血小板抗原基因分型与配型在血小板输注中的应用简

本研究建立已知HPA基因型血小板供者库,开展相同HPA基因型血小板交叉配型后输注,防止血小板抗体的产生,解决血小板无效输注.应用PCR-SSP技术对血小板献血者和患者进行HPA基因分型,采集与患者ABO血型及HPA基因型相同血小板制剂,再加以固相凝集法配型相合后输注.结果表明,牡丹江地区HPA血型分布的遗传特征具有本地区人群特点,具有最高杂合度的是HPA-15,其次是HPA-3.采用ABO血型及HPA基因型均相同加固相凝集配型相合血小板输注有效率94.4％.采用ABO血型相同随机血小板固相凝集配型相合输注有效率77.8％.结论：牡丹江地区HPA血型分布的遗传特征具有多态性,采用血小板HPA同基因型供者采集加配型输注可防止血小板免疫性抗体及输注无效的发生,采用ABO同型随机血小板加配型输注是提高血小板输注的效果、防止输注无效发生的既经济又简便的方法.     

急性白血病患者单采血小板输注疗效的回顾性分析

目的 分析急性白血病患者单采血小板输注疗效的影响因素.方法 采用回顾性方法收集54例急性白血病患者共294例次输注单采血小板的信息,按性别、年龄、血型、血小板输注次数等进行分组,评估输注疗效,计算有效率,并分析影响输注疗效的因素.结果 不同性别、年龄、血型患者的输注有效率接近.不同的输注次数影响输注疗效,输注次数越多,...     

临床727例次单采血小板输注效果分析

为分析临床单采血小板输注效果及其影响因素,回顾性分析湘雅第三医院2010年9月至2011年5月进行单采血小板输注的254名患者的727例次输注资料,计算血小板计数增高指数(CCI)和血小板回收率(PPR)评价血小板输注效果,统计输注有效率,根据患者病症、输血次数、血型和脾肿大与否分组进行统计学比较。结果表明,727例次输注单采血小板有效456例次,占62.72%,以急性失血性贫血和慢性系统性疾病患者输注效果较为明显,尤其是慢性肾疾病(有效率为94.12%);脾脏肿大影响血小板输注效果(有效率仅为40.35%);血小板输注次数与输注效果呈负相关。结论:脾脏肿大和血小板输注次数是影响输注效果的因素。     

1例急性肾功能不全病人非同型血小板输注的管理

正2014年初,中国医师协会和中华医学会临床输血学分会发布了《特殊情况紧急抢救输血推荐方案》~([1]),对特殊情况紧急抢救输注血小板提出的建议有:"首选与受血者ABO/RhD血型同型血小板输注;在紧急抢救病人生命时,发现病人血型难以判断或血小板供应短缺时,可以选择不同血型的单采血小板输注;输注不同血型的单采血小板,应选择抗-A、抗-B效价≤64的     

血液病患者两种血小板输注的临床疗效比较

目的 探讨单采和手工分离血小板输注对血液病患者的临床疗效差异,为临床合理、有效使用血小板提供参考依据.方法 选择62例(256例次)输注血小板的血液病患者,其中输注单采血小板患者39例为单采组,输注手工分离血小板患者23例为手工组,于输注前、输注后24 h进行外周血小板计数,根据血小板计数增高指数(CCI)、血小板回收率(PPR)等指标来判断临床疗效.结果 输注有效率、输血不良反应率、输注后24 h CCI和PPR在两组间比较差异有统计学意义(P＜0.05).结论 对需反复输血的血液病患者,输注血小板次数影响血小板输注疗效,输注单采血小板的临床疗效明显优于手工分离血小板,应首选单采血小板输注.     

