130例肝移植患者临床用血分析

目的分析肝移植患者围手术期输血量及其特点,总结和积累在肝脏移植方面的输血经验。方法统计我院2006～2011年130名肝移植患者的输血资料,并加以总结分析。结果 130例患者全部输注了悬浮红细胞和新鲜冰冻血浆,输冷沉淀84例,占64.6%;输血小板85例,占65.4%。结论本文统计的新鲜冰冻血浆的用量比相关报道有所增加,悬浮红细胞、冷沉淀的用量差别不大,血小板的用量比文献报道的用量有所减少。     

1166例脊柱手术围术期临床红细胞和血浆输注情况调查

目的评估各类脊柱手术围手术期用血情况,以了解本院血液保护工作取得的临床成效及存在的问题。方法收集1996年1月1日—2005年12月31日本院骨科1166名围术期曾输血的脊柱手术患者血库原始资料,分析采取血液保护措施后,不同手术种类与临床用血的变化趋势。结果10年来红细胞输注量随手术量的增加递增,但患者的平均输注量逐年降低,以术中减少为主;红细胞输注量的手术种类以脊柱肿瘤手术为主;新鲜冰冻血浆用量自2004年迅速增加,且以术中增加幅度最明显。结论血液保护工作对控制脊柱手术患者术中红细胞的输注量有一定的成效,但新鲜冰冻血浆用量的急剧增加是临床合理使用还是有滥用情况,尚需要进一步的调查研究证实。     

大量输注悬浮红细胞对骨科手术患者凝血功能的影响

目的：探讨输注不同剂量悬浮红细胞对骨科手术患者凝血功能的影响。方法将126例骨科手术患者按悬浮红细胞输注量的不同分为A组（30例）和B组（34例）,A组悬浮红细胞输注量﹤8 U,B组悬浮红细胞为8~16 U,观察两组患者悬浮红细胞输注前、后凝血酶原时间（ PT）、活化部分凝血酶原时间（ APTT）、纤维蛋白原（ FIB）及血小板（ PLT）等指标变化。结果 A组PT、APTT、FIB及PLT凝血功能指标输血前后比较差异无统计学意义（ P﹥0.05）,B组输血前后四项凝血功能指标比较差异均有统计学意义（ P﹤0.05）。结论骨科手术患者大量输注悬浮红细胞时应及时补充血小板、新鲜冰冻血浆和低温沉淀物,以避免患者发生凝血功能的障碍。     

围手术期输血对结肠癌病人长期存活的影响

为确定围术期输血是否加速肿瘤生长和降低存活率,作者对155例结肠癌病人进行了回顾性研究.不管肿瘤患者以前是否输过血及使用过血制品,如果在手术前后30天内输血则定为围术期输血,输全血或选择性输各种血细胞在本研究中均认为是输血,仅输注冰冻新鲜血浆除外,     

不同疾病RhD阴性患者成分输血策略探讨

目的 探索适合不同疾病的RhD阴性患者成分输血的保障策略及节约RhD阴性血液的方法.方法 对解放军总医院输血前检空中检出的RhD阴性患者根据病情及输血概率的大小分为4组从而采取不同的备血策略.所有手术患者只要没有禁忌症均采用术中回收式自身输血.结果 共检出95例RhD阴性患者.I组9例患者均输血,共输注RhD阴性红细胞39U,新鲜冰冻血浆1 200 ml;I组30例患者中有6例患者输血,仅榆注RhD阴性红细胞9U.新鲜冰冻血浆3 700 ml;Ⅲ组45例患者中有12例患者仅输注自体血,其他33例患者共输注RhD阴性红细胞35U,新鲜冰冻血浆8 000 ml;N组11例患者共输注RhD阴性红细胞44U,新鲜冰冻血浆6 500 ml.结论 根据RhD阴性患者的病情及手术中出血量不同采取不同的备血策略,可以保证患者手术及治疗的顺利进行并节约RhD阴性血液.     

