正形红细胞在肾性血尿中的评价

目的 为了正确地应用及评价红细胞位相对血尿定位的标准，认识正形红细胞的诊断意义。方法 对674例肾活检诊断为各类 肾小球疾病的尿红细胞形态作对比分析，结果 其中有58例表现为正形红细胞，占8.6%，说明了即使红细胞形态正常，也不能排除肾小球疾病。结论 在肾小球疾病中，正形红细胞的形成是多因素的，我们应该客观地结合临床来评价检测方法和结果。     

Usefulness of color doppler sonography and 99m Tc-RBC scintigraphy for preoperative diagnosis of a venous malformation of the small intestine in a 2-year-old child

Venous malformations of the small intestine are rare in children, and the preoperative diagnosis of a venous malformation in the small bowel can be very difficult. We report the case of a 2-year-old girl with a solitary cavernous venous malformation of the small intestine that caused gastrointestinal bleeding and anemia and review the usefulness of the combination of color Doppler sonography and 99m Tc-RBC scintigraphy for the diagnosis of venous malformation of the small intestine.     

ConA对红细胞膜力学性质的影响

本文研究了伴刀豆蛋白ＣｏｎＡ（Ｃｏｎｃａｎａｖａｌｉｎ　Ａ）以受体配体的作用方 式对红细胞膜力学性质的影响，结果显示出：（１）经ＣｏｎＡ处理后的血影红细胞膜 （ｒｅｓｅａｌ ｇｏａｓｔ）蛋白构象发生改变，蛋白运动性下降；（２）红细胞变形恢复半时间缩 短．表明ＣｏｎＡ作用后的红细胞膜切变弹性模量可能增大；（３）红细胞机械脆性随 ＣｏｎＡ浓度呈上升趋势，说明膜稳定性受到影响；（４）红细咆膜脂流动性下降．     

自身免疫性肝病患者红细胞CR1密度基因多态性与CR1免疫活性相关性分析

自身免疫性肝病是一种严重危害人类健康的慢性疾病，近年来发现患者红细胞膜分子的数量及粘附活性异常，且与病程及并发症的发生、发展密切相关。红细胞广泛表达多种膜免疫分子，目前研究最多的是红细胞I型补体受体（CR1，CD35）， CR1通过对补体活化系统的调节，参与免疫复合物的清除，调节淋巴细胞、吞噬细胞的免疫功能。     

Blood Utilization After Primary Total Joint Arthroplasty in a Large Hospital Network

Background

Since a study in orthopedic hip fracture patients demonstrated that a liberal hemoglobin (Hb) threshold does not improve patient morbidity and mortality relative to a restrictive Hb threshold, the standard of care in total joint arthroplasty (TJA) should be examined to understand the variability of red blood cell (RBC) transfusion following TJA.

Questions/purposes

The study aimed to answer the following questions: (1) What is the blood utilization rate after primary TJA for individual surgeons within a large hospital network? (2) What is the comparison of hospital charges, length of stay (LOS), and discharge locations among TJA patients who were and were not transfused?

Methods

A retrospective study was conducted on 3,750 primary total knee arthroplasties (TKAs) and 2,070 primary total hip arthroplasties (THAs), and data was retrospectively collected over a 15-month period on the number of RBCs transfused per patient, along with demographic and cost details. The number of patients who received at least 1 RBC unit and the number of RBCs transfused per patient was calculated and stratified by surgeon.

Results

In the postoperative period, 19.3% TKA patients and 38.5% THA patients received a RBC transfusion. Transfusion rates following TJA varied widely between surgeons (TKA 4.8–63.8%, THA 4.3–86.8%). Transfused TKA patients received an average of 1.65 ± 0.03 RBCs, and THA patients received an average of 1.97 ± 0.14 RBCs. LOS and hospital charges for blood transfusion patients were higher than nontransfused patients.

Conclusion

Blood utilization after primary TJA varies greatly among surgeons, suggesting that resources may be misallocated. These findings highlight the need to standardize RBC transfusion practice following TJA.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-013-9327-y) contains supplementary material, which is available to authorized users.     