ABO 血型不合的血小板输注研究进展

在临床输血中，输注ABO不相合的红细胞（RBC ）会导致严重的免疫性溶血性输血反应，因此，临床上主要采用 ABO同型RBC输注；ABO 非同型 RBC和血浆输注在临床很少采用。紧急情况下可以供者RBC与患者血浆血型相合或大量血浆输注时与患者RBC血型相合，而不管患者体内抗A或抗B的存在。血小板输注时 ABO相合的重要性一直是一个长期争论的问题［1］。我国要求按照血小板ABO同型输注，对于单采血小板，可不考虑血型，优先考虑是否与受血者RBC血型相合［2］。美国等国家血小板常规输注无需考虑ABO血型，这具有两方面的优点：第一是可供性，ABO同型血小板并不是总能常规保障充足供应，或在紧急情况下患者 ABO血型未知；第二是避免血小板浪费，因为血小板仅5d保存期，常无法满足ABO同型发放方式。但另一方面，ABO非同型血小板输注可能导致输血不良反应的发生，如急性溶血、发热、同种异体免疫反应、炎症和降低有效性［1］。本文综述ABO血型对血小板输注的安全性评价。     

单采血小板在不同病种的输注效果评价

目的 观察单采血小板在l临床应用的效果情况。方法 对不同病种患者输注单采血小板后的疗效进行比较分析。结果 25例患者61例次输注血小板48h后效果比较，经t检验，稀释性血小板减少病例与血液病、恶性肿瘤、其他等病种比较P〈0．01，另几种病种间比较P〉0．05。结论 7例稀释性血小板减少患者的输注，有效率达100％，临床止血效果明显增强，而血液病、恶性肿瘤患者，由于造血功能障碍或某些原因引起体内血小板消耗、破坏过多，导致血小板无效输注率增高。     

肿瘤临床手工辐照血小板的应用研究

目的考查辐照血小板的临床疗效。方法将输注血小板3次以上的肿瘤患者分组,分别给予辐照单采血小板和辐照手工血小板,同时各设对照组,分别给予非辐照单采血小板和手工血小板,通过测定输注后CCI值及观察临床症状改善情况对输注疗效进行监测和评价。结果 308名患者CCI值测定,辐照单采组为6.18±11.4、辐照手工组为12.23±13.5;单采对照组为9.59±16.67、手工对照组为10.31±15.64;手工辐照组的输注有效率(66.67%)在各组中最高。临床疗效观察,患者输后有明显症状改善者辐照组和非辐照组分别为71%和65%;单采血小板和手工组分别为68%和63%。结论手工辐照血小板可用于缓解单采血小板供给不足情况下的患者输注。     

儿童输注ABO主侧不合血小板的效果弱于输注血型相合的血小板

由于血小板只有5天的保存期,库存压力导致经常输注ABO血型不合的血小板.为了避免血小板过期,首先输注的是库存时间最长的血小板,包括输注ABO血型不合的血小板.AABB和英国血液学标准委员会建议,输注红细胞时必须要求ABO主侧相合,而输注血小板并没有要求ABO血型匹配.     

ABO交叉配血不合的血小板输血临床回顾性分析

目的研究ABO主侧、次侧配血不合的血小板在特殊紧急情况抢救用血时的安全性及临床疗效。方法回顾性分析特殊紧急情况抢救用血患者295例,依照ABO主侧、次侧配血是否相合分为实验组和对照组,分析两组数据的输血不良反应发生率及临床止血效果与交叉配血相合的关系。结果特殊紧急情况抢救用血时ABO主侧、次侧配血不合和配血相合的输血不良反应发生率分别为2.27%和2.45%,输血有效率分别为63.63%和68.10%,输血不良反应发生率及输血有效率的差异均无统计学意义(P0.05)。结论特殊情况紧急抢救可输ABO血型不合的血小板,但疗效低于ABO同型输注。     

Acute hemolytic transfusion reaction following ABO-mismatched platelet transfusion: Two case reports

Acute hemolytic transfusion reaction following ABO-incompatible platelet transfusion: two case reportsAn ideal platelet transfusion should provide ABO identical platelet concentrate, and cross match compatibility is not routinely performed in the standard practices. However, ABO non identical platelet transfusions are not uncommon with the limited resources and short shelf life of platelet concentrate. Though rare, acute hemolytic transfusion reaction (AHTR) may occur following minor ABO-incompatible platelet transfusion. Here, we report two cases of thrombocytopenic patients (one child and one adult) type as Group B RhD positive and received Group O RhD positive platelet transfusions. Both patients experienced an AHTR evidenced by a drop in hemoglobin level, spherocytosis and small agglutinations on the blood film, and positive direct Coombs test. They were treated symptomatically, recovered and discharged well post-event without any morbidity. No anti-B isohemagglutinins titer were done to confirm the high titer of the antibody in the platelet donors. Our cases highlighted the importance of ABO-compatible platelet transfusion, especially to children and those vigilant groups of patients.     