四川某三甲医院2017-2018年各年龄段患者临床用血的分析

目的:分析不同年龄组患者血液制剂的使用情况。方法:回顾性分析四川省人民医院2017-2018年10784例输血患者的临床资料,对患者临床用血的基本情况进行统计描述;根据年龄和疾病进行分组,分析不同疾病不同年龄组各种血液制剂的使用情况。结果:10784例输血患者的年龄主要集中在40-80岁,最常见的疾病为肿瘤(约占28%)。本院平均每年输注红细胞24936.5 U,血小板3795治疗量,血浆2455500 ml,冷沉淀3461.5 U。多数血液系统恶性肿瘤和肝硬化患者输注了两种或两种以上血液制剂,其中血液系统恶性肿瘤患者使用较多的是辐照红细胞悬液(76.4%)、血小板(67.8%)和悬浮红细胞(59.9%),肝硬化患者使用最多的是悬浮红细胞(64.2%)和新鲜冰冻血浆(59.4%)。创伤和慢性肾脏病患者最常使用的血液制剂为悬浮红细胞(分别为95.7%和91.5%)。在血液系统恶性肿瘤患者中,年龄≥60岁患者辐照红细胞悬液、血小板和新鲜冰冻血浆的输注量均低于<60岁的患者(P<0.05);在创伤患者中,年龄≥60岁患者悬浮红细胞的输注量低于<60岁的患者(P<0.05)。在血液系统恶性肿瘤、创伤和肝硬化患者中,年龄≥60岁患者输注血小板和(或)血浆的比例均低于<60岁的患者(P<0.05),且均更倾向于只输注红细胞。结论:同一种疾病中,年龄<60岁和≥60岁患者输注血液制剂的情况存在差异,60岁以上老年患者只输注红细胞的可能性更大,纠正缺氧是临床的主要考量,应根据患者人群制定用血计划,并根据不同人群制定不同的输血策略,最大程度提高血液的使用效率。     

围手术期FFP输注对脊柱侧弯后路矫形术患者预后的影响

目的了解输注新鲜冰冻血浆(FFP)是否可以改善脊柱侧弯后路矫形手术的患者预后。方法采用配对研究方法,分为FFP组:回顾行脊柱侧弯后路矫形手术且围手术期输注FFP的病例52例;对照组:选取同期行同样手术但未输注FFP,具有相近出血量、年龄、性别、身高、体重及术前基础Hb的病例52例。记录并比较2组患者的术前一般资料、术前及术后d3的Hb及凝血指标、术中及术后出血量、手术时间、止血药物、围手术期血制品输注情况及术后住院时间。结果 2组脊柱侧弯后路矫形手术患者的术前一般资料、术前及术后d3的Hb水平及凝血指标、术中及术后出血量、手术时间、止血药物使用及术后住院时间基本相似(P0.05)。FFP组与对照组术中自体血回输率(%)为92.31%(48/52)vs 71.15%(37/52)(P0.01);围术期异体悬浮红细胞输注量为400.00(400.00,800.00)vs 0.00(0.00,400.00)(P0.01)。结论行脊柱侧弯后路矫形手术患者围术期输注FFP并未减少其术后引流量、改善凝血功能或缩短术后住院时间,而自体血回输量,异体红细胞输注量却上升。     

新鲜冰冻血浆与红细胞高比例输注对严重创伤大量输血患者凝血功能及免疫功能的影响

目的：探讨新鲜冰冻血浆与红细胞高比例输注对严重创伤大量输血患者凝血功能及免疫功能的影响。方法：回顾性分析2017年12月~2019年12月收治的72例严重创伤大量输血患者临床资料,根据输血方案分为对照组和观察组,各36例。对照组新鲜冰冻血浆、红细胞比例为1:3,观察组新鲜冰冻血浆、红细胞比例为1:1。比较两组输血前、输血后1 d的T淋巴细胞亚群（CD4+、CD3+、CD4+/CD8+）、凝血酶时间、凝血酶原时间、纤维蛋白原、活化部分凝血活酶时间、舒张压、收缩压变化。结果：输血后1 d两组血压及CD4+、CD3+、CD4+/CD8+水平比较,差异无统计学意义（P＞0.05）;但输血后1 d观察组凝血酶时间、凝血酶原时间、活化部分凝血活酶时间均短于对照组,纤维蛋白原水平高于对照组（P＜0.05）;输血前、输血后1 d两组舒张压、收缩压对比无显著差异（P＞0.05）。结论：新鲜冰冻血浆、红细胞比例输注可改善严重创伤大量输血患者免疫功能,而新鲜冰冻血浆、红细胞高比例输注有助于防止凝血障碍发生,且不会增加应激反应。     

