mPEG-BTC修饰RhD( )红细胞在解决疑难输血问题上的探讨

目的采用mPEG-BTC (1.0 mmol/L,1 h)遮蔽红细胞表面的血型抗原,解决临床配血困难病例的输血问题.方法收集了15例临床配血困难及含高效价抗体的血清,用mPEG-BTC修饰供体红细胞,再将mPEG-BTC修饰后的红细胞与疑难配血患者的血清混合,用聚凝胺和抗人球蛋白方法检测.结果疑难配血病例的血清与未经mPEG-BTC修饰的RBC混合,聚凝胺法和抗人球蛋白法均有不同程度的凝集;而与mPEG- BTC修饰后RBC混合,采用聚凝胺法和抗人球蛋白法显微镜下多视野均未见凝集.结论在体外实验中,经mPEG-BTC修饰红细胞后,不再与临床配血困难病例血清中的抗体发生反应,为解决临床配血的困难奠定了基础.     

人红细胞RhD血型抗原的甲氧基聚乙二醇修饰研究

目的：探讨甲氧基聚乙二醇（mPEG）遮蔽修饰的红细胞RhD血型抗原的有效性和稳定性以及被修饰红细胞结构和功能的变化。方法：用mPEG-SPA修饰RhD血型阳性人红细胞,观测修饰和未修饰红细胞的抗-D凝集反应性、mPEG结合产物稳定性、电镜下细胞形态、变形指数、渗透脆性、自身溶血率、2,3-二磷酸甘油酸含量、膜Na^＋,K^＋ATP酶、乙酰胆碱酯酶活性和胆固醇含量。结果：0．5mmol／L、1．0mmol／L、2．Ommol／L、2．5mmol／L和5．0mmol／L的mPEG-SPA修饰红细胞与抗D的凝集反应情况依次为50％凝集、可见凝集、无凝集、无凝集、无凝集,在4℃保存14d和在37℃保存2d的修饰红细胞与抗D均无凝集反应,而末修饰红细胞则全凝集。电镜下修饰和未修饰红细胞均为双凹圆盘状形态．细胞大小均一。修饰和未修饰红细胞的各观测指标分别为：2,3-二磷酸甘油酸含量（71．00±12．88）mmol／L和（65．13±13．98）mmol／L,红细胞沉降率（2．75±2．05）mmjh和（8．00±3．82）mm／h,细胞变形指数（0．98土0．18）和（0．98士0．29）,自身溶血率（2．27±0．28）％和（1．32±0．32）％,渗透脆性（0．44±0．06）％和（0．44±0．03）％,膜胆同醇含量（0．10±0．03）g／i．和（0．10±0．06）g／L,Na^-,K^-ATP酶活性（4．834±1．27）U／mg和（5．41±1．32）U／mg,乙酰胆碱酯酶活性（27．88±5．09）U／mg和（29．68±4．165U／mg。修饰红细胞的沉降速率低于未修饰红细胞,自身溶血率高于未修饰红细胞（P＜0．05）,但是修饰红细胞沉降速率和自身溶血率都在参考值范围。结论：2．0mmol／L的mPEG-SPA能够有效并且稳定地遮蔽红细胞RhD血型抗原。修饰红细胞具有未修饰红细胞的双凹圆盘状形态、细胞膜结构、变形性和运送氧气能力．     

疑难血型系统新生儿溶血病母儿输血问题的处理

在临床工作中,经常能遇到疑难的血型鉴定与交叉配血,一般情况下,通过一系列血清学实验检查,是能够确定血型,也能通过筛选法配血得到相合的血液。但是近期,我们遇到1例疑难血型系统所致的新生儿溶血病,在患儿红细胞上和母亲血清中抗体性质一时确定不下来的情况下要求输血的棘手问题,经过我们的认真分析和对症处理,使患儿母子均得到输血治疗的救治,现报告如下。     

3例疑难血型分析及其输血策略

<正>输血治疗对于严重贫血和大量失血的患者来说是临床上一项非常重要的治疗措施,为确保输血安全,在输血治疗前都要进行血型鉴定、不规则抗体筛查和交叉配血等实验。在日常工作中,常常会遇到血型鉴定正反不符的情况,从而对配血工作带来困难,更重要的是,如果为患者选择了不正确的血液制品,不但会影响到输血的疗效,甚至可能会危及到患者的生命。因此,正确的血型鉴定和血液制品的选择对输血安全起到至关重要的作用。     

