限制性输血与开放性输血在髋关节置换术中的应用效果比较分析

目的比较分析限制性输血与开放性输血在髋关节置换术中的应用效果,为髋关节置换术患者选择合适的输血方案。方法收集2014-10~2015-11在该院骨科行髋关节置换手术治疗的患者82例。根据随机数字表法将患者分为观察组和对照组,每组41例。对照组采用开放性输血方案,观察组采用限制性输血方案,比较两组术中低血压发生率、术中输血量、输血不良反应发生率、出院前1 d的红细胞蛋白(Hb)、切口感染、住院时间及术后随访3个月时患者髋关节功能改善情况。结果观察组术中低血压发生率、术中输血量、输血不良反应发生率明显低于对照组(P0.01)。观察组术后随访3个月时的总优良率明显高于对照组(P0.05)。结论相对于开放性输血,限制性输血在髋关节置换术中围手术期可降低输血量和输血相关不良反应,能一定程度改善患者髋关节功能,值得临床推广应用。     

医院输血科在输血质量管理中的实践探讨

<正>临床输血医学的迅速发展,给我们带来严峻的挑战!即如何保证输血质量,确保输血安全[1]。对拥有650张病床,年用血量6 000U的二等甲级综合医院的输血科来说,如何管理、提高输血质量是我们的工作重点。下面是我科近几年里实践探索和积累的部分经验,现报告如下。1积极开展创建活动,参加室间质评,提高输血质量2011年我院输血科申报了创建湖北省临床输血重点专科[2],参加了湖北省临检中心室间质量控制,从参加室间质控以来,每次质评(ABO正定型;     

输血科在临床输血工作中的作用

<正>输血科肩负临床输血工作,是临床参与临床急救及危重患者救治的重点科室。为了进一步规范临床用血,提高血液使用效能,本文就如何科学、合理、安全用血进行剖析,特别是通过对临床输血流程科学合理的管理,加强输血科与临床用血科室沟通,把握临床用血指征,规范临床用血疗效评估,持续改进临床输血工作,提高临床用血质量,把安全输血提高到重要地位。1输血科要对临床医护人员进行输血相关知识的针对性培训     

临床输血病历管理与临床输血医疗纠纷的防范

目的：探讨在临床输血工作管理中,通过对临床输血病历的管理,达到提高临床输血安全性,防范因输血导致的医疗纠纷。方法：以《中华人民共和国献血法》及卫生部《医疗机构临床用血管理办法》、《临床输血技术规范》、《医院感染管理规范》为依据,制定医院临床输血病历的管理办法。对我院2005年1月～2006年9月临床住院患者输血病历进行检查分析。结果：2005年1月～2006年9月住院患者输血病历为2650例,检查了输血病历2321例,占总输血病历的87．6％,合格输血病历2109例,占检查输血病历90．9％,不合格输血病历212例,占检查输血病历9．1％。结论：通过对临床输血病历的检查,医护人员对临床输血管理相关的法律法规的认识,风险意识有所增加,提高了临床输血的安全性,起到了防范临床用血管理不善及输血传播病毒性疾病引起的医疗纠纷。     

Hepatitis viruses and the safety of blood donations

Since the beginning of blood transfusions concomitant transmission of viral hepatitis has been a frequent and serious side-effect. A first measure to reduce the frequency of transmission was the screening of blood donors for elevated levels of liver enzymes in the blood, which was introduced in Germany in the 1960s, but not in most other countries. After the discovery of hepatitis B virus (HBV), donors in all countries have been screened since the 1970s for its surface antigen (HBsAg). When it was realized that there was at least one other type of virus that was even more frequently transmitted, screening for liver enzymes and HBV antibodies (anti-HBc) was introduced as a surrogate marker in most, but not all, countries in the 1980s. Furthermore, donors at risk for parenterally transmitted viruses were excluded. The discovery of the hepatitis C virus (HCV) genome and the development of sensitive anti-HCV assays has meant that reliable detection of persistently infected HCV carriers has been possible since 1991. Recently infected donors, however, are infectious for several weeks or months before anti-HCV is detectable. Therefore, starting in April 1999 all donations in Germany have to be tested, by nucleic acid amplification tests, for the presence of HCV RNA, although preliminary experience shows that such recent HCV infections are very rare. Newly detected viruses, named GBV-C or HGV and TTV, have been detected in patients with non-A-E post-transfusion hepatitis, but their association with the disease seems to be coincidental. These viruses cause persistent viraemia and are quite prevalent world-wide, but do not cause any known disease. At present, transfusion-transmitted hepatitis has been virtually eliminated, and any improvement in safety will be very small and will require huge costs.     

Malaria and blood transfusion

The transmission of malaria by blood transfusion was one of the first recorded incidents of transfusion-transmitted infection. Although a number of different infections have been reported to be transmitted by transfusion since then, on a global scale malaria remains one of the most common transfusion-transmitted infections. Transfusion-transmitted malaria can have serious consequences, as infection with Plasmodium falciparum may prove rapidly fatal. Ensuring that, in non-endemic countries, the blood supply is free from malaria is problematical, especially as travel to malarious areas is increasing and there is some spread of the disease into new areas, as well as a resurgence of malaria in areas where previously it had been eradicated. In non-endemic countries, donor deferral can be effective, but clear guidelines are needed. In endemic countries the problem is far greater as the majority of donors may be potentially infected with malaria parasites. In both situations, the simple deferral of donors may be wasteful and can eventually erode the donor base. Thus, other strategies are needed to ensure safety with sufficiency. However, the screening of donations for evidence of malaria is not without its problems. Although the examination of blood films is still the basis for diagnosing acute malaria, in most situations it is not sufficiently sensitive for blood bank screening. In non-endemic countries, donor deferral in combination with screening for specific antimalarial immunoglobulin provides an effective means of minimizing the risk of transmission. In endemic countries, more specific donor questioning, consideration of seasonal variation and geographical distribution may help to identify the population of donors who are most likely to be infected. In addition, the administration of antimalarials to transfusion recipients may help to prevent transmission. Nonetheless, no matter what strategy is adopted, it is likely that cases of transfusion-transmitted malaria may still occur, so malaria must always be considered in any patient with a febrile illness post-transfusion.     