Flow cytometric determination of RBC survival in autoimmune hemolytic anemia

BACKGROUND: In cases of warm autoimmune hemolytic anemia (WAIHA), crossmatch incompatible RBCs are most often used for transfusion. The determination of the in vivo survival of transfused and autologous RBCs in WAIHA is helpful in the assessment of the efficacy of transfusion and other therapeutic interventions. CASE REPORT: A 38-year-old man presented with acute WAIHA, thrombocytopenia, and neutropenia. Steroids and IVIG therapy were ineffective, and the patient received RBCS: Because of increasing hemolysis and persisting thrombocytopenia, splenectomy was performed, resulting in partial remission. Further improvement was achieved by immunosuppressive therapy. MATERIALS AND METHODS AND RESULTS: Survival of transfused and autologous RBCs was determined, using a flow cytometric method based on the determination of different blood group antigens of patient and donor RBCS: The survival of autologous and transfused RBCs before splenectomy was determined on two consecutive days. The life span of autologous RBCs remained rather stable at 69 and 64 hours on Days 10 and 11, respectively, whereas the life span of transfused RBCs decreased from 186 hours to 25 hours. After splenectomy, the life span of transfused RBCs almost normalized: 43 days at postsplenectomy Day 3 and 87 days at postsplenectomy Day 69. CONCLUSION: Flow cytometry was successfully used to determine changing hemolytic activity during the clinical course of WAIHA. Additionally, the survival of transfused RBCs could be measured, which may be helpful to judge for the compatibility of allogeneic RBCS: Thus, we were able to show the therapeutic inefficacy of steroids and immunoglobulins, and quick improvement after splenectomy.     

不同麻醉方法对髋关节置换术后红细胞内源性恢复的影响

目的 比较蛛网膜下腔-硬膜外腔联合阻滞（combined spinal—epidural anesthesia，CSEA）、静吸复合全麻（general anesthesia，GA）和全麻复合硬膜外麻醉（combined epidural and general anesthesia，CA）三种麻醉方法对髋关节置换术后病人红细胞总量恢复的影响。方法 48例ASAⅠ～Ⅲ级，拟行髋关节置换术患者随机分为CSEA、GA和CA三组，记录术中失血量，检测术前、术后第1、3、5d血常规，根据Nadler公式计算血容量．红细胞总量为血容量乘以单位红细胞计数。结果 三组病人术中失血量差异无统计学意义（F分别=0．22、0．25．P．均〉0．05）；术后第1天与术前相比，CSEA、GA、CA三组病人红细胞总量显著下降，差异均有统计学意义（t分别=3．65、3．48、3．66，P均〈0．05）。CSEA组与术前比较，术后第5天开始出现红细胞内源性恢复，差异有统计学意义（t=2．03，P〈0．05），而GA、CA组比较，差异无统计学意义（t=0．08、0．09，P均〉0．05），未出现红细胞内源性恢复。术后第3、5天CSEA组与GA、CA组比较，红细胞总量差异均有统计学意义（t分别=2．04、2．03、1．71、3．15，P〈0．05）。结论 CSEA下行髋关节置换术病人内源性红细胞总量的恢复较GA和CA组迅速。     

直抗阳性导致交叉配血次侧不合的肿瘤患者红细胞输注疗效观察

目的观察微柱凝胶法直抗(DAT)阳性交叉配血次侧不合的肿瘤患者红细胞输注疗效。方法收集2014年1月-2015年12月期间我院交叉配血主侧相合次侧不合,DAT阳性的25例输血肿瘤患者作为实验组,随机挑选100例同类型疾病但配血主次侧均相合且DAT阴性的患者作为对照组,比较两组白蛋白(ALB)、球蛋白(GLB)以及输血前后的胆红素(TBIL、DBIL、IBIL)、血红蛋白(Hb)、红细胞压积(Hct)、红细胞(RBC);并评估红细胞输注的临床疗效。结果实验组输血前后的Hb、Hct、RBC显著性升高(P0.05),TBIL、DBIL、IBIL无明显变化(P0.05);实验组比对照组GLB显著性升高(P0.05),实验组和对照组TBIL、DBIL、IBIL、ALB以及输血前后血象的变化无显著性差异(P0.05)。实验组无效输血率16%,与对照组无显著性差异(P0.05)。结论红细胞输注对于DAT阳性导致交叉配血次侧不合的肿瘤患者是安全有效的。     

ABO反定型试剂红细胞的质量控制

已知血型的试剂红细胞是ABO血型的血清学鉴定中检测抗体必不可少的试剂。为了提高ABO血型检定结果的准确性，解决自制试剂红细胞无标准和无质控的问题，本研究组建立了ABO反定型试剂红细胞的质控方法，进行了试剂红细胞的特异性和亲和性检测、振荡检测、流式细胞术和原子显微镜观察。通过筛选建立了质控参考品，并在此基础上确定质量检定标准及质控方法，同时对制备的3批次试剂红细胞进行了评价。研究结果表明：制备的反定型试剂红细胞既能保证质量和性能的稳定，又能最大限度地降低批次间的差异。结论：制备的AB0反定型试剂红细胞解决了自制红细胞的质控问题，并能提高血型检定结果的准确性。     

Screening of HLA sensitization during acute burn care

Background

Since the inception of clinical VCA almost two decades ago, burn victims have been identified as immunologically complex patients owing to preformed HLA antibodies. However, it remains unclear whether the detected HLA antibodies are the result of former alloantigenic events or if their de novo formation occurs during primary burn care.