紧急抢救输血患者出凝血与用血量关系分析

目的:通过研究按《特殊情况紧急抢救输血推荐方案》指导的ABO同型血液储备无法满足需求时发生紧急抢救输血患者术前凝血功能,探讨术中血液制剂用量与出凝血之间的关系。方法:收集本院2015年8月-2016年12月外科患者术中用血1 600 ml的病例218例,分为凝血功能正常组(A组,106例)和凝血功能异常组(B组,紧急抢救输注O型红细胞患者31例)和未输注O型红细胞患者(C组,81例),比较各组患者基本信息,术中输注悬浮红细胞(red blood cell,RBC)、病毒灭活冰冻血浆(virus-inactivated frozen plasma,VIFP)、新鲜冰冻血浆(fresh frozen plasma,FFP)、冷沉淀血浆(cryoprecipitate plasma,CP)、血小板(platelets,Plt)(ml),术前凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、国际标准化比值(INR)的数据;分析用血量和凝血功能的相关性,对患者输血前及输血后24 h、3 d、7 d血红蛋白(hemoglobin,Hb)、未结合胆红素(indirect bilirubin,IBiL)、不规则抗体筛查、直接抗球蛋白试验(direct antiglobulin test,DAT)等指标进行对比分析,探讨患者输血前及输血后安全和疗效。结果:A组和B组患者年龄及血型分布无统计学意义(P0.05),B1组患者A型和AB型比例、输注RBC、FFP、CP和Plt量最高(P0.05);B组和C组的PT、APTT、INR、FIB明显异常(P0.05),与RBC、FFP、C的输注量相关(P0.05)。各组患者输血前DAT和不规则抗体阴性,输血后未检出新的不规则抗体,C组患者输血后Hb与输血前无统计学差异,且输血后IBiL无明显升高(P0.05),提示紧急抢救输血安全有效。结论:术前凝血功能是术中血液制剂输注量的影响因素之一,是临床术前评估患者术中出血和用血的依据,而紧急抢救输注O型红细胞可以达到ABO同型输注的安全性和有效性。     

135例肝移植患者围术期输血情况分析

目的分析135例原位经典肝移植患者在围术期的用血情况,为原位肝移植合理输血和备血提供依据。方法分析本院2010~2013年进行的135例原位肝移植患者围术期各阶段的输血率、输血量、红细胞与血浆的比例,并采用多元回归分析术中输血量的影响因素。结果 135例肝移植患者中,术前、术中和术后输血率分别是15.6%、100.0%、80.0%;围术期人均用血总量为4 808.8ml,术前、术中和术后分别占3.2%、72.0%和24.8%,术前、术中和术后的红浆比例分别为0.59∶1,0.95∶1,2.43∶1。经过多元线性回归分析发现,术中红细胞的输注量与上腹部手术史、血红蛋白和凝血酶原时间活动度相关。结论原位肝移植患者围术期血液的需求主要在术中,术前以应用血浆为主,术中和术后以应用红细胞为主。对于有上腹部手术史、血红蛋白低和凝血酶原时间活动度低的患者,手术备血时建议多备一些。     

