联合输注冰冻单采血小板与新鲜冰冻血浆治疗急性大出血的比较

严重创伤急性大出血患者失血量大、病情危重,输血抢救是主要方法之一。但短期内输入大量晶体盐、人造胶体及库存红细胞,会引起稀释性血小板和凝血因子减少,导致凝血功能障碍而难于止血。因新鲜血小板在(22±2)℃轻振荡保存有效期短,采集检验费时,不能满足临床危重患者急救需要。我们采用冰冻单采血小板与新鲜冰冻血浆(FFP)联合输注(部分病例加冷沉淀),报告如下。1资料与方法1.1临床资料:35例患者输注悬浮红细胞>10U时,随机分为输注冰冻单采血小板组(冰冻单用组,17例)与冰冻单采血小板联合FFP输注组(冰冻联合组,18例),其中男21例,女14例;…     

危重病人的输血

ICU中的危重病人是血液输注的一个重要群体,因为这些危重病人普遍都存在不同程度的贫血、血小板减少和凝血异常等现象,故分别需要输注红细胞、血小板和新鲜冰冻血浆等血液成分。据调查,在苏格兰,ICU中的红细胞输注量占了该地区红细胞总供血量的7%[1]。但目前大多数红细胞和其它     

烧伤患者成分血液的选择与疗效分析

目的通过对烧伤住院患者成分输血的使用及其疗效分析,为指导临床科学合理输血提供依据。方法对本院2008年1月～2011年5月收治的130例烧伤患者的成分输血量和临床效果作回顾性分析。结果 130例患者在住院治疗期间共输注红细胞悬液979U,冰冻血浆7 064U,机采血小板56U,冷沉淀20U。轻度、中度与重度及特重度烧伤患者两两比较,在治疗期间红细胞悬液、冰冻血浆及血小板输注量差异有统计学意义（P〈0.05）,48h体液渗出期间冰冻血浆输注量的差异有统计学意义（P〈0.05）。红细胞的输注应用于重度及特重度烧伤患者疗效显著高于其他组;血小板输注防止了烧伤后继发感染及脓毒血症;冰冻血浆的使用既有效扩充血容量,也使凝血指标明显改善。结论不同烧伤程度和烧伤后不同时期患者对输注的血液成分需求和输注量不同,相应临床疗效也不同。根据病情发展制定科学合理的成分输血方案是烧伤患者治疗的一项重要措施。     

血液成分在大面积烧伤患者中的应用

目的总结大面积烧伤患者血液成分的应用情况,为指导临床科学、合理用血提供依据。方法对本院接治的30例大面积烧伤患者的血液成分输注量、输注次数进行回顾性分析。结果 30例患者中男性24例,占80%,女性6例,占20%,A、B、O、AB血型人数分别为10例(33.3%)、11例(36.7%)、8例(26.7%)及1例(3.3%)。共用血液成分7 558U,其中红细胞1 811U(24.0%)、血浆5 604U(74.1%)、血小板143U(1.9%),成分输血率为100.0%。A型为2 413U(31.9%)、B型为3 153U(41.7%)、O型为1 894U(25.1%)、AB型为98U(1.3%)。结论大面积烧伤患者除应大量补充晶体及其他胶体液外,输注血浆、红细胞及血小板等血液成分也尤为重要。     

成批特重烧冲复合伤救治中血液成分的应用

目的总结成批特重烧冲复合伤救治中血液成分的应用情况,为指导临床科学、合理用血提供依据。方法对一批16名特重烧冲复合伤救治过程中血液成分使用做回顾性分析。结果本组治愈14例,死亡2例,死亡率12.5%;其中1人伤后5 d死于ARDS,1人伤后20 d死于肺部严重真菌感染。输血次数为24—59次,平均(44.8±14.1)次;输注血浆总量36—130 U,平均(88.7±27.1)U;输注浓缩红细胞6—69.5 U,平均(41.9±18.4)U;输注血小板8—56 U,平均(25.0±9.9)U。在整个治疗过程中未出现输血反应。结论成批特重烧冲复合伤患者较单纯烧伤患者,除应大量补充晶体及其他胶体外,更应注意加强血浆和红细胞等血液成分的应用尤为重要。     

