远海岛礁医院血液保障面临的问题与展望

近年,随着健康中国战略的稳步推进和21世纪海上丝绸之路经济带倡议下的国际合作不断扩大,我国远海岛礁军民的医疗环境明显改善,中国应对海上灾难救援和履行国际人道主义救助的能力不断提高,面临的任务越来越多。岛礁医院作为远离大陆本土的海上医疗救治平台,担负着驻岛(礁)军民、周边海上作业者及过往舰船人员救死扶伤的重任,如何做好岛礁医院的血液保障是要解决好的重要环节。我医疗队在帮建某岛礁医院建设期间,建立了1套全程冷链条件下由陆地医院通过舰船向岛礁医院前送血液结合由驻岛军民组成流动血库的血液保障应急机制;2种模式基本保障了岛礁医院的备血需求。实践发现,通过舰船运送血液存在运输时间长、易受天气因素影响等问题;流动血库存在从采血至输血过程耗时长、中间环节多等问题。展望未来,为解决海运方式速度慢问题,空运模式是较好选择;为避免船体晃动对悬浮红细胞质量的影响,在远海岛礁医院建立冰冻红细胞血液储备库是行之有效的办法;在较大的远海医院建立自采自供的中小血站是发展方向。     

远海岛礁医院血液保障模式实践与评价

目的总结远海岛礁医院血液保障的经验做法,探索远海岛礁医院适宜的血液保障模式。方法回顾远海岛礁医院血液保障的实践做法,建立了后方支援保障与流动血库相结合的血液保障模式。结果 2种血液保障模式不仅可以满足驻岛军民、过往舰船人员及周边海域作业者的常规医疗用血需求,而且对平时突发事件的血液需求也有一定的保障能力。结论虽然2种血液保障模式可以满足少量常规医疗用血需求,但遇大量用血及批量伤员时则存在一定困难,建立冰冻红细胞储备为基础储备的保障模式是未来血液保障的理想选择。     

库存血红细胞流变特性的变化

目的 观察血液保存时间对红细胞流变特性的影响。方法 选择56例健康献血员,常规采血及保存。取新鲜血(采集后1小时)、采集后1周、2周及3周的血液于4个时相点．用MOPEL R80型电脑全自动血液流变学测定仪．检测全血高切粘度、中切粘度、低切粘度、红细胞压积及RBC聚集指数(AI)和刚性指数(IR)。结果 红细胞压积、中切粘度在保存3周内无显变化,高切粘度在第3周显升高．而低切粘度则下降。AI在第3周显降低;IR则在第2周时显上升．第3周更为明显。结论 随库存血保存时间的延长．对RBC的变形性及聚集性会产生重要影响．特别是在第3周出现显性变化。     

冰冻红细胞制备过程中若干问题探讨

目的　为简化冰冻红细胞的制备程序 ,保证临床及时用血。方法　比较不同条件制备的成品冰冻红细胞的红细胞回收率、溶血率、上清游离血红蛋白及体外溶血试验。结果　红细胞冰冻前在 4℃贮存 1～ 6d与 7～1 2d、甘油化红细胞先冰冻待解冻后再去甘油与先去甘油再冰冻、洗涤时加不同量的 9%氯化钠溶液所制备的成品冰冻红细胞的红细胞回收率、溶血率、上清游离血红蛋白及体外溶血试验均无显著性差异 ,缓慢匀速加甘油与快速加甘油中间静置平衡使红细胞甘油化后甘油中血红蛋白含量有显著性差异 ,前者高于后者。结论　上述条件的改变可简化冰冻红细胞的制备程序且不影响冰冻红细胞的质量     

Changes in red blood cell membrane phosphate concentration during blood bank storage

The change in red blood cell membrane phosphate concentration of standard CPD whole blood stored in Fenwal blood bags at 4 C was measured daily for two weeks. Membrane phosphate concentrations increased rapidly when stored pH fell to 6.95. At the same time, the rate of K+ leakage from the cells increased, and transport of inorganic phosphate across the membrane decreased. It is concluded that gross uptake of phosphorus by the red blood cell membrane during blood bank storage may be in part responsible for physical changes in the membrane.     