骨折患者的术中输血分析

目的为评估各类骨折患者手术备血,为合理保障手术用血提供参考依据。方法对应骨折手术并输血的445名患者进行病例回顾性调查分析,包括不同骨折部位手术的出血量、手术中及手术前后的用血量,术中输血指征的遵循状况等。结果骨折手术输血患者中,髋臼及股骨258例,颈、胸、腰椎72例,小腿及足部56例,上肢(上臂、前臂及手)血49例,分别占57.89%、16.19%、12.58%和11.01%。颈、胸、腰椎部位手术术中出血量最多,平均出血量(881.7±695.9)ml,髋臼及股骨部位的术中出血量最少,平均出血量(378.2±414.7)ml。术中平均输血量与出血的趋势基本一致,髋臼及股骨部位手术的术中和术后输血均相对较少,术中输血22.02%符合术中输血指征。失血量400 ml和400≤失血量800 ml的患者平均年龄显著高于失血量≥800 ml,髋臼及股骨部位手术在失血400 ml的患者中所占比例最高(72.91%)。结论有77.98%输血不符合输血指征,但该部分患者髋臼及股骨部位手术比例较高,且平均年龄较高。     

骨科围手术期急性等容稀释性自体输血安全性研究

目的探讨急性等容稀释性（acute normovolemic hemodilution,ANH）自体输血在骨科围手术期的安全性。方法对本院骨科2007年7月～2013年8月住院的40例患者在麻醉后临手术前采集自体血,同时补充晶体液和（或）胶体液,采集过程中监测患者各项生命体征,手术近结束后立即将自体血回输。对照组为同期住院行择期骨科手术的患者34例,对照组未自体或异体输血。测定两组患者入院时及手术后2d的血常规并进行对比。结果两组患者手术前血常规各项指标的差异无统计学意义,ANH自体输血患者手术前和自体血回输后红细胞（RBC）、血红蛋白（HB）、红细胞压积（HCT）、血小板（PLT）的差异无统计学意义;对照组患者手术后RBC、HB、HCT较手术前显著下降（P〈0.05）。40例ANH自体输血患者均未发生采血及回输血不良反应,各项生命体征正常。结论 ANH自体输血能解决骨科血源稀缺难题,在应对骨科手术患者术中出血时发挥重要作用,对患者无不良影响,是一种安全、有效的输血方式。     

225例地震伤外科手术用血调查

目的调查四川大学华西医院救治汶川地震伤员手术用血情况。方法收集2008年5月12日—6月30日在四川大学华西医院进行手术治疗的地震伤员的输血原始发血单,记录其性别、年龄、手术名称、输血量、输血时间。结果因手术需要,手术前、中、后24h输入红细胞悬液(RBC)或新鲜冰冻血浆(FFP)的地震伤员共有225名,年龄1—87岁;用血量:RBC为1163U、FFP为124500ml。输入RBC≤2U者占手术总人数的40.89%(为总量的14.4%),2.5—4U者占27.56%(19.7%),4.5—10U者占24.89%(32.5%),RBC>10U者占6.67%(33.4%)。输入FFP100—400ml者占44.89%(26.87%),450—1000ml者占18.22%(24.02%),>1000ml者占9.33%(49.12%),另有27.56%的地震伤员未使用FFP。FFP输入量与RBC输入量具有明显的相关性(R2=0.8547,P<0.05)结论华西医院地震伤员手术用血属于少量或中等量用血,相对于RBC用量而言,FFP的用量可能偏多,规范血浆的使用,提供快速有效的检测方法将是血液保护工作的一个重点。     

输血对脑外伤患者术后感染的影响

目的 探讨输血对脑外伤患者术后感染的影响，指导合理输血。方法 选择本院1997年1月~2004年1月525例脑外伤手术患者，其中225例术中输注普通悬浮红细胞，202例输注悬浮去白细胞红细胞，98例未输血。对3组患者术后感染率及输血剂量与感染率的关系进行比较。结果 普通悬浮红细胞输血组术后感染率为11．11％，悬浮去白细胞红细胞输血组术后感染率为3．46％，与普通悬浮红细胞输血组相比差异有显著性（P〈0．01），与未输血组感染率（2．04％）比较差异无显著性。普通悬浮红细胞输血组患者的输血量与术后感染的发生显著相关（P〈0．01），而悬浮去白细胞红细胞输血组的输血量与术后感染率的相关性不显著。结论 脑外伤患者术后感染的发生与输血、血液成分及输血量等有关。在保证患者能够耐受手术的情况下，应尽量不输血或少输血，对确需输血的患者，应该输注去白细胞红细胞。     

