去白细胞输血对肿瘤患者的术后疗效观察

目的探讨去白细胞输血对恶性肿瘤患者的术后影响。方法总结围手术期输血治疗的186例早期肿瘤患者（其中输注去白细胞悬浮红细胞58例,输注悬浮红细胞66例和未输血62例）,对输血反应、术后感染和转移复发做比较分析。结果在输血反应,术后感染和转移复发三组疗效比较中,去白细胞悬浮红细胞组明显低于输注悬浮红细胞组,与未输血组相近。结论去除白细胞的悬浮红细胞输血可以减少输血反应发生,降低输血对肿瘤患者的预后影响,提高输血效果。     

围术期输血对患者术后感染的影响

本研究通过对中国人民解放军总医院术后感染病例的回顾性分析,探讨患者围术期的输血状况是否会加重术后感染程度。应用中国人民解放军总医院输血科开发软件“临床输血数据库”进行检索,选取150例外科手术后感染病例,按感染部位分为深部感染组和浅部感染组,对两组患者的年龄、住院时间、红细胞输注量、非红细胞输注量、输血次数和平均每次输血量进行对比分析。结果表明,发生浅部感染患者的中位红细胞输注量和非红细胞输注量分别为4．50（0-59）u和2．95（0-119．6）U,深部感染组中位红细胞输注量和非红细胞输注量分别为9．00（0-153）U和8．05（0-136．6）U,两组患者存在明显差异（P〈0．05）。两组患者最显著的差异是输血次数的不同,发生浅部感染的患者中位输血次数为2（1-31）次,远远低于发生深部感染患者的输血次数4（1-49）次（P〈0．001）。两组患者的平均每次输注量没有明显差异。结论：手术患者围术期的输血量及输血次数同患者术后感染的严重程度似乎呈正相关。     

髋关节手术异体红细胞输注概况分析

目的回顾性分析近年来髋关节手术的临床病例资料,评价髋关节手术输血治疗现状。方法选取1999-2015年在本院进行髋关节手术病例共4 250例,描述平均住院日变化趋势,计算进行异体输血治疗的患者比例,术中红细胞平均输注量,单/双髋关节手术围术期的红细胞平均输注量;并将其分为异体红细胞治疗组(去白细胞红细胞组/悬浮红细胞组)与未输注红细胞治疗组,分别评价组别之间输注红细胞后的指标变化。结果 4 250例进行髋关节手术的患者中,进行输血治疗的比例为55.72%,术中进行输血治疗患者的红细胞平均输注量为3.17±1.27 U;自1999-2015年间,各年的平均住院日整体呈现下降趋势;各年的输血患者比例约在40%-70%之间,以2013年最高;术中红细胞平均输注量在2000年达到最大值,之后逐渐下降;单/双髋关节手术围术期的红细胞平均输注量分别在2009/2010年达到最大,之后均逐年下降。红细胞输注后的白细胞计数变化值在输血组与非输血组别之间具有统计学差异,而在输注去白细胞红细胞组和悬浮红细胞组别之间不具有统计学差异。结论近年来,髋关节手术患者的平均住院日、红细胞平均输注量均呈下降趋势,输血治疗的比例维持在一定范围内;输血可能导致术后感染率升高。     

少白细胞红细胞与普通悬浮红细胞在心脏瓣膜手术中应用的比较

目的比较少白细胞红细胞与普通悬浮红细胞在心脏瓣膜手术患者输注效果及对预后的影响。方法305例需输血治疗的体外循环心脏瓣膜置换手术患者,随机分为少白细胞红细胞组(160例)和悬浮红细胞组(145例)。少白细胞红细胞组患者只接受少白细胞红细胞的输注,悬浮红细胞组患者只接受普通悬浮红细胞的输注。少白细胞红细胞与普通悬浮红细胞均由北京市红十字血液中心提供。观察指标:红细胞和血浆输注量,白细胞计数,血红蛋白水平,术后机械通气时间,术后住院时间和住院费用。结果两组患者间一般情况比较差异无统计学意义(P>0.05);红细胞输注量和血浆输注量两组间比较差异无统计学意义(P>0.05);手术前后血红蛋白水平和白细胞计数两组间比较差异无统计学意义(P>0.05)。两组患者术后白细胞计数比术前均显著增加(P<0.01),但两组间比较差异无统计学意义(P>0.05)。少白细胞红细胞组患者手术后机械通气时间缩短(33.8±21.9)h与(49.1±31.2)h,P<0.05,术后住院时间减少(8.2±2.5)d与(9.1±4.7)d,P<0.05,住院费用减低(7.4±2.1)万元与(8.0±3.4)万元,P<0.05。结论与输入普通悬浮红细胞相比,体外循环心脏瓣膜手术患者输入少白细胞红细胞有利于术后早期恢复,缩短住院时间,减少住院费用。     