Factors that influence platelet recovery after transfusion: resolving donor quality from ABO compatibility

BACKGROUND: A system was established to examine the extent to which the apheresis donor determines platelet recovery after transfusion, to measure the impact of ABO identity, and to predict outcome by evaluating the donor. STUDY DESIGN AND METHODS: The percentage of platelet recovery was measured after prophylactic transfusion of apheresis units divided from single donors to paired recipients with uncomplicated thrombocytopenia secondary to leukemia chemotherapy. Platelet microaggregation induced by citrate was measured at the time of apheresis. RESULTS: Platelet recoveries in paired recipients correlated strongly when both transfusions were ABO- identical. When one recipient was ABO-identical and the other was ABO-nonidentical, nonidentical transfusions yielded one-third the recovery of ABO-identical transfusions. In ABO-identical transfusions, platelet recovery in donors having microaggregates in the before-apheresis ACD sample was one-third that in donors without microaggregates. This difference was observed at 1 and 24 hours. Expression of P-selectin in the apheresis units at the time of transfusion correlated well with ACD microaggregates in the before-apheresis sample. CONCLUSION: When transfusions of platelets are ABO-identical, donor quality dominates recovery in circulation. Donor quality is predicted by a rapid and simple assay of citrate-induced microaggregation performed at the time of apheresis. When donor quality is factored out, ABO identity prevails.     

利用两次血型制减少ABO不相容输血风险的研究

目的评估两次血型制在防止标本差错导致ABO不相容输血中的作用。方法对于需要或可能需要输血的患者,实施输血前采集2份单独的标本测定ABO/RhD血型。记录和分析输血前标本中错误标识和错误采集的比率。结果2007年7月—2009年6月,共接收到79115人份输血前相容性测试标本,检出273份错误标识的标本,错误标识标本比为1/290;校正的错误采集标本比为1/1485(基于47507份多次标本中检出23份错误采集标本,校正因子为1.3912)。在23份错误采集的标本中,9份(39%)可导致ABO不相容的红细胞输注。结论两次血型制可减少因标本错误标识和错误采集所致ABO不相容输血的风险。     

Enhanced detection of blood bank sample collection errors with a centralized patient database

BACKGROUND: Pittsburgh's Centralized Transfusion Service (CTS) provides transfusion support to 16 hospitals and features an electronic database that contains patient transfusion and serologic histories. This database can be accessed from any hospital in the system. A major cause of ABO-incompatible transfusions is the "wrong blood in tube" (WBIT) phenomenon, that is, the sample is not from the recipient identified on the label. We hypothesized that having access to patient historical ABO types from anywhere in the CTS system can identify WBIT errors and prevent mistransfusions.
STUDY DESIGN AND METHODS: The transfusion committee records of the 16 CTS hospitals from March 2005 to September 2007 were reviewed for major collection errors, that is, the current ABO type differed from the historical type in the database. The patient's historical ABO type, the discrepant type, and the hospital(s) where these samples were collected were recorded.
RESULTS: In 6 of 16 major collection errors for which complete information was available, the current and historical ABO types were obtained from different hospitals within the CTS system. In 3 cases, selection of ABO type–specific blood based on the current sample would have led to an ABO-compatible transfusion (e.g., correct type A, current type O). In the other 3 cases, an ABO-incompatible transfusion would have resulted (e.g., correct type O, current type A).
CONCLUSIONS: Access to a centralized patient database detected 38 percent more ABO typing errors and prevented six mistransfusions, which would not have been prevented at a single institution. Centralization of patient transfusion data should be encouraged.     