加强输血病历检查节约临床用血探讨

目的：通过统计分析临床输血病历检查数据,探讨输血病历检查在节约临床用血方面的作用。方法：2022年每天随机抽取前1日10％的输血病历,全年共抽取814份,就输血病历合理情况进行检查,并通过2012年全年的输血病历检查工作,回顾统计比较分析2011年、2012年各个季度临床用血情况。结果：2012年4个季度合格输血病历分别为55％、58．75％、72．96％、82．14％。人均输血量2012年与2011年相比：第一季度增长0．82U,第二季度降低0．90U,第三季度降低2．46U,第四季度降低3．03U。2011年人均输血量为11．39u,2012年人均输血量为10．05U。结论：通过加强输血病历检查力度,对临床用血进行科学、规范管理,使临床血量不断降低,为节约宝贵的血液资源起到了一定的作用。     

Documentation of consent for blood transfusion

In 2012, 110 hospitals reported on consent policy against national guidelines, with 105 (95%) including a statement on blood transfusion. Of the 103 hospitals (1788 transfusion episodes) that participated in the consent practice component, 89 specified the method of consent used; 46 (52%) had a specific transfusion consent form and achieved compliance of 90% compared to 43–69% for most other methods. The consent audit shows that a specific blood consent form achieved a high rate of medical record documentation compliance.     

The use of cord blood for transfusion purposes: current status

Although the use of umbilical cord blood (UCB) for transfusion purposes has been proposed decades ago, the employ is still limited. In this article we review studies evaluating UCB collection efficiency and sterility, examine processing and storage of UCB-derived red blood cells (RBC) and discuss clinical studies in which UCB was used for transfusion purposes.
Efforts to provide preterm newborns with autologous RBC derived from UCB have not been very successful. UCB collected after full-term deliveries can however easily be processed into RBC products and could be used autologous in case surgery of the neonate is indicated early after birth, or for allogeneic small volume paediatric transfusions. To harvest enough UCB volume, immediate clamping of the umbilical cord is commonly used as standard practice. Although delayed cord clamping has shown to improve the iron status in full-term infants; for small-for-gestational-age infants this has not been demonstrated. In addition, an increased need for phototherapy after delayed clamping exists. Altogether, we could find no disencouraging evidence to collect UCB, which could be processed into an easily available RBC product for paediatric transfusion in resource-restricted countries.     

TT viral infection through blood transfusion: retrospective investigation on patients in a prospective study of post-transfusion hepatitis

AIM To investigate the role of blood transfusion in TT viral infection (TTV).METHODS We retrospectively studied serum samples from 192 transfusion recipients who underwent cardiovascular surgery and blood transfusion between July 1991 and June 1992. All patients had a follow-up every other week for at least 6 months after transfusion. Eighty recipients recipents blood before screening donors for hepatitis C antibody (anti-HCV), and 112 recipients reveiver screened blood.Recipients with alanine aminotransferase level ＞ 2.5 times the upper normal limit were tested for serological markers for viral hepatitis A, B,C, G, Epstein-Barr virus and cytomegalovirus.TTV infection was defined by the positivity for serum TTV DNA using the polymerase chain reaction method. RESULTS Eleven and three patients, who reveiver anti-HCV unscreened and screened blood, respectively, had serum ALT levels ＞90 IU/L. Five patients (HCV and TTV: 1; HCV,HGV, and TTV: 1; TTV: 2; and CMV and TTV: 1 )were positive for TTV DNA, and four of them had sero-conversion of TTV DNA. CONCLUSION TTV can be transmitted via blood transfusion. Two recipients infected by TTV alone may be associated with the hepatitis.However, whether TTV was the causal agent remains unsettled, and further studies are necessary to define the role of TTV infection in chronic hepatitis.     

术中自体血回输在神经外科手术中的应用分析

目的:了解术中自体血回输在神经外科手术中的实际应用情况和临床效果分析。方法:对2012年神经外科手术中132例自体血回输患者的回收量,回输量,异体血输注量,及手术前后Hb,Hct等指标进行回顾性分析。结果:术中共回收自体血146 200ml,平均每例回收1 107.6ml;共回输自体血83 290ml,平均每例回输630.9ml。其中43例除自体血回输外,还分别输注了数量不等的红细胞和血浆。患者均未发生输血反应。患者术前术后的血常规变化差异无统计学意义。结论:术中自体血回输在神经外科手术中的应用能明显减少异体血输注量,节约血资源,并能减少或避免输血反应的发生。     

Advantage of autologous blood transfusion in surgery for hepatocellular carcinoma

AIM: To evaluate the significance of autologous blood transfusion (AT) in reducing homologous blood transfusion (HT) in surgery for hepatocellular carcinoma (HCC). METHODS: The proportion of patients who received HT was compared between two groups determined by the time of AT introduction; period A (1991-1994, n = 93) and period B (1995-2000, n = 201). Multivariate logistic regression analysis was performed in order to identify independent significant predictors of the need for HT. We also investigated the ...