提问：
有一 17 岁患儿急需肝移植，父亲坚持活体供肝，患儿 O 型血，父亲 AB 型血、母亲 A 型血，如何进行沟通？
不要着急胡思乱想，作为专业的医生，我们要用专业的角度思考问题：
1、顺式 AB 型血的产生的原因
cisAB 这一术语也在 1965 年由日本学者 Yamaguchi 等正式提出和命名。1990 年 ABO 基因被克隆和测序以后，cisAB 血型的分子遗传模式才得以逐步揭示。导致顺式 AB 表现型的原因主要与 A 或者 B 基因 7 号外显子的点突变有关。
普通的 AB 型血型，A 基因和 B 基因位于两条不同的
染色体
上
，
ABO 血型是由三个复等位基因 IA、IB、i 决定的。
两条染色体分别来自父母亲中的一方，当继续向后代遗传时，只能随机将其中的一个基因遗传给子女。即 AB 型的丈夫、O 型的妻子，子女的基因组合只可能是 AO 或 BO，表现在血型上即是 A 型或 B 型，因此一般认为不可能出现 AB 型的子女。
但是，顺式 AB 型（CisAB）的染色体在某次减数分裂的过程中，出现了小小的意外。两条同源染色体之间互换，所以 IA 基因和 IB 基因就变成了一条染色体上的「蚂蚱」。
（一条染色体上同时具有 IA 基因和 IB 基因）
IA 基因与 IB 基因牢牢绑在一起，在遗传给下一代时就可以同时遗传给子女。
2、顺式 AB 型血的父亲怎么生出 O 型血的孩子呢？
若父亲是顺式 AB 型（CisAB）血，如果儿子从父亲方遗传一个 IAB 基因，即使从母亲方遗传得到一个 i 基因，那么这个儿子也是 CisAB 血。
那如何跟 A 型血的母亲生出 O 型血的儿子呢？
若父亲是顺式 AB 型血，并且是顺式 AB 型血与 O 型血的杂合基因（基因型为 IAB i），母亲是 A 型血的杂合基因（基因型为 IA i）。儿子从父方遗传得到一个 i 基因，然后再从母亲遗传得到一个 i 基因：
儿子的 O 型血不就成立了么。
血型可不只是 ABO 和 RH，据说血型有 1000 多种，一一细说就留到以后吧，今天咱们还是再好好看看顺式 AB 型血吧，这又一逆天的遗传的血型。
3、顺式 AB 型与普通 AB 型血指在遗传特征上的区别？
正常的 AB 型血，基因分别位于 9 号的两条染色体上，一条染色体为 A 基因，编码 A 抗原，一条染色体为 B 基因，编码 B 抗原，两条染色体各司其职，正定型时表现出 AB 的表型，ABO 血型表观遗传学符合孟德尔规律。
而顺式 AB 型血，是一条染色体就干了两条染色体的活，其 ABO 血型表观遗传学不符合孟德尔规律，而是以顺式遗传为特点
，即当一单倍体的 A 或 B 等位基因发生一点或多点突变时，此单倍型编码的基因产物同时具备转运 α-1,3-N - 乙酰半乳糖胺和 α-1,3 - 半乳糖两种糖基的能力，分别加到 L - 岩藻糖上形成 A 和 B 抗原，在进行正定型时表现出 AB 的表型。
4、顺式 AB 型血与普通 AB 型在血清学特征上的区别
在 ABO 亚型中，cisAB 是较为常见的表现型，虽然也是同时表达 A 抗原和 B 抗原，其与正常的 AB 型除了基因上的差异，在日常的正反定型中也存在一定的差异。
正常 AB 型血血清学特征：
(1) 红细胞膜上同时表达 A 抗原和 B 抗原性。
(2) 血清中不存在 A 抗体和 B 抗体。
顺式 AB 型血血清学特征为:
(1) 当顺式 AB 型血等位基因与 O 基因杂合时 (基因型为 IABi 时)，可同时表达 A、B 基因性状，血清学常表现为 A2B3 或 A2Bx，即这种表现型以 A 抗原为主、B 抗原较弱。
(2) 当顺式 AB 型血等位基因与正常的 A 或 B 等位基因共存时（IAB IA 或 IAB IB），分别表现为 ABx（A 抗原为主，B 抗原较弱）或 AxB（B 抗原为主，A 抗原较弱）。
(3) CisAB 分泌型人的唾液中有 A 物质、H 物质和非常弱的 B 物质，因为个体差异，有的 CisAB 亚型人群的唾液中 B 物质几乎检测不到，
故而，顺式（Cis）AB 型血在常规血型鉴定中，极易出现正反定型不符
。而 cisAB 血型的人通常无其他临床不适表现，由此极易导致血型错判，在借助常规方法判定子代血型的临床检测 (如亲子鉴定等) 中，应特别慎重。在出现正定型弱凝集或者正反定型不符的情况，应进一步进行基因测序，确证血型。
5、顺式 (Cis) AB 型血输血注意事项
在临床输血时，配血不相合，可引起溶血性输血反应，对于血型为 cisAB 的受血者，由于其血清中偶有抗 - A 或抗 - B（比如：表现型为 A2B 含有弱的抗 - A1），故以输注 O 型洗涤红细胞和 AB 型血浆为佳。
首发：丁香园检验时间
参考文献：
[1] 赵晖，姜悦，闫芳，苗天红，何喜友，崔衢，刘元波。遗传性 CisAB 血型的血清学和基因型特征研究 —— 附一例家系报告 [J]. 中国输血杂志，2015,28 (01):18-21.
