贮存式自体输血在自体骨髓移植中的应用

目的:探讨实行贮存式自体输血对自体骨髓移植的可行性.方法:10例自体骨髓移植在采血前按一定的要求合格后合采髓前2周左右,采集患者自体全血,每次采血200 ml～400 ml,2次采血间隔不少于5 d,最后1次采血应在移植前2 d完成,采集的血于4℃保存,待患者进行采髓时还输给患者.结果:10例患者共采集自体血7900 ml,无一例不良反应.在采髓回输过程中10例患者通过贮存式自体血顺利的完成采髓手术,无不良反应.结论:贮存式自体输血对自体骨髓移植是一种科学、安全、合理、经济、有效的输血方法,     

贮存式自体输血在肝癌择期手术中的应用

［摘要］　目的　探讨贮存式自体输血在肝癌择期手术中应用的可行性。方法　34例肝癌择期手术的患者采用自体血贮存备血,对采血前后Hb、BP变化结果进行分析。结果　最大采血量1 200 ml,平均726 ml,采血前后Hb变化差异有统计学意义（P<0.05）,但仍在正常范围内,采血前后BP变化差异无统计学意义（P>0.05）,均能按预期手术治疗,无围手术期肝性脑病。结论　贮存式自体输血简单、安全,值得在肝癌手术患者中推广应用。     

贮存式自体输血在泌尿外科择期手术患者中的应用

目的:探讨贮存式自体输血(PABD)在泌尿外科择期手术中的应用。方法:回顾性分析2016-01—2017-05在泌尿外科择期手术,进行PABD的239例患者资料。结果:①进行PABD的泌尿外科疾病主要是尿路结石、肾和肾上腺肿瘤、前列腺疾病和膀胱肿瘤,分别占58.58%、16.73%、9.21%和7.95%。②异体RBC输血率尿路结石组显著低于其他3组(0.71%VS 2.50%、9.09%、5.26%、5.56%,P<0.05);自体血弃输率尿路结石组显著高于其他3组(37.86%VS 17.50%、13.63%及10.52%,P<0.05)。③术前血红蛋白<125 g/L组、125～140 g/L组及≥140 g/L组自体血弃输率,尿路结石组分别为33.3%、38.1%、40.00%;肾和肾上腺肿瘤组分别是12.5%、21.1%及15.4%,差异无统计学意义(P>0.05)。结论:①泌尿外科患者进行PABD,异体RBC输血率低、自体血弃输率高,患者没能受益;②目前PABD技术在泌尿外科的应用有待改良。     

贮存式自体输血在Rh（D）阴性孕妇分娩中的应用

目的：了解贮存式自体输血在Rh（D）阴性孕妇分娩中的实际应用情况。方法：产前1～3周采集并贮存孕妇自身血液,分娩时或分娩后回输给产妇。结果：产前45例贮存自体血的Rh（D）阴性孕妇中,有10例在分娩中或分娩后回输了自体血（未输异体血）,未见不良输血反应发生,母婴状况良好,Apgar评分多为10分。另外有7例产妇除了回输自体血外,又输注了一定量的异体血。比较采血前后、回输前后、回输与未回输组以及回输自体血与回输自异体血四组血液指标变化情况,均显示差异无统计学意义（P〉0.05）。结论：贮存式自体输血在Rh（D）阴性孕妇分娩中是行之有效的输血方式,既解决了血源紧张的问题,尤其是对稀有血型患者,减少异体血的输注,又提高了输血的安全性和合理性,对母婴不会造成危险,值得推广。     

骨外科手术自体输血130例效果观察

自 1998年以来 ,我们对 130例骨外科髋关节置换择期手术患者进行了自体输血 ,取得良好的效果。现报告如下。临床资料 :本组 130例髋关节置换术患者中 ,男 87例 ,女4 3例 ;年龄 4 1～ 82岁 ,均为择期手术 ,心肺、肝肾功能及出凝血机制正常 ,体温正常 ,无感染病灶 ,Hb12 0 .0 g/L ,HCT4 0 %以上。自体输血方法 :采用贮存式自体输血。采血前 10分钟口服晶体液 5 0 0 m l,用碘酊严格消毒采血部位。用国产 CPD- A采血袋采集血液 (血液保存期 35天 ) ,同时不断轻摇血袋以防血液凝集。每次采血量 (m l) =体重 (kg) /5 0 (kg)× 4 0 0 ml。手术…     