腹部闭合性脏器损伤围手术期血浆输注与术后感染的相关性

目的：探讨腹部闭合性脏器损伤患者围手术期输血浆与术后感染的相关性。方法：收集2004-01/2008-01于我院普外科收住的腹部闭合性脏器损伤并接受手术治疗的226例完整病历资料,并按统计学分层随机抽样,抽取131例作回顾性分析,分为输过滤白细胞的红细胞悬液＋血浆组或只输血浆组（A组）45例、输过滤白细胞的红细胞悬液（B组）51例、未输血组（C组）35例。结果：A组感染率明显高于B组和C组感染率,有统计学差异（P〈0.01）;B组和C组感染率无统计学差异（P〉0.05）;术后感染发生随输血量的增多而增大（P〈0.01）。结论：围手术期输血浆可导致术后感染并发症的增多;输血浆越多,发生术后感染的危险性越大。     

48例严重创伤失血性休克患者应用火急非同型输血抢救的临床分析

目的：分析48例严重创伤失血性休克患者应用火急非同型输血抢救的临床效果。方法：回顾性分析2019年7月-2023年7月我院急诊科应用火急非同型输血抢救的48例严重创伤失血性休克患者（均为O型去白细胞悬浮红细胞输注）的临床资料。记录48例患者抢救情况[输血等候时间、24 h抢救成功率]、去白细胞悬浮红细胞输注量。记录输血前和输血后12 h时抢救成功患者凝血功能[血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）]、溶血指标[总胆红素（TBIL）、间接胆红素（IBIL）]的变化。结果：48例患者输血等候时间平均（15.22±2.39）min;去白细胞悬浮红细胞输注量为：42例输注3U,3例输注4.5U,3例输注1.5U;24 h抢救成功率为87.50%(42/48)。输血后12 h时,抢救成功患者PT、APTT水平显著低于输血前（P<0.05）;TBIL、IBIL水平略高于输血前,但差异无统计学意义（P>0.05）。结论：火急非同型输血用于抢救严重创伤失血性休克患者中有利于缩短输血等候时间,提高抢救效率,且安全性良好。     

围手术期去白细胞输血与术后切口感染的关系

目的探讨围手术期输注去白细胞输血与患者术后切口感染的关系。方法对2008年1月至2009年6月来自本院外科、妇科、口腔科病区的427例手术患者的病例资料进行围手术期输注去白细胞悬液与术后切口感染关系的回顾性调查分析。结果输注去白细胞悬液组切口感染率为13.1%,未输血组切口感染率为11.1%,2组差异无统计学意义(P0.05);但是随着去白细胞输血量增加,切口感染发生率逐渐增加,去白细胞悬液输血量为8～12 U组和12～16 U组同2～4 U组相比切口感染发生率明显增加,差异有统计学意义(P0.05)。结论围手术期患者术后感染发生率与输注去白细胞悬液之间无明显相关性,但大量输注去白细胞悬液可能会成为增加术后切口感染率的一个危险指标,对于去白细胞悬液临床医生应慎重、合理应用。     

去白细胞的红细胞对心脏外科术后感染率的影响

目的 为评价输注以下血液成分术后感染率的变化:1)少血浆的红细胞(白细胞残留量高);2)去白膜红细胞(残留10％～20％白细胞);3)白细胞滤器过滤后的红细胞(残留白细胞<1％)。白细胞过滤是在采血后短时间内在输血中心控制的条件下进行的。方法 参试患者为择期冠状动脉旁路搭桥或瓣膜修补术患者,随机地输注上述3种血液成分之一。出院后检查患者的病历,收集输血的品种和死亡等资料,依据确定的标准判断是否为术后感染。要求负责患者的主治医师对患者术后3个月后,包括术后感染和抗生素使用等情况进行一次简短的问答式小结。结果 595例随机参与应用白细胞过滤成分的组中有6例严重感染者和3例患者死亡,应用去白膜的成分组中有5例严重感染,7例死亡,应用少血浆红细胞组中9例严重感染、5例     