血浆交换与血浆输注治疗血栓性血小板减少性紫癜的比较

血浆交换与血浆输注均为治疗血栓性血小板减少性紫癜(TTP)的有效方法,作者对两者进行多中心前瞻性比较研究,以确定何种方法疗效更佳。102例TTP 患者平均(±SD)年龄40.5±14.3岁,男35、女67例。全部患者被随机分为血浆交换组和血浆输注组,每组51例,均以新鲜冷冻血浆进行治疗。血浆交换组在第1治疗周期(9天)平均接受血浆21.5±7.8升,血浆输注组接受6.7±3.3升。血浆输注治疗无效者改为血浆交换治疗。治疗结果:经第1周期治疗,血浆交换组24例(47%)显效,血浆输注组只有13例(25%)(P=     

249例烧伤患者的成分输血分析

目的分析烧伤患者血液成分使用情况,为指导烧伤患者在治疗过程中实施科学合理输血提供依据。方法回顾性分析甘肃省人民医院2013年8月至2014年5月收治的249例烧伤患者输注的血液成分种类、数量。结果 249例烧伤患者共用血液成分3 962.50U,其中红细胞683.00U(17.24%),血浆3 274.50U(82.64%),血小板5.00U(0.12%)。O型血患者成分血用量最多(34.80%),AB型血患者用量最少(12.22%)。3岁以下烧伤患儿例数最多,占40.16%;40~55岁年龄段患者的输血量最大。结论该院烧伤患者血浆用量较多,临床医生应权衡输注价值和输注风险,正确把握输血治疗时机,根据患者情况制订不同的输血治疗方案。     

成分输血在儿童血液疾病治疗中的应用分析

目的 分析儿童血液病房成分输血的应用特点,总结成分输血的经验,提高血液资源的有效利用率.方法 对本院2011年儿童血液病房所有成分输血(包括红细胞悬液、去白红细胞、洗涤红细胞、机采血小板、浓缩血小板、新鲜冰冻血浆、冷沉淀)资料进行回顾性统计分析.结果 1)儿童血液病房全年成分输血763人次,占儿内科(不包括NICU、PICU)输血人次的99.2％.输注量占前3位的成分血分别是红细胞悬液、血小板、去白红细胞,分别占65.15％ (497/763)、19.0％(145/763)、9.57％ (73/763).成分输血应用率达100％.2)病因主要为地中海贫血、白血病、再生障碍性贫血.白血病患儿输注红细胞成分时Hb平均(66.90±9.87) g/L,输注血小板成分时Plt平均(15.92±8.05)×109/L.再生障碍性贫血患儿输注红细胞成分时Hb平均(65.54±11.75)g/L,输注血小板成分时Plt平均(7.29±5.22)× 109/L.白血病、再生障碍性贫血患儿输注红细胞成分时输血指征与诊疗指南符合率分别为93.3％、91.1％,输注血小板时输血指征符合率分别为73.1％、77.7％.地中海贫血患儿输注红细胞成分时Hb平均(75.97±11.56)g/L,与地中海贫血诊疗指南比较,输血指征符合率仅为9.35％.3)输血不良反应发生率为1.70％,其中,红细胞悬液发生不良反应1例,血浆1例,其余11例均为血小板输血不良反应(7.53％).主要表现为发热反应、过敏反应,通过对症治疗均缓解,顺利完成输注,无休克等严重不良反应发生.结论 成分输血是血液疾病治疗的重要手段,严格掌握成分输血指针,节约血液资源,同时又保证有效治疗患儿,提高血液病患儿的生活质量,应当引起高度重视及进一步探讨.     

