Exchange transfusion in Reye''s syndrome with saline-washed red blood cells

Reye's syndrome (RS) consists of encephalopathy, fatty degeneration of viscera, and elevation of ammonia, certain amino acids, and liver enzymes in the blood. It is most characteristically a disease of children and has been considered to have a poor prognosis despite the use of various treatment regimens. Exchange transfusion (ET) with fresh blood (less than 24 hours old) for the removal of toxic metabolic byproducts in TS is a relatively recent development which appears to have improved the survival rates. However, because RS may occur in epidemic proportions at any time the demand for fresh blood can place an excessive stress on blood resources. We have, therefore, utilized saline-washed (to remove potentially toxic metabolites) red blood cells (RBC's) less than six days old, and fresh frozen citrate-phosphate-dextrose (CPD) plasma in treating this disorder. Nine patients in the Milwaukee community with severe encephalopathy secondary to RS were treated with ET. These patients collectively required 151 units of washed RBC's for 21 ET. Eight of nine patients survived without sequelae. Age of blood used did not correlate with the number of exchanges required or the eventual outcome. A continual computerized EEG in five patients provided objective evidence of the effectiveness of ET. We conclude that ET with saline-washed RBC's reconstituted with fresh frozen plasma (FFP) is a fast, safe, and effective means of treating patients with RS.     

Prevention of adverse reactions to blood transfusion by the administration of saline-washed red blood cells

We prospectively compared the incidence of complications following saline-washed versus packed red blood cell transfusions, to determine whether routine use of washed red blood cells could reduce significantly the incidence of transfusion reactions. Clinical reports of reactions were evaluated carefully to confirm whether the reaction was caused by transfusion. In 3,799 washed red blood cell transfusions, there were eight confirmed reactions (0.21%). Of 6,359 packed red blood cell transfusions, 31 reactions occurred (0.49%). The difference in incidence of confirmed complications was statistically significant (p less than 0.03). Administration of washed red blood cells to all patients requiring transfusions can thus be seen to reduce significantly the incidence of adverse reactions. This is likely the result of the removal of leukocytes and plasma achieved by the washing process. The increased safety of washed red blood cells must be weighed against their extra expense to determine their cost-effectiveness in transfusion therapy.     

Analysis of a linear peristaltic infusion device for the transfusion of red cells to pediatric patients

A linear peristaltic infusion device was evaluated for red cell (RBC) transfusion in the pediatric and neonatal setting. CPDA-1 RBC units (n = 24) divided into six groups of 4 units each underwent simulated transfusion. Blood was infused by using manufacturer-provided administration sets with either a 21-gauge needle or a 24-gauge catheter. Filters were used in two groups to evaluate the effect of negative pressure on filter function. Two groups of RBCs less than 1 week old were washed, irradiated, and infused at 5 mL per hour, by using a standard administration set, or at 10 mL per hour, by using a syringe set. Four-week-old RBCs (washed and irradiated, irradiated and filtered, filtered only, or unmanipulated) were infused at 100 mL per hour. Paired samples from 0 and 2 hours before and after infusion were analyzed for hemoglobin, hematocrit, RBC count, plasma hemoglobin, lactate dehydrogenase, potassium, alanine aminotransferase, and aspartate aminotransferase. Hausser and Nageotte hemocytometers were used to perform white cell (WBC) counts when a filter was used. By analysis of variance and percentage of change, data from 0 and 2 hours before and after infusion were compared. No clinically or statistically significant differences were seen for hemoglobin, hematocrit, or RBC count. The difference in preinfusion and postinfusion plasma hemoglobin levels in washed RBCs at 2 hours was statistically but not clinically significant (14.5 +/− 6.8 vs. 19.3 +/− 7.1 mg/dL). No clinically significant differences were noted for the remaining analytes.(ABSTRACT TRUNCATED AT 250 WORDS)     

输注红细胞对治疗新生儿呼吸窘迫综合征的临床影响

目的 分析新生儿呼吸窘迫综合征(Neonatal respiratory distressyndrome,NRDS)患儿输注红细胞次数相关危险因素,并探讨输注红细胞次数增加的相关并发症及预测指标.方法 选择2017年1月～2019年1月住院的NRDS新生儿,根据输注红细胞次数分为输血0次、输血l～2次、输血≥3次,比较...     