输注去白细胞悬浮红细胞对肿瘤患者术后感染及伤口愈合的影响

去白细胞悬浮红细胞输血主要用于准备器官移植的患者输血和需要反复输血患者的临床输血与同时免疫的研究.由于反复输血已产生白细胞或血小板抗体引起非溶血性发热反应,国内外输血界公认为,去白细胞输血具有减少同种异体输血副作用的效果,可减少非溶血性发热反应的发生率和严重程度,防止HLA（人类白细胞抗原）同种免疫和血小板输注无效,降低传播白细胞相关传染病病原体的危险性.近年来随着输血医学技术水平的不断提高,去白细胞血液的临床应用,愈来愈受到临床医生和患者的广泛认可.去白细胞血液成分的临床应用,大大降低了输血不良反应的发生.为进一步观察输注去白细胞悬浮红细胞对肿瘤患者术后感染及伤口愈合的影响,笔者对胶州市人民医院2007年1月～2009年12月98例肿瘤患者跟踪观察,现报告如下.     

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。     

非自身免疫性溶血性贫血患者直接抗人球蛋白试验阳性对临床输血效果影响

目的:研究非AIHA患者DAT阳性对临床输血效果影响.方法:收集多个科室96例DAT阳性的非AIHA输血者为阳性组,均分为甲组(48例输注洗涤红细胞)和乙组(48例输注普通红细胞悬液),对照组为58例DAT阴性的常规输血患者.采用微柱凝胶法(MGT)和凝聚胺法进行交叉配血.检测患者红细胞(RBC)、血红蛋白(Hb)、红...     

Perioperative red blood cell transfusion for patients undergoing elective non-cardiac surgery: an audit at a Chinese tertiary hospital

Perioperative blood transfusion still takes a large proportion in inappropriate blood transfusion. As the data are limited in China, we reported a perioperative red blood cell (RBC) transfusion practices in a tertiary hospital in Guangzhou, China.In 2008–2009, patients who underwent elective surgeries receiving RBC transfusions were recorded and the rate of overtransfusion was analyzed. Overtransfusion was defined as discharge hemoglobin (Hb) exceeding 10g/dL. The median amount of RBC transfused perioperatively was four units in all 2572 patients. The overall rate of overtransfusion was 48.6% and the Department of Neurosurgery had the highest overtransfusion rate. These results are of great use for the future management of blood resource.     

创伤患者输血后发生细菌感染的危险因素探讨

目的探讨创伤患者在输注红细胞或血小板后发生细菌感染的危险因素。方法对2007年1月至2012年1月在我院输注红细胞或血小板后发生细菌感染的56例创伤患者(感染组)与输血后未发生感染的140例创伤患者(未感染组),采用多元回归方法对感染危险因素进行分析。结果创伤患者输血后感染与输注保存14天以上的红细胞密切相关[OR1.038(95%CI:1.01～1.07),P=0.036],而与输注红细胞的数量或血小板的数量无关。结论输注保存时间超过14天的红细胞是创伤患者输血后感染的一个重要危险因素。     

非血缘脐血移植术后患者输血情况相关影响因素分析

目的探讨行非血缘脐血移植术(UCBT)后患者成分输血及剂量的相关影响因素。方法回顾29例行非血缘脐血移植的血液病患者移植后60天内输血信息,将患者分为低剂量输注组:红细胞和血小板输注量总计<18 U;高剂量输注组:红细胞和血小板输注量总计≥18 U。分析患者的移植前临床资料、移植后植入情况、移植后急性移植物抗宿主病(aGVHD)发生以及一年内生存率与临床输血情况的关系。结果29例患者移植后60天内平均红细胞输注量为(10.97±11.80)U,平均血小板输注量为(7.12±5.06)U,血小板与红细胞的输入量呈显著正相关;高低剂量输注组移植前两组患者临床资料无显著差异,移植后中性粒细胞植入时间与血小板输注量呈正相关(P<0.05);移植后发生Ⅱ~Ⅳ级aGVHD的患者输注红细胞与血小板显著高于0~I级aGVHD的患者;低剂量输注组一年生存率显著高于高剂量输注组(P<0.05)。结论非血缘脐血移植患者移植后60天内红细胞和血小板输注量与供体植入,移植后aGVHD发生以及移植后生存期显著相关。     