骨科术后伤口引流血液自体回输的临床应用

目的：观察由骨科患者术后伤口引流液中回收洗涤浓缩红细胞的含量和细胞功能的变化,并探讨自体血液再回输的护理方法。方法：选择利用自体血液回输的患者30例,术中使用自体血回输仪,术后将处理后的浓缩红细胞回输给患者。在术前、术中以及术后6 h内,进行血常规和生化检查,并统计学分析。结果：30例患者共回输浓缩血量达6 876 mL,平均每例219 mL,自体血回吸收率为75%,患者术前、术后Hb及Hct比较有统计学意义（P〈0.05）。结论：术后使用自体血回输仪,及时回收了伤口引流失去的血液,减少术后患者对异体输血的需要量,是安全有效的血液回输技术。     

自体血液回收技术在大失血手术患者中的应用研究

目的：探讨自体血液回收技术对循环、血细胞和凝血功能的影响及应用效果。方法：选择急诊大失血手术患者27例,采用ZITI-2000型血液回收机回收血液,经过滤、离心、清洗后回输给患者。分不同时点观察HR、SBP、MAP、DBP、SPO2的变化,并监测RBC、Plt、HB、Hct、FIB、PT、APTT的变化。计算输血量和异体输血率。随机选择8例进行回收原血和回输血血细胞学比较。结果：（1）术前血压较低,心率较快,回输血液后,HR显著降低（P〈0.01）,SBP和MAP显著升高（P〈0.01）。（2）术前RBC、HB和Hct均低于正常水平,回输后各时点均升高明显（P〈0.01）。术前FIB和Plt低于正常水平,回输后各时点增高,但无显著意义。PT、APTT无明显变化。（3）回收原血平均每例3735 mL,回输血平均每例1589 mL,异体输血率为25%。（4）回输血RBC、HB和Hct均显著高于回收原血（P〈0.01）。结论：自体血液回收技术用于临床安全可靠,能有效维持循环的稳定,对凝血功能无明显影响,节约血源,减少异体输血。     

'Blind' transfusion of blood products in exsanguinating trauma patients

BACKGROUND: In trauma, as interventions are carried out to stop bleeding, ongoing resuscitation with blood products is of vital importance. As transfusion policy in exsanguinating patients cannot be based on laboratory tests, transfusion of blood products is performed empirically or 'blindly'. The aim of this study was to delineate 'blind' transfusion practice in the hectic clinical situation of exsanguination. METHODS: Seventeen trauma patients were selected who died due to uncontrolled bleeding despite haemostatic interventions within 24h after admission and who received more than 12 U of RBC. Transfusion data were compared with a theoretically optimal transfusion model with a fixed ratio between units of RBC, FFP, and platelets. The difference between the observed and expected amounts of blood products was calculated. RESULTS: The patients (82%) received insufficient amounts of FFP and platelets when compared to the calculated amounts. The total numbers of transfused FFP and platelets were on average 50% lower than the calculated amounts. Regression models showed an increase of FFP and platelets with increasing amounts of RBC but not in sufficient quantities. CONCLUSION: Exsanguinating trauma patients receiving massive transfusions are subject to 'blind' transfusion. This is associated with insufficient transfusion of both FFP and platelets, which may aggravate bleeding. A 'blind' transfusion strategy consisting of a validated guideline with a predefined ratio of the different blood products, timing of laboratory tests as well as a sound logistic protocol facilitating this procedure, involving the blood bank and treating physicians, is needed urgently.     