冰冻机采血小板用于急性严重失血患者的治疗性输注

目的探讨冰冻机采血小板在急性严重失血患者中输注的有效性。方法对45例急性严重失血患者采用冰冻机采血小板输注,测出患者输注冰冻机采血小板后1h、24h的血小板计数增高指数(CCI)值、出血时间及续用红细胞量,与21例输注新鲜机采血小板的患者作平行对照。结果急性严重失血患者输注冰冻机采血小板后,1h CCI值有效率非常显著低于新鲜机采血小板组,且患者出血时间和输注血小板后24h内人均续用红细胞量也显著小于新鲜机采血小板组,提示冰冻机采血小板被即时消耗起止血作用。结论冰冻机采血小板治疗急性严重出血患者即时止血效果优于新鲜血小板,血小板供应紧张地区对急性严重失血患者可推广应用冰冻机采血小板。     

四川某三甲医院2017-2018年各年龄段患者临床用血的分析

目的:分析不同年龄组患者血液制剂的使用情况。方法:回顾性分析四川省人民医院2017-2018年10784例输血患者的临床资料,对患者临床用血的基本情况进行统计描述;根据年龄和疾病进行分组,分析不同疾病不同年龄组各种血液制剂的使用情况。结果:10784例输血患者的年龄主要集中在40-80岁,最常见的疾病为肿瘤(约占28%)。本院平均每年输注红细胞24936.5 U,血小板3795治疗量,血浆2455500 ml,冷沉淀3461.5 U。多数血液系统恶性肿瘤和肝硬化患者输注了两种或两种以上血液制剂,其中血液系统恶性肿瘤患者使用较多的是辐照红细胞悬液(76.4%)、血小板(67.8%)和悬浮红细胞(59.9%),肝硬化患者使用最多的是悬浮红细胞(64.2%)和新鲜冰冻血浆(59.4%)。创伤和慢性肾脏病患者最常使用的血液制剂为悬浮红细胞(分别为95.7%和91.5%)。在血液系统恶性肿瘤患者中,年龄≥60岁患者辐照红细胞悬液、血小板和新鲜冰冻血浆的输注量均低于<60岁的患者(P<0.05);在创伤患者中,年龄≥60岁患者悬浮红细胞的输注量低于<60岁的患者(P<0.05)。在血液系统恶性肿瘤、创伤和肝硬化患者中,年龄≥60岁患者输注血小板和(或)血浆的比例均低于<60岁的患者(P<0.05),且均更倾向于只输注红细胞。结论:同一种疾病中,年龄<60岁和≥60岁患者输注血液制剂的情况存在差异,60岁以上老年患者只输注红细胞的可能性更大,纠正缺氧是临床的主要考量,应根据患者人群制定用血计划,并根据不同人群制定不同的输血策略,最大程度提高血液的使用效率。     

Augmented autologous transfusions in major reconstructive spine surgery

Intraoperative autologous transfusion during major reconstructive spine surgery decreased allogeneic red blood cell transfusions, but patients were exposed to significant numbers of allogeneic blood products. This study reports a prospective study of 160 randomized patients undergoing major reconstructive spine surgery. Without delaying start of surgery, 80 patients underwent hemapheresis with coincidental normovolemic hemodilution in the operating room to sequester autologous blood components. A therapeutic dose plateletpheresis product and an average of 2 U each of freshly collected autologous red cells and fresh plasma were prepared prior to surgical incision. The same supplies and equipment were used subsequently to carry out intraoperative autologous transfusion (IAT). Autologous plasma and platelets were transfused to Sequestration patients, contributing to a significant decrease of total allogeneic donor exposures. One or more autologous red blood cell unit equivalents were cost effectively salvaged and retransfused to 78% of the Sequestration patients. Altogether, autologous red cells comprised 87% of the total red cells transfused. During the same time period, 80 age-, sex-, and weight-matched controls, who received IAT only, were accrued for comparison with Sequestration patients. Of all red cells transfused to control patients, autologous units comprised 47%. Both patient groups received the same total perioperative red blood cell support. The per patient cost for IAT, with or without sequestration, was competitive with supplying one unit of cross-matched allogeneic red cells. IAT only patients had greater allogeneic blood donor exposures than Sequestration patients, in whom the numbers of allogeneic red cells, plasma and platelet transfusions were decreased. Compared with IAT alone, the hospital post-operative stay of Sequestration patients was 23% less than IAT only patients. J. Clin. Apheresis 13:62–68, 1998. © 1998 Wiley-Liss, Inc.     