体外循环冠脉搭桥患者围术期输红细胞量的评估及其对术后肺部并发症的影响分析简

本研究旨在明确围术期红细胞输注量对体外循环冠脉搭桥患者术后肺部并发症的影响并对输红细胞量的影响因素进行评估.根据红细胞输注量不同,将292名患者分为未榆红细胞组（n=71）、输1-4U红细胞组（n=144）和输＞4U红细胞组（n-77）.用逐步增加变量的多元logistic回归方法分析围术期红细胞输注量与术后肺部并发症的关系;用多元线性回归方法分析围术期红细胞输注量的影响因素.结果发现：3组比较,术后肺部并发症的发生率有显著差异（1.4％ vs 14.6％ vs24.7％,P＜0.001）;红细胞输注量以逐级递增的趋势体现其与肺部并发症的相关性,OR值从回归分析模型1中1.205到模型2中1.241,直到模型3中的1.251（95％ CI：1.120-1.398,P＜0.001）;多元线性分析影响红细胞输注量的因素包括：年龄（B：0.102; 95％ CI：0.046-0.157,P＜0.001）、性别（B：1.825;95％ CI：0.692-2.957,P=0.002）、术前Hct（B：-36.044;95％ CI：-47.724--25.163,P＜0.001）、体外循环时间（B：0.031;95％ CI：0.013-0.050,P=0.001）和急性心肌梗塞（B：2.769;95％CI：1.295-4.243,P＜0.001）.结论：体外循环冠脉搭桥患者术后肺部并发症的发生与围术期红细胞输注量显著相关,影响围术期红细胞输注量的因素主要有：术前HCT、年龄、急性心肌梗塞、性别和体外循环时间.     

Pre-storage leucocyte depletion and transfusion reaction rates in cancer patients

Passenger leucocytes transfused with allogenic blood are responsible for potential adverse effects. The impact of pre-storage leucodepletion (in-line filtration) of all whole blood units on transfusion reaction rate among patients suffering from cancer was retrospectively studied, comparing all reactions following red blood cell (RBC) transfusions during 2 years of pre-storage vs. 2 years of selective (bedside) leucodepletion. During selective leucodepletion, 5165 RBC units - of which 2745 were bedside filtered units- were transfused to 866 patients. Twenty-eight reactions were recorded: 22 (15 in the bedside group) febrile non-haemolytic transfusion reactions (FNHTR) and six allergic reactions (five in the bedside group). The overall percentage of reactions was 0.54 (0.76 for bedside) and 0.42 for FNHTR (0.54 for bedside). During pre-storage leucodepletion, 4116 RBC units were transfused to 841 patients. Eleven reactions were recorded: four FNHTR and seven allergic reactions (urticaria). The percentage of reactions for transfused RBC units was 0.26 (0.09 for FNHTR). Comparison between pre-storage filtration and bedside filtration with regard to FNHTR showed an odds ratio of 2.80 (95% confidence interval = 0.83-14.87) for bedside filtration. The study suggests that, for transfused patients affected by cancer, pre-storage leucodepletion is more effective than selective (bedside) filtration in reducing the incidence of transfusion reactions (FNHTR).     

Safety and efficacy of unmodified whole blood vs. buffy coat-depleted red cell concentrates in autologous transfusion of elective orthopaedic surgery patients

Storing autologous blood as whole blood (WB) has been proposed for increasing the cost-effectiveness of preoperative autologous blood donation programmes. However, experimental data suggest that autologous leucocytes might lead to immunomodulation similar to the effect attributed to allogeneic leucocytes. In a retrospective analysis, the postoperative outcome of 120 patients undergoing elective orthopaedic surgery and having donated up to two units of autologous WB (AWB) was compared with that of a control group of 52 patients, whose autologous donation had been processed into buffy coat-depleted red cell concentrates (RCC). At least one autologous unit, but no allogeneic units, had been transfused in all analysed patients. Donation schemes were equally efficacious in both groups. There was no significant difference in postoperative infection rates between the two groups. Overall rates were 7.7% in the RCC group and 8.3% in the WB group. Surgical, thromboembolic and other recorded complications, length of postoperative hospital stay and days of the use of antibiotics were also not significantly different between the two groups. The results of this study suggest that transfusion of up to two units of unmodified AWB is as efficacious as the transfusion of autologous RCC and does not negatively influence the postoperative outcome in elective orthopaedic surgery.     