回收式自体输血与异体输血对心脏手术患者凝血功能及血液流变学指标的影响

目的 观察回收式自体输血与异体输血对心脏手术患者凝血功能及血液流变学的影响。方法 回顾性分析,采集我院2019年6月至2022年1月期间收治的心脏手术患者的基线资料,异体组（45例,异体血回输）,回收组（45例,回收式自体输血）,对比两组凝血功能、血液流变学及不良反应。结果 回收组输血后1 d、5 d活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、D-二聚体（D-D）表达低于异体组,纤维蛋白原（FIB）高于异体组（P<0.05）;输血后1 d,异体组高切全血黏度（HSBV）、低切全血黏度（LSBV）、全血黏度及血细胞比容均下降（P<0.05）,回收组HSBV、LSBV、红细胞聚集指数（EAI）、全血黏度及血细胞比容下降（P>0.05）;回收组总发生率低于异体组（P<0.05）。结论 回收式自体输血对心脏手术患者凝血功能及血液流变学影响均较小,且安全可靠。     

等容稀释性自体输血对妇科恶性肿瘤患者围手术期免疫功能的影响

目的：本文旨在对妇科恶性肿瘤患者术中等容稀释性自体输血（ANH）初期研究的基础上,探讨异体输血及ANH对妇科恶性肿瘤患者围手术期机体免疫功能的影响差异。方法：选择妇科恶性肿瘤患者40例,随机分为2组。等容稀释性自体输血组（I组）：于麻醉后手术切皮前经桡动脉放血400～600ml,同时经静脉输入相当容量的羟乙基淀粉,手术后半阶段将自体血回输;异体输血组（Ⅱ组）：术中输异体悬浮红细胞2～3U。分别于术前、术后1d、术后5d抽取静脉血,用流式细胞仪测定外周血中自然杀伤细胞（NK）、巨噬细胞、IL系列因子、IgG、IgM、CD3^＋、CD4^＋、CD4^＋／CD8^＋的变化情况。结果：①2组术后1dCD3^＋、CD4^＋、CD4^＋／CD8^＋较术前显著减少,其中Ⅱ组较I组减少更明显,NK细胞升高（P〈O．05）;术后5dⅡ组CD3^＋、CD4^＋、CD4^＋／CD8^＋仍较术前显著减少,而I组均基本恢复正常,且I组CD3^＋、CD4^＋高于Ⅱ组（P〈O．05）。②术后1dIgA、lgG2组均减少．IL-6、IL-8、TNF-α2组均升高,2组差异有统计学意义（P〈O．05）;术后5dI组均基本恢复正常,Ⅱ组与术前相比,差异有统计学意义（P〈0．05）;IgM2组变化不显著,差异无统计学意义。结论：自体输血对患者免疫功能影响较小,对机体细胞免疫功能无明显抑制作用,而异体输血对免疫功能抑制明显。围手术期自体输血较异体输血具有明显的优越性。     

回收式自体输血对手术患者凝血及免疫功能的影响

目的探讨回收式自体输血（BS）对机体凝血状态和T淋巴细胞亚群、NK细胞功能的影响。方法选择骨科大手术患者40例,随机分为自体输血组（BS组）和异体输血组（异体组）各20例,术中分别采用BS及输异体血,分别于术前、输血后1h及输血后24h测定血常规、APTT、PT、FIB及ACT;流式细胞仪测定输血后第1天、第5天T淋巴细胞亚群CD3^＋、CD4^＋、CD8^＋、CD4^＋／CD8^＋值及NK细胞。结果输血后1h两组APTT、PT、ACT均延长,FIB和PLT计数均降低（P〈0．05）,但尚在正常范围内,组间比较元显著性差异（P〉0．05）。异体输血组输血后第1天和第5天CD3^＋、CD4^＋、CD8^＋、NK变化显著低于BS组（P〈0．01）;BS前后上述指标元明显变化（P〉0．05）。结论．BS对凝血功能的影响与异体输血相似,大量回输时应注意补充凝血因子和血小板;BS对机体细胞免疫功能元明显抑制作用。     