精准定量制备去白洗涤红细胞在新生儿输血中的应用

目的建立新生儿非免疫因素贫血治疗中精准定量制备输注去白洗涤红细胞的方法。方法将96例患儿随机分为两组,对照组共43例,实验组共53例。记录两组患儿输血前后血红蛋白浓度及输注后实际血红蛋白浓度/预期血红蛋白浓度和极差等数据,进行t检验。结果对照组输注前后血红蛋白浓度分别为120. 95±5. 75 g/L和164. 75±11. 94 g/L、实际/预期为113. 26±34. 12%、输注后极差为62 g/L;实验组输注前后血红蛋白分别为121. 27±5. 61 g/L和160. 61±2. 99 g/L、实际/预期为101. 63±8. 21%、输注后极差为9 g/L。实验组输血后血红蛋白和实际/预期与对照组比较具有统计学意义(P<0. 05)。结论精确定量制备去白洗涤红细胞可降低血液制备及输注过程中的误差,更精确的提高血红蛋白浓度至预期值,保证输注的血红蛋白总量,达到临床精准输血要求。     

大量输注多种抗体红细胞但无不良反应的输血分析

目的分析一例临床配血不合的不明抗体的成分和来源,探讨大量输注配血不合红细胞而没有导致输血不良反应的原因。方法对患者血浆做血型鉴定、直抗、抗筛、抗体鉴定和抗体效价测定等血清学试验。结果患者血浆中同时存在效价高达1∶1024的抗-I为主的多种抗体,包括特异性抗体和药物抗体且已激活补体,造成配血不合。结论大量配血不合红细胞的输注并没有引起明显输血不良反应,临床输血应根据患者病情灵活调整输血方案。     

Transmission of human T-lymphotrophic virus type I infection to a neonatal infant by transfusion of washed and irradiated red cells

Human T-lymphotropic virus type I and/or II (HTLV-I/II) may be transmitted by the transfusion of blood and blood components. Several factors are critical to the efficiency of transmission. These include the number of contaminating white cells, the component volume, and the age of the component. After look-back notification, there was an investigation of the HTLV-I/II serostatus of three patients who had received blood from a donor now found to be positive for HTLV-I antibodies by enzyme immunoassay and Western blot. The donor red cell unit was group O negative and cytomegalovirus antibody negative; it was washed and irradiated at 2800 cGy and aliquoted into six small-volume transfusions for four neonatal infants. Three of the four patients were available for testing 3.5 years after their exposure. The fourth neonatal infant died on Day 11 of life. The three tested infants received 14, 14, and 44 mL of component, respectively. HTLV-I seroconversion was documented by enzyme immunoassay and Western blot (p19, p24) and occurred only in the patient receiving 44 mL. On the basis of quality control data, it is estimated that the affected infant received 8 × 10(7) white cells in the 44-mL aliquot. Washing and irradiation will not necessarily eliminate HTLV-I transmission.     