Processing and transfusion of residual cardiopulmonary bypass volume: effects on haemostasis,complement activation,postoperative blood loss and transfusion volume

The aim of this prospective randomized study was to compare the effects of the transfusion of unprocessed and cell saver-processed residual cardiopulmonary bypass (CPB) volume on haemostasis, complement activation, postoperative blood loss and transfusion requirements after elective cardiac surgery. Blood samples were taken at eight points in time, perioperatively. Haematological data, including haemoglobin, haematocrit and platelet counts as well as coagulation parameters, including activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen and the fibrinolytic parameter D-dimers, were measured from each blood sample. For the assessment of complement activation, the total complement CH50 was analysed. In addition, postoperative blood loss and transfusion requirements were measured during the first 24 hours, postoperatively. The results of the study showed impaired haemostasis after the transfusion of both unprocessed and processed CPB volume. No significant differences were found between the groups in the measured coagulation parameters. Nor was a significant difference found in the complement concentration. However, in patients transfused with unprocessed CPB volume, a significantly (p = 0.019) higher amount of blood loss was found, postoperatively. In the same group of patients, the number of units of allogeneic erythrocyte concentrate suspension transfused was also significantly (p = 0.023) higher during the first 24 hours, postoperatively, compared to the patients transfused with processed CPB blood. The number of units of fresh frozen plasma and platelet suspension transfused was not significantly different between the groups. In conclusion, processing CPB volume in combination with processing peroperative blood loss may result in reducing the volume of transfusion needed of allogeneic blood products.     

Blood use in elective surgery: the Austrian benchmark study

BACKGROUND: Benchmarking transfusion activity may help to eliminate inappropriate use of blood products. The goal of this study was to measure and to compare the current transfusion practice and to identify predictors of transfusion in public hospitals to develop strategies to optimize transfusion practices. STUDY DESIGN AND METHODS: This was a prospective observational study in 18 randomly selected public hospitals from April 2004 to February 2005. Primary outcome measures were the amount of intra- and postoperative blood components transfused and intercenter variability of transfusion rate. Secondary outcome measures were prevalence of preoperative anemia, calculated perioperative blood loss, and lowest measured perioperative hemoglobin (Hb) level. RESULTS: Adult patients undergoing primary unilateral total hip replacement (THR, n = 1401), primary unilateral knee replacement (TKR, n = 1296), hemicolectomy (HECOC, n = 148), and coronary artery bypass graft (CABG) surgery (n = 777) were enrolled. Due to the small number, data of HECOC patients were not fully analyzed. In the remaining procedures, there was a large intercenter variability in the percentage of patients who received transfusions: THR 16 to 85 percent, TKR 12 to 87 percent, and CABG 37 to 63 percent. In the patients who received transfusions, the number of red blood cells (RBC) units transfused varied significantly. There was also a considerable intercenter variability in RBC loss. The prevalence of preoperative anemia was 19 percent and identical in both sexes. The incidence of preoperative anemia was three times higher in patients who received transfusions compared to those who did not. CONCLUSION: This study demonstrates a high intercenter variability in RBC transfusions and RBC loss in standard surgical procedures. Whereas the variability in blood loss remains largely unexplained, the main predictors for allogeneic RBC transfusions are preoperative and nadir Hb and surgical RBC loss.     

A randomized trial on the efficacy of an autologous blood drainage and transfusion device in patients undergoing elective knee arthroplasty

The purpose of the study reported here was the determination of the efficacy of a postoperative autologous blood drainage and transfusion device in reducing allogeneic red cell requirements in patients undergoing elective knee arthroplasty. The study was a randomized controlled trial with adult patients undergoing unilateral elective arthroplastic knee surgery. Patients underwent suction drainage, attached to an autologous blood drainage and transfusion device, or standard suction drainage. Allogeneic red cells were given according to strict transfusion guidelines based on blood loss and postoperative hemoglobin values. Outcome measures included the mean number of allogeneic red cell concentrates required and the number of patients in each group who required no transfusion. Patients assigned to standard suction drainage had a mean allogeneic red cell utilization of 1.2 units (SD 1.0), as compared to a mean of 0.4 units (SD 0.8) in the group undergoing drainage with the autologous blood drainage and transfusion device (p = 0.0007). The percentage of patients not requiring allogeneic red cells was significantly higher in the latter group (74.3% vs. 32.5%; p = 0.002). The postoperative drainage and transfusion device was efficacious in reducing the amount of allogeneic red cells required by patients undergoing knee arthroplasty, and its use resulted in a 42 percent reduction in the number of patients requiring allogeneic transfusion.