An update on predeposit autologous blood donation and transfusion in Europe

BACKGROUND AND OBJECTIVES: The aim of this study was to update previous data on the practice of autologous blood transfusion in Europe. MATERIALS AND METHODS: A questionnaire, mainly about predeposit, was distributed to each National Representative on the Council of Europe's Committee of Experts on Blood Transfusion and Haematology. Detailed replies were received from 23. RESULTS: Predeposit autologous blood units collected in 2000 amounted to 3.3% of the allogeneic units, compared with 4.2% in 1997. Predeposit collection was commonest in Italy (7.8%) and Germany (6.4%). CONCLUSIONS: Although autologous transfusion showed no sign of increase in Europe from 1997 to 2000, the need for alternatives to allogeneic transfusion is growing. Policy and practices in this field should be followed on an ongoing basis.     

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。     

Intraoperative autologous blood recovery in prostate cancer surgery: in vivo validation using a tumour marker

Background and Objective Intraoperative autologous blood recovery during radical retro pubic prostatectomy has the potential of contamination with tumour cells. Its safety is proved by similar survival rates between allogeneic and autologous transfusion to oncology patients without standardization. Silencing of the gene encoding pi class of gluthatione-S transferase is a specific and sensitive molecular marker for prostate cancer, because it is present in more than 90% of prostate tumours. Using such tumour marker, we aimed to demonstrate that viable tumour cells could be eliminated using leucodepletion filters followed by irradiation. Materials and Methods Fifty patients with pi class of gluthatione-S transferase promoter hypermethylation in their primary prostate tumours were included in the analysis. Peripheral blood samples were collected during anaesthetic induction and recovered blood was collected throughout the surgery and then submitted to washing, leucoreduction and irradiation. Samples were analysed stepwise for the presence of promoter hypermethylation using real-time methylation-specific polymerase chain reaction. Results Positive hypermethylation was found in recovered blood (two samples), recovered and washed blood (three samples), and recovered washed and filtered blood (two samples). After filtration and irradiation of the recovered blood, this marker could not be detected in any of the cases analysed, suggesting the absence of viable tumour cells. Conclusion Even though the risk of disseminating tumour cells in prostate cancer surgery by intraoperative autologous blood recovery is not yet fully established, no tumour-specific gene amplification was found after the association of blood filtration and irradiation, suggesting a significant reduction of such risk.     

2011—2012年用血比较分析

目的：比较分析2011-2012年三峡大学仁和医院临床用血情况,探讨医院用血规律和存在的问题。方法：收集近2年输血科输血管理系统统计资料,统计分析。结果：2年来共有3326例住院患者输异体血,异体用血总量11798U,用血最多的科室是外科,其次是ICU,主要成分是红细胞和血浆,其次是冷沉淀。结论：随着自体输血有序开展,异体用血总量显著下降。输血科一方面严格掌控输血指征,另一方面积极推动手术科室开展多种形式的自体输血,进一步加强异体输血和自体输血的管理,促进临床科学合理用血,降低输血风险。     

Safety of leucodepleted salvaged blood in oncological surgery: an in vitro model

Intra‐operative blood cell salvage (IOCS) is mainly avoided in onco surgery due to the suspicion that it could increase metastasis’ risk. We simulated IOCS followed by leucodepletion: HCT116 (human colorectal cancer) cells were inoculated into packed red blood cells units, and their distribution was evaluated, step‐by‐step, by flow cytometry and immunohistochemistry. Most of HCT116 cells were lost during washing, and almost completely removed after filtration. IOCS plus leucodepletion could be of great advantage for oncological patients, where allogenic blood transfusion could influence tumour progression.     