High titers of anti-A1 and anti-B antibodies among Peruvian group O platelet donors

Critical antibody titers have been described as factors associated with hemolysis in ABO plasma-incompatible platelet (PLT) transfusions. This study was carried out to describe the frequency of high-titers anti-A and antiB IgM and IgG antibodies in group O apheresis platelet donors, and to explore differences according to the donor characteristics. A cross-sectional study was carried out at the Blood Bank of a National Hospital in Peru from January to March 2019. IgM and IgG antibodies against A1 and B antigens were quantified in 339 platelet donors using the direct hemagglutination technique and the solid-phase adherence technique, respectively. For analysis purposes, two cut-off points; ≥128 and ≥64, were used to define a critical titer for IgM due to a lack of consensus. An IgG titer of ≥256 was also defined as critical. Of the donors, 22.1 % had critical IgM titers when the cut-off point was defined as ≥128. However, when the IgM cut-off was ≥64, the frequency of platelet donors with critical titers increased to 54.0 %. The frequency of donors with critical IgG titers was 23.5 %. Higher IgG titers were associated with female donors while higher IgM titers were negative associated with age. One in two or three platelet donors, depending on the cutoff point used to define a critical IgM titer, had at least one critical titer of anti-A or anti-B antibodies. Early identification of platelet donors with critical antibody titers could prevent passive transfusion of ABO antibodies to non-isogroup recipients.     

白细胞过滤在预防血小板输注无效中的作用

目的 探讨白细胞过滤在预防血小板输注无效(PTR)中的作用.方法 患者于输注机采血小板前1h和输注后24 h检查静脉血小板数量,计算血小板计数纠正增加指数(CCI),以输注后24 h CCI＜4.5×109/L为PTR;部分发生PTR的患者,于再次输注血小板前,采用白细胞滤器进行白细胞过滤.结果 机采血小板输注次数、累积剂量与输注效果比较,差异有统计学意义(P＜0.005);白细胞过滤与未过滤组比较,差异有统计学意义(P＜0.005).结论 PTR的发生与患者血小板输注剂量和次数有关,输注剂量越大,次数越多,发生PTR的机率越高;白细胞过滤可有效预防PTR.     

Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence

BACKGROUND: There are multiple benefits to transfusing only ABO‐identical blood components. Historically our institution routinely transfused ABO‐nonidentical platelets (PLTs) and cryoprecipitate to surgical patients. In April 2005, we implemented a policy of transfusing only ABO‐identical components whenever feasible, regardless of outdating or logistic considerations. STUDY DESIGN AND METHODS: Technical staff closely monitored product usage and adjusted blood center orders based on recent utilization and planned transfusions. When unable to provide ABO‐identical PLTs, ABO‐compatible PLTs were washed to remove incompatible plasma. Data on outdating were collected for 18 months before and after implementation. We compared transfusion reaction and red blood cell (RBC) alloimmunization incidence for 4 years preceding (2001‐2004) and subsequent (2006‐2009) to implementation. RESULTS: In the year after implementation, only 11 of 410 surgical patients received ABO‐nonidentical PLTs (2.7%). There was a 5.6% increase in outdating of PLTs. Transfusing ABO‐identical components was associated with significant reductions in febrile (?46%; 8.0 to 4.3 per 10,000 components; p < 0.0001) and allergic transfusion reactions (?23%; from 7.0 to 5.4 per 10,000 components; p = 0.025). A progressive reduction in de novo RBC alloimmunization incidence also occurred (?50% by 2009; p = 0.03). CONCLUSIONS: Providing ABO‐identical PLTs to almost all patients was feasible in our setting by changing ordering and inventorying procedures and making the ABO‐identical policy a staff priority. Unexpected and striking reductions in febrile and allergic reactions and RBC alloimmunization were observed, of uncertain causal relationship to this ABO policy change, which will require further study.     

ABO血型对异基因造血干细胞移植患者植入的影响探讨

目的 探讨ABO同型及3种ABO血型不合对异基因造血干细胞移植患者各系植入的影响,为患者优化移植方案提供依据.方法 回顾性分析本院2014年1月～2018年6月期间进行异基因造血干细胞移植患者70例,ABO同型18例,ABO血型不合52例,在确保对比组患者年龄;性别;供/受者亲缘关系;疾病诊断;移植前骨髓造血功能状况;...