RhD阴性血型抗原分析应用于临床输血的安全性

Rh血型是目前临床上除ABO血型之外常用的输血血型〔1,2〕,对于指导临床上输血和进一步提高新生儿溶血病的实验室诊断及维护母婴健康,都具有非常重要的临床作用。调查〔3,4〕显示,Rh阳性血型在中国大多数人群中高达99%以上,而Rh阴性血型相对罕见。因此建立一个相对稳定的Rh阴性血型库具有非常重要的临床意义。本研究旨在探讨RhD阴性血型抗原分析应用于临床输血的安全性。     

输血后人类白细胞抗原与红细胞同种免疫关系初探

目的:初步探讨反复多次输血患者人类白细胞抗原(HLA)同种免疫与红细胞(RBC)同种免疫的关系,为RBC同种抗体阳性患者制定科学合理输血方案提供依据.方法:RBC同种抗体检测采用常规方法;HLA Ⅰ、Ⅱ类抗原IgG抗体检测采用ELISA法.结果:RBC不规则抗体阳性者HLA抗体阳性率为25.3(20/79), RBC同种抗体阴性者HLA抗体阳性率为10.8%(11/102),2者差异有统计学意义(χ2=6.689,P＜0.01).结论:反复多次输血后RBC同种抗体阳性者更易产生HLA抗体.     

多种红细胞抗原相合性输血在自身免疫性溶血性贫血患者中的临床应用

目的:探讨多种红细胞抗原相合性输血在自身免疫性溶血性贫血(AIHA)患者中的临床应用效果,寻求安全有效的输血策略。方法:采用回顾性研究对196例AIHA患者的输血疗效进行统计与分析,其血清或放散液均经过同种或类同种抗体鉴定,红细胞进行直接抗人球蛋白试验检测。按照输注方式将其分为2组:试验组(相合性输注)和对照组(不合性输注),试验组选用:ABO、Rh、Kidd、Duff、MNSs、lewis血型系统抗原相合的主侧配血供者血液,对照组选用:ABO、Rh血型系统抗原相合的主侧配血供者血液,分别输注2单位后,观察2组患者输血前后血红蛋白(Hb)和血细胞比容(HCT)的变化情况及不良反应的发生。结果:试验组患者输血治疗后Hb和HCT水平明显高于输血治疗前(P<0.05)。试验组与对照组患者输血治疗前Hb和HCT水平差异无统计学意义(P>0.05);而输血治疗后,试验组患者Hb和HCT水平高于对照组患者(P<0.05)。试验组患者均无溶血性输血反应,输血有效性为100%。结论:对于AIHA患者的输血治疗,选用多种红细胞抗原相合性输血,能更好的提高临床输血的有效性和安全性,还能够...     

术前单采红细胞自体输血在临床上的应用

目前开展的全血采集方式有一定的局限性 ,特别对有心脏疾患者具有一定的风险。 2 0 0 1年 3月至 2 0 0 2年 6月 ,我科应用美国产 MCS+多功能血细胞分离机 ,对 16 8例择期手术患者进行术前单采红细胞 ,供术中自身输注 ,均顺利完成手术。现报告如下。临床资料 :16 8例均为择期手术病例 ,男 117例、女 5 1例 ,年龄 2 1～ 6 8岁、平均 4 0 .16岁。其中骨科疾病 82例 ,乳腺肿瘤 2 8例 ,胃部疾病 34例 ,子宫肌瘤 2 4例。术前肝、肾功能及出、凝血检查均正常 ,血红蛋白 >110 g/ L、红细胞压积(Hct) >33%、血小板 >10 0× 10 9/ L。方法 :自决定…     

影响红细胞输血无效的相关因素分析

目的:开展红细胞输血无效原因分析,制定预防输血无效现象发生的对策,科学有效输血。方法:通过调查洛阳地区3000份输血病例,总结输血无效现象在各科室分布情况,输血无效与性别、年龄、输血次数、妊娠次数的关系,输血不良反应与输血无效现象的关联性。结果:临床各科室都存在红细胞输血无效现象,其中血液科、普通外科占比例较高;红细胞输血无效现象与男女性别、输血次数、妊娠次数均差异有统计学意义;迟发型溶血反应导致输血无效率最高占输血不良反应的85.71%。结论:针对红细胞输血无效的原因找到经济实用的解决办法,提出红细胞输血无效的预防对策,使临床输血科学有效,既节约宝贵的血液资源,又保障受血者身心健康。     