Blood component therapy

Blood loss in orthopaedic injuries or procedures may be substantial, and more than 23 million units of blood components are transfused each year. The most frequent components used include whole blood, packed red blood cells, platelets, plasma derivatives, leukocytes, and clotting factors. This article will discuss blood classification systems, transfusion components, administration and potential complications of transfusion therapy, and nursing implications.     

Anti-A1 in the plasma of platelet concentrates causing a hemolytic reaction

A patient with acute leukemia who typed as AintB received 10 packs of platelets of group 0. Subsequent transfusion of A1B blood resulted in a hemolytic transfusion reaction. Anti-A1 was detected in the serum and on the red blood cells of a post-transfusion sample. This anti-A1 reacted with the transfused A1B red blood cells and other A1 cells, but not with the patient's pretransfusion red blood cells. The plasma of the transfused platelet concentrates had a high titer of immune anti-A.     

34例异位妊娠破裂伴失血性休克术中自体血回输的临床应用

目的：探讨自体血回输在异位妊娠破裂伴失血性休克术中的临床应用价值。方法：我院2010-05-2012-05采用自体血液回输机对34例异位妊娠破裂伴失血性休克患者在术中进行自体血回输,分别记录术中出血量和回输血量。结果：34例患者共回收自体血52940ml,回输血32130ml,所有患者术后恢复良好,无相关并发症。结论：异位妊娠破裂伴失血性休克术中运用自体血回输安全,可快速获得新鲜红细胞,有效维持血容量,减少异体血的使用,降低输血并发症,提高抢救成功率。     

Massive blood transfusion in the elective surgical setting.

Massive haemorrhage in elective surgery can be either anticipated (e.g. organ transplantation) or unexpected. Management requires early recognition, securing haemostasis and maintenance of normovolaemia. Transfusion management involves the transfusion of packed red cells, platelet concentrates and plasma (fresh frozen plasma and cryoprecipitate). Blood product support should be based on clinical judgment and be guided by repeated laboratory tests of coagulation. Although coagulation tests may not provide a true representation of in vivo haemostasis, they do assist in management of haemostatic factors. Below critical levels (prothrombin time or activated partial thromboplastin time >1.8; fibrinogen <1.0 g/l; platelet count < 80 x 10(9) 1(-1)) it is difficult to achieve haemostasis. Despite seemingly adequate blood component therapy there remain situations where haemorrhage is uncontrollable. In this setting, alternative approaches must be considered. These include the use of other blood products (e.g. prothrombin complex concentrates; fresh whole blood; fibrin glue) and pharmacological agents (e.g. aprotinin). Complications of massive transfusion result in significant morbidity and mortality. These may be secondary to the storage lesion of the transfused blood products, disseminated intravascular coagulation, hypothermia or hypovolaemic shock. The use of fresh blood products and leucocyte-reduced packed red cells and platelets, may minimise some of the adverse clinical sequelae.     

Intravascular [correction of intracellular] hemolysis and renal failure in a patient with T polyagglutination

A patient with postoperative intravascular hemolysis aggravated by transfusion with fresh whole blood and fresh plasma products had acute renal failure. Screening with Arachis hypogaea and Glycine soja lectins showed that his red cells were T-transformed. Only washed red cells were transfused subsequently, and no further fresh plasma products were given. All hemolysis ceased, the renal function returned to normal, and the T-polyagglutination as measured by lectin tests disappeared 4 months after surgery. Early diagnosis of polyagglutination using lectin screening tests is simple to perform, and will facilitate the immediate choice of the correct transfusion therapy, which in this case may have been life-saving.     