Population-based audit of fresh-frozen plasma transfusion practices

BACKGROUND: In contrast to decreasing red blood cell (RBC) consumption in Finland, the use of fresh-frozen plasma (FFP) has been increasing since the 1990s, suggesting that FFP use may not always be optimal. To improve transfusion practices, knowledge of current FFP use and regional, national, and international comparison is necessary. STUDY DESIGN AND METHODS: Nine (of 21) Finnish hospital districts participated. Data concerning FFP-transfused patients in the years 2002 and 2003 were collected from existing computerized medical records into a yearly updated database as part of a Finnish benchmarking project on blood component use. RESULTS: Data included 11,590 FFP-transfused patients and 60,240 FFP units (71.2% of Finnish FFP use) delivered to Finnish hospitals during the study period. FFP was transfused most often to surgery patients (62.8% of FFP transfusion hospital visits) with blood circulatory system problems (32.3% of surgically treated and FFP-transfused patients). In only 65.9 percent of FFP-transfused patients were coagulation variables measured at any point in the hospital episode, and FFP was usually transfused in paired doses. Mean FFP use in Finland is comparable to other countries. CONCLUSION: Although overall FFP use in Finland is similar to that of international figures, it does not ensure best practice. Perioperative staff, being the largest FFP user, should be encouraged to dose FFP based on coagulation variables and body weight. Improvement efforts should be directed to patient groups transfused with large amounts of FFP.     

Posterior reversible encephalopathy syndrome following blood transfusion in a patient with factor X deficiency: Is it an unusual systemic manifestation of an adverse transfusion reaction?

Adverse neurological transfusion reactions including posterior reversible encephalopathy syndrome (PRES) following blood transfusion are rare. Our case an 18-year-female with known Factor X deficiency with menorrhagia developed severe hypertension, followed by generalised tonic clonic convulsions apparently after blood component transfusion. She had earlier received 4 units of red blood cells (RBC) for anaemia and 10 units of fresh frozen plasma (FFP) for menorrhagia (with prolonged PT and APTT) within short span of time at another hospital. There was no history of hypertension, convulsions, any cardiovascular, renal or neurological disease before transfusion. The clinical features and magnetic resonance imaging findings led to the diagnosis of PRES. Abnormal electroencephalogram and a hypercoagulable haemostatic profile on thromboelastography along with derangement in blood glucose and liver function tests were also observed. Patient responded well to the anticonvulsants and antihypertensive agents prescribed and was discharged in a stable condition. Our patient had a systemic transfusion reaction involving predominantly neurological system, however, cardiovascular, hepatic, haemostatic and endocrine systems were also affected. This case is unusual being the first report of PRES occurring in a patient with factor X deficiency presenting with an array of clinical and laboratory features which have not been reported in earlier studies involving PRES. Presumably the initial aggressive red cell transfusion to treat anaemia initiated the crisis and further large volumes of transfused FFP contributed to this adverse transfusion reaction in our case. Clinicians and Transfusion Medicine specialists should be aware about this uncommon clinical entity.     

Transmission of hepatitis A via WBC-reduced RBCs and FFP from a single donation

BACKGROUND: Currently, individuals donating whole blood and cellular components are not screened for hepatitis A (HA). However, transfusion-transmitted HA can occur, albeit very rarely. Although infection is typically mild and self-limited, it may be catastrophic in a small percentage of cases. Two cases of HA transmission from a single donation to two patients with subsequent variable morbidity are reported. CASE REPORTS: A 50-year-old, asymptomatic, volunteer blood donor made a whole-blood donation. He was found to have HA 18 days later. When notified, the donor center initiated a recall of the components produced from the donated unit. However, the RBCs and FFP had already been transfused. Subsequently, both recipients developed HA as documented by IgM anti-HA serology. The RBC recipient was a 49-year-old woman, transfused after a hysterectomy, who was found to have HA at the time of unit recall (20 days after transfusion). Her condition required the use of medical disability leave. The FFP was infused to a 52-year-old female cardiac surgical patient. Her course was marked by multiple complications, including postoperative development of mild hepatic dysfunction. After testing negative for HA, hepatitis B, and hepatitis C (24 days after transfusion), she suffered a second bout of more severe hepatic dysfunction and was documented to have HA at Day 55 after transfusion. Evaluation of both recipients' close contacts revealed no evidence for exposure to HA by any route other than transfusion. CONCLUSION: HA can be transmitted by transfusion of units obtained from asymptomatic, infectious donors. Two patients contracted HA from components obtained from a single whole-blood donation. The RBC recipient had a typical self-limited course of HA. The FFP recipient developed HA of relatively delayed onset. Both recovered from HA.