The proteome of red cell membranes and vesicles during storage in blood bank conditions

BACKGROUND: During storage of red cells (RBCs) for transfusion, RBCs undergo a number of biochemical and morphologic changes. To be able to identify the mechanisms underlying these storage lesions, a proteomic analysis of the membranes of RBCs and their vesicles was performed during various periods of storage in blood bank conditions. STUDY DESIGN AND METHODS: RBCs and vesicles were isolated from RBCs after various storage periods. The proteins of RBC membranes and vesicles were separated by gel electrophoresis and identified by a semiquantitative proteomic analysis. RESULTS: Our findings confirm previous data, such as a storage-associated increase in hemoglobin binding to the membrane and aggregation and degradation of the integral membrane protein band 3, suggesting a remodeling of the RBC membrane during storage. Our data also show storage-dependent changes in the membrane association of proteasome and chaperone proteins, metabolic enzymes, small G proteins, and signal transduction proteins. Vesicles display similar changes in their protein composition during storage. CONCLUSION: The results of this analysis indicate that the storage-related changes in the RBC membrane are the results of disturbance and/or acceleration of physiologic processes such as cellular aging, including vesicle formation. The latter may serve to remove damaged membrane patches that would otherwise lead to accelerated RBC removal. These data provide a framework for future studies toward the development of better storage conditions and a reduction of the side effects of RBC transfusion.     

致敏红细胞和未致敏红细胞物理特性比较

目的研究致敏红细胞和未致敏红细胞形态大小及渗透脆性的差异。方法对健康献血者0型和Rh（＋）型红细胞用IgG型抗-D致敏后,与未致敏的相同献血者的红细胞用血细胞分析仪进行检测,比较两种红细胞的平均红细胞体积和红细胞分布宽度,用红细胞渗透脆性试验对二者进行渗透脆性比较。结果致敏红细胞平均体积大于未致敏红细胞（P〈0.05）,未致敏红细胞分布宽度大于致敏红细胞（P〈0.01）,致敏红细胞渗透脆性大于未致敏红细胞。结论红细胞致敏后在体积上大于未致敏红细胞,渗透脆性降低,可能与红细胞膜上血型抗原与相应抗体结合后对红细胞膜的结构和稳定性有一定的影响。     

红细胞输血同种免疫发生率的研究

红细胞同种免疫通常由输血或妊娠刺激产生。为探讨由输血引起的红细胞同种免疫 ,笔者对上海地区 1 9345例输注含红细胞成分血单位的患者的输血后血样进行检查 ,共检出 1 3例同种抗体 ,通过分析初步得出了上海地区红细胞输血的同种免疫发生率。同时 ,由于上海地区各医院输血水平参差不齐 ,故将患者按其样本是否使用增强技术 (抗人球法、Polybrene法、酶法、凝胶技术等 )进行输血前免疫血液学检查分为两组 ,比较这两组患者的同种免疫发生率 ,探讨免疫血液学增强技术在输血前的应用与红细胞免疫性输血反应的相关性 ,现将结果报告如下。材料与…     

Microaggregates in frozen and saline washed red blood cells

The microaggregates which accumulate in stored blood have been implicated in the development of posttraumatic pulmonary insufficiency. These particles are known to be composed of degenerated leukocytes and platelets. Because frozen and saline washed red blood cells contain small numbers of leukocytes and platelets, they were studied as a possible source of microaggregate-free red blood cells. Using a Model T Coulter Counter to quantitate all particles 13-80 microns in size, it was shown that freezing and deglycerolization, or simple saline washing (manual or automated), could reduce the number of microaggregates in stored blood by 80 to 90 per cent. These findings add to a growing list of potential advantages in the routine use of frozen red cells for patients requiring transfusion.