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。     

Preoperative autologous blood donation in primary total knee arthroplasty: a single-centre experience on 214 consecutive patients

BACKGROUND AND OBJECTIVES: Although preoperative autologous blood donation (PABD) is a widespread practice in elective orthopedic surgery, it is controversial whether this procedure avoids allogeneic blood transfusions in patients undergoing total knee arthroplasty (TKA). PATIENTS AND METHODS: We performed a retrospective study on 214 consecutive patients undergoing PABD before elective primary TKA. RESULTS: Thirty-eight patients (17.8%) were transfused with autologous red blood cells (RBC), while four of them (10.5% of those requiring transfusions, 1.9% of all patients) also received allogeneic RBC. The transfused patients were, in most cases, female and had significantly lower basal and preoperative haemoglobin levels. CONCLUSIONS: Based on the results of this study, PABD is not necessary in most patients undergoing TKA, although older female patients with low basal haemoglobin levels could benefit from a predeposit programme and/or erythropoietin support in order to reduce the risk of exposure to allogeneic blood.     

Effect of perioperative blood transfusion on clinical outcomes in hepatic surgery for cancer

Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of different types of complications： infectious complications, tumor recurrence, decreased survival. Even if there is clear evidence of transfusion-induced immunosuppression, it is difficult to demonstrate that transfusion is the only determinant factor that decisively affects the outcome. In any case there are several motivations to reduce the practice of blood transfusion. The advantages and drawbacks of different transfusion alternatives are reviewed here, emphasizing that surgeons and anesthetists who practice in centers with a high volume of liver resections, should be familiar with all the possible alternatives.     

Microparticles in stored red blood cells: an approach using flow cytometry and proteomic tools

Background and Objectives Microparticles (MPs) are small phospholipid vesicles of less than 1 µm, shed in blood flow by various cell types. These MPs are involved in several biological processes and diseases. MPs have also been detected in blood products; however, their role in transfused patients is unknown. The purpose of this study was to characterize those MPs in blood bank conditions. Materials and Methods Qualitative and quantitative experiments using flow cytometry or proteomic techniques were performed on MPs derived from erythrocytes concentrates. In order to count MPs, they were either isolated by various centrifugation procedures or counted directly in erythrocyte concentrates. Results A 20-fold increase after 50 days of storage at 4°C was observed (from 3370 ± 1180 MPs/µl at day 5 to 64 850 ± 37 800 MPs/µl at day 50). Proteomic analysis revealed changes of protein expression comparing MPs to erythrocyte membranes. Finally, the expression of Rh blood group antigens was shown on MPs generated during erythrocyte storage. Conclusions Our work provides evidence that storage of red blood cell is associated with the generation of MPs characterized by particular proteomic profiles. These results contribute to fundamental knowledge of transfused blood products.     

Net haemoglobin increase from reinfusion of refrigerated vs. frozen red blood cells after autologous blood transfusions

BACKGROUND AND OBJECTIVES Two main blood storage procedures can be used for storing red blood cells: refrigeration and freezing. Nevertheless, the efficiency of these procedures measured as the increase in haemoglobin after reinfusion compared with baseline has never been examined. The main objective was to examine which storage procedure yielded the largest increase in circulating haemoglobin after reinfusion compared to baseline. MATERIALS AND METHODS Equal volumes of blood from 15 men were withdrawn and stored either frozen or refrigerated as packed red blood cells. Serial measures of circulating haemoglobin by carbon monoxide rebreathing provided an opportunity to monitor recovery from anaemia, as well as the net increase in circulating haemoglobin after transfusion. RESULTS The post-thaw yield of haemoglobin in the bags was 72% after refrigerated storage compared with only 52% after freezing. Nevertheless, frozen storage allowed haemoglobin to fully recover before reinfusion, while the haemoglobin was 10% lower in the refrigerated group compared with baseline. After reinfusion, the haemoglobin levels were 11·5% higher than the baseline values in the group reinfused with frozen blood, while for the refrigerated group, haemoglobin levels were only 5·2% higher than baseline. CONCLUSION The relatively larger recovery from anaemia in the frozen group during storage more than compensated for the larger loss of haemoglobin during freezing and resulted in a larger net gain in haemoglobin. Based on the average 23 g per week recovery of haemoglobin, extending refrigerated storage to 7-8 weeks may yield sufficient time for patients to fully replenish harvested haemoglobin from three bags of blood without reliance on frozen storage of RBC.