[2] 武文，张志波，马红霞，黄象艳.CisAB 亚型误判原因分析及其家系遗传规律研究 —— 附 1 例病例报告 [J]. 中国输血杂志，2019,32 (06):542-545.
[3] 金沙，蔡晓红，刘曦，王健莲，陆琼，沈伟，范亮峰，向东。上海地区献血人群 cisAB 和 B (A) 血型的研究 [J]. 中国输血杂志，2013,26 (12):1198-1201.
[4] 张莉尼，陈忠。对国内 7 例顺式 (cis) AB 的分析 [J]. 中国输血杂志，1993 (01):54-55+62.
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and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root[data-weui-mode=care]:not([data-weui-theme=light]),body:not(.pages_skin_pc) body[data-weui-mode=care]:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .85);--weui-FG-HALF: rgba(255, 255, 255, .65);--weui-FG-1: rgba(255, 255, 255, .55);--weui-FG-2: rgba(255, 255, 255, .35);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, 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rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) 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#10aeff;--weui-INDIGO: #1485ee;--weui-PURPLE: #6467f0;--weui-WHITE: #fff;--weui-LINK: #576b95;--weui-TEXTGREEN: #06ae56;--weui-FG: #000;--weui-BG: #fff;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: #fa9d3b;--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: #06ae56;--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: #10aeff;--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(0, 0, 0, .5);--weui-TAG-BACKGROUND-BLACK: rgba(0, 0, 0, .05)}.wx-root,body{--weui-BTN-ACTIVE-MASK: rgba(0, 0, 0, .1)}.wx-root,body{--weui-BTN-DEFAULT-ACTIVE-BG: #e6e6e6}.wx-root,body{--weui-DIALOG-LINE-COLOR: rgba(0, 0, 0, .1)}.wx-root,body{--weui-BG-COLOR-ACTIVE: #ececec}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BTN-ACTIVE-MASK: rgba(255, 255, 255, .1)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BTN-DEFAULT-ACTIVE-BG: rgba(255, 255, 255, .126)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-DIALOG-LINE-COLOR: rgba(255, 255, 255, .1)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--APPMSGCARD-BG: #1E1E1E}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--APPMSGCARD-LINE-BG: rgba(255, 255, 255, .07)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BG-COLOR-ACTIVE: #373737}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BG-6: rgba(255, 255, 255, .1);--weui-ACTIVE-MASK: rgba(255, 255, 255, .1)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-REDORANGE: #ff6146;--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--discussInput-BG: rgba(255, 255, 255, .03)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--nickName-FG: #959595}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--appmsgExtra-BG: #121212}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) :root{--appmsgPageGap: 20px;--appmsgPageBottomGap: 40px}}:root{--articleFontsize: 17px}:root{--sab: env(safe-area-inset-bottom)}:root{--wxBorderAvatarRatio: 3}:root{--discussPageGap: 20px}:root{--immersive-safe-bottom: env(safe-area-inset-bottom)}:root{--appmsgPageGap: 20px;--appmsgPageBottomGap: 40px}*{margin:0;padding:0}.rich_media_content *{max-width:100%!important;box-sizing:border-box!important;-webkit-box-sizing:border-box!important;word-wrap:break-word!important}.rich_media_content p{clear:both;min-height:1em}td p{margin:0;padding:0}@media(prefers-color-scheme:dark){body:not([data-weui-theme=light]) .rich_media_content img:not(.wx_img_placeholder){filter:brightness(.8)}}
div.autoTypeSetting24psection > p,div.autoTypeSetting24psection > section{margin-bottom: 24px;}
