在一起,那些红细胞有时会成团凝结——有时却不会。这取决于「谁」配上了「谁」。

他把 22 名健康者的血液两两相互测试,看出了一个清晰的格局:人们落入为数不多的几个群。他称之为 A、B 与 C(今天我们把 C 称作 O 群)。你的血型,决定了你的身体会接纳谁的血、又会攻击谁的血。正是这一个洞见,让今天的输血成了寻常之事,而不再是一场与死神的掷币赌博。

它是如何诞生的

到 1900 年,输血背着一个可怕的名声。有时病人康复了;有时他们的血凝结成团、人就死了,却没人知道为什么。许多医生以为,这种凝结是疾病的征象。而在维也纳一所病理研究所工作的兰德施泰纳,怀疑的却是更离奇的事——健康人,彼此之间本就不同。

于是他做了那个事后看来理所当然的实验:他和同事抽出自己的血,把每一份样本与其余每一份交叉相试。凝结并不是随机的。它把所有人分进了为数不多的几个类型,且服从一条工整的规则——而你自己的血,从不与自己凝结。他于 1901 年把它写成了一篇三页的论文。第四、也是最罕见的 AB 型,就在次年由他的两位同事发现。

它为何重要

正是这一发现,让输血变得安全。一旦你能给供者和病人定型,你就能为他们配对——于是手术室、产房、战地医院,都以前所未有的方式变得可活下来。兰德施泰纳还准确地指出了另外两项用途:在犯罪现场鉴定血迹,以及终于解释了为何过去的输血如此难以预料。他凭此在 1930 年赢得了诺贝尔奖。

一个可以想象的画面

把每个红细胞想象成举着一面彩旗:A 红细胞举「A」旗,B 红细胞举「B」旗,AB 红细胞两面旗都举,而 O 红细胞一面也不举。你的免疫系统则像一名门卫,凡是认不出、不属于「自家」的旗子,他都要攻击。O 型的人没见过任何旗子,所以他的门卫会同时攻击 A 与 B——可他自己那不举旗的红细胞,谁也不冒犯,这正是 O 型血能输给任何人的缘由。AB 型的人两面旗都见过,所以他的门卫对谁都放行。那些旗子,就是抗原;门卫的那些「积怨」,就是你血浆里的抗体。

一张可交互的血型鉴定卡:选择 O、A、B 或 AB 型,同样的红细胞被滴入两个孔——一孔为抗 A 血清,一孔为抗 B 血清。唯有红细胞带有相配的抗原时,那一孔才会凝集,于是凝集的格局反过来读出血型。

它的位置

兰德施泰纳站在免疫学走向实用的那个起点上。在他身后,是证明了疾病可以被驯服的巴斯德与科赫;在他前方,是 Rh 因子的发现(这也有他的一份功劳,在 1940 年)、现代血库与器官移植——而这每一样,都依赖于把供者与受者配对。在本馆里,你还可以读到弗莱明所开启的下一项救命之器——抗生素;二者一道,让二十世纪的医学变得可以活下来。

The original document
Original source text

开篇——健康人的血液彼此有别

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.

凝集反应表

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.
[ … ]

划分为三个群

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.

结尾——法医与输血

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