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;     

Variant Creutzfeldt–Jakob disease: risk of transmission by blood transfusion and blood therapies

Summary.  In the last decade, a new variant of the human prion disease Creutzfeldt–Jakob disease (now known as variant CJD or vCJD) was identified and causally linked to dietary exposure to bovine spongiform encephalopathy (BSE) during the 1980s and early 1990s. Preliminary studies in animal models suggest that prions can be transmitted by blood. Based on two recent reports of iatrogenic vCJD transmission by blood transfusion in humans, a Department of Health-sponsored risk assessment warned that recipients of plasma therapies are now at risk of contracting vCJD from potentially infected donors. It is believed that all the population may be susceptible to vCJD infection, although clinical cases have so far occurred only in methionine homozygotes at codon 129 in the human prion protein gene. A non-invasive blood-based diagnostic assay is urgently needed. Because the incubation period may be upwards of 40 years and there is no reliable screening test, it is currently unknown how many people may be in an asymptomatic phase of vCJD infection in the UK. However, there remains a distinct possibility that some infected patients may never develop clinical symptoms but will remain asymptomatic carriers who can potentially transmit the disease to other individuals. Therefore, screening of infectious individuals will be a critical component for individuals who rely on blood transfusions and/or blood therapies. In the absence of screening tests or effective therapies to treat this disease, a formidable worldwide public health challenge lies ahead to prevent new infections, accurately assess infection rates and treat infected patients.     

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.     

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。     

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。     

Technical aspects of the development and validation of tests for variant Creutzfeldt-Jakob disease in blood transfusion

The development of tests for variant Creutzfeldt-Jakob disease in the context of blood transfusion is technically complicated by a number of factors, including the long asymptomatic period and uncertainty as to whether infectivity is present in human blood at all. The specific needs of a donor test impose constraints. It is argued that the only possible analyte will be blood, and that while the initial work will involve animal studies, these will provide only an approximate guide. A rapid infectivity assay is key to confirming positives in human samples, and dilutions of infected human brain will probably provide adequate routine control samples to ensure the correct performance of the test.     

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     

Comparison of candidate vCJD in vitro diagnostic assays using identical sample sets

Background and Objectives With four transfusion related transmissions of variant Creutzfeldt–Jakob Disease (vCJD), three of which developed clinical disease and the other died of other causes but was positive for markers of infection, there is an increased urgency to identify and implement a test for blood donor screening. With limited amounts of blood samples from vCJD cases available test evaluation is challenging. Alternative approaches are therefore needed. Control and vCJD tissues homogenates, where levels of markers of infectivity are known, were sequentially diluted in pooled human plasma. Identical sets of samples were provided blind to research groups developing diagnostic tests for vCJD; identical sample sets allows for direct comparisons of sensitivity to be made. Materials and Methods Control and vCJD tissue homogenates were sequentially diluted in pooled human plasma (detergent solvent treated or cryo‐depleted) supplied by commercial fractionators. Dilutions of vCJD tissues were within and beyond the limits of detection previously determined by the conformation‐dependent immunoassay (Cooper et al.: Vox Sang 2007;92:302–310; Bellon et al.: J Gen Virol 2003; 84 : 1921–1925). A number of methods were used for the analysis of the blinded panels; with background signal from the normal prion protein (PrP) being removed by digestion with proteinase, epitope protection or selective capture of PrP^tse. Results Assay sensitivities were directly compared using identical sample sets. This approach identified several transmissible spongiform encephalopathies (TSE) diagnostic tests, based on different principles, high in analytical sensitivity that reproducibly detected markers of vCJD infectivity in tissue homogenates. Conclusion The approach outlined has successfully compared in vitro diagnostics assays for their sensitivity and reproducibility and is a first step toward the evaluation of an assay suitable for blood donor screening/diagnosis of vCJD.     

Oxygenating the microcirculation: the perspective from blood transfusion and blood storage

Tissue oxygen delivery depends on red blood cell (RBC) content and RBC flow regulation in the microcirculation. The important role of the RBC in tissue oxygenation is clear from anaemia and the use of RBC transfusion which has saved many lives. Whether RBC transfusion actually restores tissue oxygenation is difficult to determine due to the lack of appropriate clinical monitoring techniques. Some patients with restored haemoglobin levels and stable haemodynamics still develop tissue hypoxia, emphasizing that, in addition to global parameters, local microcirculatory control mechanisms are also important in the restoration of tissue oxygenation. Both clinical and animal experimental studies have indicated that storage of RBC diminishes their ability to oxygenate the tissue. Several intrinsic RBC parameters that change during storage and might influence tissue oxygenation will be mentioned. The release of vasodilators from RBC that will alter blood flow during hypoxia, mediated by haemoglobin in the RBC that functions as an oxygen sensor, could be impaired during storage. A better understanding of hypoxia-induced vasodilator release from RBC might become a potential target for drug development and improve tissue oxygenation after transfusion.     

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.     

输血前不规则抗体筛查与临床安全输血

目的：回顾性分析本院输血患者血型不规则抗体的检出情况,探讨输血前不规则抗体筛查的重要性和高危科室。方法：微柱凝胶法和聚凝胺法对需要输血的2500例患者血清进行不规则抗体筛检。结果：2500例申请输血的患者不规则抗体总阳性率为1.0%;微柱凝胶检出的敏感度为100%,聚凝胺法敏感度为88.0%,2种方法的敏感度差异具有统计学意义（P〈0.05）。肝病科、肛肠科以及肾病科不规则抗体检出阳性率占了总阳性率的80.0%。结论：微柱凝胶法进行输血前不规则抗体的筛检敏感度高,更有利于保证临床上的输血安全;对于肝病科、肛肠科以及肾病科等出现反复输血的科室,在输血前更应该进行不规则抗体的筛查,以减少输血风险。     

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.