恶性肿瘤患者红细胞血型抗原变化的临床研究

目的 了解恶性肿瘤患者化疗对红细胞血型抗原效价的影响.方法 检测174例恶性肿瘤患者化疗前后红细胞血型抗原效价的变化,同时观察红细胞血型抗原效价与化疗疗程时间长短的关系.采用抗原检测法,将抗原倍比稀释与受检者红细胞进行反应,结果以凝集效价表示.结果 恶性肿瘤患者化疗后ABH抗原明显减弱,且跟化疗时间长短呈正比关系;Rh(D)抗原减弱不明显.结论 在给恶性肿瘤患者输血时遇到正、反定型不符合时,一定要考虑红细胞血型抗原减弱,同时根据患者详细的临床资料,进一步做血型鉴定有关的试验,确保输血安全,防止意外发生.     

重症监护病房住院患者红细胞输注和疗效分析

目的：调查重症监护病房（ICU）住院患者输血疗效和影响输血疗效原因。方法：通过回顾性分析2003年1月-2005年10月期间ICU患者的输血情况。结果：712名住院患者215名输血,共输血432人次。平均输血总量为（2．5±0．70）U（1U～25U）。有贫血、感染、心功能不全、肾功能不全的患者的输血的危险增大（P〈0．01）输血前感染、进行性失血或凝血功能不全的患者的输血无效的危险增大（P〈0．01）。结论：输血在不同年龄、不同疾病类型中分布不同。患者输血前的疾病状态：贫血程度、感染、肾功能情况是影响输血的有关因素。而进行性失血和凝血功能障碍以及重症感染是影响输血疗效的因素。     

Cost of allogeneic blood transfusion

Blood is a scarce and costly resource to society. Therefore, it is important to understand the costs associated with blood, blood components, and blood transfusions. Previous studies have attempted to account for the cost of blood but, because of different objectives, perspectives, and methodologies, they may have underestimated the true (direct and indirect) costs associated with transfusions. Recognizing these limitations, a panel of experts in blood banking and transfusion medicine gathered at the Cost of Blood Consensus Conference to identify a set of key elements associated with whole blood collection, transfusion processes, follow-up, and to establish a standard methodology in estimating costs. Activity-based costing (ABC), the proposed all-inclusive reference methodology, is expected to produce standard and generalizable estimates of the cost of blood transfusion, and it should prove useful to payers, buyers, and society (all of whom bear the cost of blood). In this article, we argue that the ABC approach should be adopted in future cost-of-transfusion studies. In particular, we address the supply and demand dilemma associated with blood and blood components; evaluate the economic impact of transfusion-related adverse outcomes on overall blood utilization; discuss hemovigilance as it contributes not to the expense, but also the safety of transfusion; review previous cost-of-transfusion studies; and summarize the ABC approach and its utility as a methodology for estimating transfusion costs.     

Reporting and grading of abnormal red blood cell morphology

In spite of the continual standardization of test result formats, the improvements of laboratory technologies, publications of reference guidelines, and the advancements in hematology analyzers, the methods of reporting or grading abnormal red blood cell morphology still vary among laboratories everywhere. This article describes the methods or systems of reporting abnormal red cell morphology and the conditions associated with the abnormalities.     

Antigen specificity determines anti‐red blood cell IgG‐Fc alloantibody glycosylation and thereby severity of haemolytic disease of the fetus and newborn

Haemolytic disease of the fetus and newborn (HDFN) is a severe disease in which fetal red blood cells (RBC) are destroyed by maternal anti‐RBC IgG alloantibodies. HDFN is most often caused by anti‐D but may also occur due to anti‐K, ‐c‐ or ‐E. We recently found N‐linked glycosylation of anti‐D to be skewed towards low fucosylation, thereby increasing the affinity to IgG‐Fc receptor IIIa and IIIb, which correlated with HDFN disease severity. Here, we analysed 230 pregnant women with anti‐c, ‐E or –K alloantibodies from a prospective screening cohort and investigated the type of Fc‐tail glycosylation of these antibodies in relation to the trigger of immunisation and pregnancy outcome. Anti‐c, ‐E and –K show – independent of the event that had led to immunisation – a different kind of Fc‐glycosylation compared to that of the total IgG fraction, but with less pronounced differences compared to anti‐D. High Fc‐galactosylation and sialylation of anti‐c correlated with HDFN disease severity, while low anti‐K Fc‐fucosylation correlated with severe fetal anaemia. IgG‐Fc glycosylation of anti‐RBC antibodies is shaped depending on the antigen. These features influence their clinical potency and may therefore be used to predict severity and identify those needing treatment.     