Microvascular response to red blood cell transfusion in trauma patients

Trauma patients are often transfused allogeneic red blood cells (RBCs) in an effort to augment tissue oxygen delivery. However, the effect of RBC transfusion on microvascular perfusion in this patient population is not well understood. To this end, we investigated the effect of RBC transfusion on sublingual microvascular perfusion in trauma patients. Sublingual microcirculation was imaged at bedside with a sidestream dark-field illumination microscope before and after transfusion of one RBC unit in hemodynamically stable, anemic trauma patients. The perfused proportion of capillaries (PPC) before and after transfusion was determined, and the percent change in capillary perfusion following transfusion (ΔPPC) calculated. Sublingual microcirculation was observed in 30 patients. Mean age was 47 (SD, 21) years, mean Injury Severity Score was 29 (SD, 16), and mean pretransfusion hemoglobin was 7.5 (SD, 0.9) g/dL. No patients had a mean arterial pressure of less than 65 mmHg (mean, 89 [SD, 17] mmHg) or lactate of greater than 2.5 mmol/L (mean, 1.1 [SD, 0.3] mmol/L). Following transfusion, ΔPPC ranged from +68% to -36% and was found to inversely correlate significantly with pretransfusion PPC (Spearman r = -0.63, P = 0.0002). Pretransfusion PPC may be selectively deranged in otherwise stable trauma patients. Patients with relatively altered baseline PPC tend to demonstrate improvement in perfusion following transfusion, whereas those with relatively normal perfusion at baseline tend to demonstrate either no change or, in fact, a decline in PPC. Bedside sublingual imaging may have the potential to detect subtle perfusion defects and ultimately inform clinical decision making with respect to transfusion.     

红细胞无效输注回顾性初探

在临床成分输血中,红细胞用量最大[1]。以本站为例,2005年提供各种成分血137846.5U,其中红细胞61893U,占44.9%。临床血小板无效输注已受到高度重视,而红细胞是否也存在无效输注还有待研究。我们将本血站的回顾性调查结果报道如下。1资料与方法1.1病例洛阳地区6所医院2005年1-10     

Hemolytic transfusion reaction following transfusion of frozen and washed autologous red cells

A case of hemolytic transfusion reaction, accompanied by hypotension and followed by transient renal failure, occurred after the transfusion of 1 unit of previously frozen autologous red cells. Subsequent investigation revealed the probable cause of the hemolysis to be inadequate deglycerolization of the unit. The cause of the associated symptoms is unknown. Possibilities include nephrotoxic effects of hemoglobin or stroma, toxic effects of glycerol, or release of vasoactive or thrombogenic substances from lysed red cells. This case of a hemolytic reaction adds to the known risks of autologous transfusion.     

Coexistence of autoantibodies and alloantibodies to red blood cells due to blood transfusion

BACKGROUND: Autoantibodies (AUTO) to red blood cells (RBCs) are frequently associated with alloantibodies (ALLO). The mechanism for the coexistence of these antibodies is obscure. STUDY DESIGN AND METHODS: Between August 1998 and June 2006, all in- and outpatients of the Charité University Hospital, Berlin, with detectable AUTO were included in this study. Serologic examination was performed with standard techniques for the detection of RBC antibodies. RESULTS: A total of 717 patients were found to have AUTO, with ALLO observed in 200 of these patients (28%). The history of antibody production could be evaluated in 98 of the 200 patients. Both AUTO and ALLO were due to RBC transfusion in 73 cases (75%) and peripheral blood progenitor cell transplantation in 6 cases (6%). Nine (9%) patients were primarily alloimmunized and subsequently developed AUTO. The remaining 10 (10%) patients were primarily autoimmunized and later developed ALLO. Only 6 of these patients had chronic idiopathic autoimmune hemolytic anemia. CONCLUSION: The majority of AUTO associated with ALLO appears to be due to RBC transfusion that must be recognized as a major cause for autoimmunization.     

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。     

悬浮红细胞及血浆输注对大量输血手术患者凝血功能的影响

目的 观察悬浮红细胞及血浆输注对大量输血手术患者凝血功能的影响.方法 选取2018年12月至2020年5月该院大量输血手术患者63例,输注悬浮红细胞的31例患者为对照组,输注悬浮红细胞及血浆的32例患者为联合组.比较两组输注前后凝血功能指标[凝血酶原时间(PT)、纤维蛋白原(FIB)、凝血酶时间(TT)、活化部分凝血活...