Transfusion practice in military trauma

summary .  Modern warfare causes severe injuries, and despite rapid transportation to theater regional trauma centers, casualties frequently arrive coagulopathic and in shock. Conventional resuscitation beginning with crystalloid fluids to treat shock causes further dilutional coagulopathy and increased hemorrhagic loss of platelets and coagulation factors. Established coagulopathy was difficult to reverse in the face of uncontrolled hemorrhage. Because many of the casualties met conventional plasma and platelet transfusion criteria on admission, thawed AB plasma was prepositioned in the trauma receiving area and used in a 1:1 ratio with red cells for resuscitation and fresh whole blood was used as a source of platelets. Retrospective assessments of this 1:1 therapy strongly suggested that it resulted in improved hemostasis, shorter ventilator times, and improved survival. Component therapy, when available, appears to be as effective as fresh whole blood. In field emergencies, fresh whole blood can be lifesaving.     

Massive transfusion: a review

The most generally accepted definition of massive transfusion is the replacement of the patient's blood volume in under 24 hours. This corresponds to 3000ml of red cells or approximately 10 units of packed cells in an average weight person. The most frequent reasons for massive transfusion include trauma, GIT bleeding, obstetric bleeding, bleeding abdominal aortic aneurysm, and major elective vascular surgery. Survival in massively transfused patients will vary depending on the underlying disease process. Overall survivals of 45–67% have been reported and of these 90% regain full independence and 75% return to work. Massive transfusion imposes a considerable strain on blood banking resources and in many centres a relatively small number of patients consume 10–15% of the total blood supply annually. Severe coagulopathy (INR and/or APTT double normal) will develop in 40% of patients and severe thrombocytopenia (platelets <50 × 10⁹/L) in 30% of patients between 10 and 20 units of units transfused. Coagulopathy, hypothermia and tissue injury all contribute to the phenomenon of microvascular oozing which develops in approximately 30% of massively transfused patients. There is only a weak correlation between the severity of coagulopathy/thrombocytopoenia and the total units transfused suggesting that factors such as duration of tissue hypoperfusion and consumption are likely to play a more important role than simple haemodilution of coagulation factors. Because of the lack of clear correlation between coagulopathy/thrombocytopenia and the number of units transfused, “formula” replacement with plasma and platelets is not recommended. The approach to blood product support in the massively transfused patient will be discussed.     

Blood transfusion utilization and recipient survival at Hospital das Clinicas in São Paulo, Brazil

BACKGROUND: The characteristics of blood recipients including diagnoses associated with transfusion and posttransfusion survival are unreported in Brazil. The goals of this analysis were: 1) to describe blood utilization according to clinical diagnoses and patient characteristics and 2) to determine the factors associated with survival of blood recipients. STUDY DESIGN AND METHODS: A retrospective cross‐sectional analysis was conducted on all inpatients in 2004. Data came from three sources: The first two files consist of data about patient characteristics, clinical diagnosis, and transfusion. Analyses comparing transfused and nontransfused patients were conducted. The third file was used to determine survival recipients up to 3 years after transfusion. Logistic regression was conducted among transfused patients to examine characteristics associated with survival. RESULTS: In 2004, a total of 30,779 patients were admitted, with 3835 (12.4%) transfused. These patients had 10,479 transfusions episodes, consisting of 39,561 transfused components: 16,748 (42%) red blood cells, 15,828 (40%) platelets (PLTs), and 6190 (16%) plasma. The median number of components transfused was three (range, 1‐656) per patient admission. Mortality during hospitalization was different for patients whose admissions included transfusion or not (24% vs. 4%). After 1 year, 56% of transfusion recipients were alive. The multivariable model of factors associated with mortality after transfusion showed that the most significant factors in descending order were hospital ward, increasing age, increasing number of components transfused, and type of components received. CONCLUSION: Ward and transfusion are markers of underlying medical conditions and are associated with the probability of survival. PLT transfusions are common and likely reflect the types of patients treated. This comprehensive blood utilization study, the first of its kind in Brazil, can help in developing transfusion policy analyses in South America.