Modulating the red cell membrane to produce universal/stealth donor red cells suitable for transfusion

Two approaches have been used to produce universal group O donor red blood cells (RBCs) from groups A, B, and AB RBCs. The first involves cleavage of the terminal immunodominant sugars from carbohydrate chains on the RBC membrane, using specific enzymes, to produce so-called enzyme-converted group O (ECO) RBCs. ECO RBCs have been produced from whole units of B RBCs and transfused successfully to humans. Group A RBCs (especially A(1) RBCs) have been more difficult. New sources of enzymes have produced ECO RBCs from A(1) and A(2) RBCs that do not react with powerful monoclonal anti-A. Unfortunately, there are still problems encountered with polyclonal human antibodies (i.e. cross-matching). The second approach interferes with an antibody reaching its specific antigen on the RBC membrane by bonding polyethylene glycol (PEG) to the RBC. PEG will attract water molecules, yielding a combination that may block most RBC antigens, including A and B antigens. Initial excitement generated by preliminary reports of the possibility of producing 'stealth' PEG-RBCs were tempered by the findings of in vitro serological problems and possible reduced in vivo RBC survival. Many of these problems were solved, but recent findings that PEG is immunogenic in animals and humans, and that PEG antibodies can shorten the survival of PEG-RBCs (in rabbits) and pegylated proteins (e.g. PEG-asparaginase) in humans, are disturbing, suggesting that 'stealth' RBCs may never become a reality.     

非洛地平对高血压患者红细胞膜结合钙的影响

目的比较非洛地平缓释片和氢氯噻嗪对高血压患者治疗前、后红细胞膜结合钙的影响。方法按中国医科院阜外医院Fever研究规划,入选70例高血压患者,年龄50～70岁,血压160～180／90～100mmHg,经3个月安慰剂观察,采用多中心双盲分为非洛地平缓释片2．5～5．0mg／d治疗组（T组）和氢氯噻嗪12．5-25mg／d对照组（C组）各33例。经5年随访,对比两组治疗前后血压、心率、心电图、空腹血糖、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）、肌酐、尿酸、血清钾和红细胞膜结合钙。结果T组33例治疗前收缩压和舒张压分别为（159．65±9．51）mmHg和（95．96±3．07）mmHg,治疗后降到（134．09±8．85）mmHg及（82．78±4．21）mmHg,P〈0．01;红细胞膜结合钙治疗前为（2．24±0．3）μg／mg,治疗后上升到（3．21±0．27）μg／mg,P〈0．01;总胆固醇、甘油三酯均有下降。C组有2例脑卒中（均为脑出血）,T组未发现心脑血管事件。结论非洛地平缓释片和氢氯噻嗪均有良好降压作用,治疗组脑卒中死亡少于对照组。非洛地平缓释片对红细胞膜结合钙有升高作用,同时对总胆固醇、甘油三酯有降低作用。     

Prudent strategies for elective red blood cell transfusion.

OBJECTIVE: To review the literature on the appropriateness of red blood cell transfusion and current physician practice, with emphasis on the physiologic and symptomatic implications of elective transfusion in the treatment of anemia. DATA SOURCES: Studies on the therapeutic use of red blood cell transfusion were identified through a search of MEDLINE (1966 to the present) and through a manual review of bibliographies of identified articles. In addition, evidence was solicited from selected experts in the field and recent consensus panels that have developed transfusion guidelines. DATA SYNTHESIS: No controlled trials of blood transfusion were identified, but data were available on four issues relevant to transfusion practice: current physician practice and evidence for excessive use of red blood cell transfusion; physiologic adaptation to anemia; human tolerance of low hemoglobin levels; and strategies for reducing homologous transfusion requirements. CONCLUSIONS: Despite the recent decline in red blood cell use because of concerns about infection, current transfusion practice remains variable because physicians have disparate views about its appropriateness. The remarkable human tolerance of anemia suggests that clinicians can accept hemoglobin levels above 70 g/L (7 g/dL) in most patients with self-limited anemia. In patients with impaired cardiovascular status or with anemias that will not resolve spontaneously, however, the data are insufficient to determine minimum acceptable hemoglobin levels, and therapy must be guided by the clinical situation. Several therapeutic strategies and pharmacologic interventions are available in the perioperative and non-operative settings to further reduce red blood cell use.