CRP在输血不良反应中的临床意义

输血是临床重要的辅助治疗措施，但其并非绝对安全，有可能发生多种不良反应。随着现今血型检测和配血技术的不断提高和严格输血技术规范，血型不合所引起的溶血性输血反应已经很少，但非溶血性发热反应和过敏反应仍较常见，为了解CRP在输血不良反应发生前后的变化，我们通过对本院77例有输血不良反应患者的CRP检测结果进行回顾性分析。现将结果报告如下。     

57例输血不良反应临床分析

目的探讨输血反应的临床特点．减少输血不良反应发生。方法对57例输血不良反应进行回顾性分析。结果发热反应、过敏反应是最常见输血反应。结论严格掌握输血适应症，选择合适的血液制品，能有效降低输血不良反应率。     

Rh阴性血型鉴定及其意义

目的 确保鉴定输血安全,防止溶血性输血反应的发生.方法 对我院1181例血型鉴定标本同时进行Rh血型的鉴定.结果 RH血型阴性者有5例,检出率为0.4%.结论 将血型鉴定作为血型筛查的常规检验,对有效预防溶血性反应的发生,提高输血的安全性具有重要意义.     

输血安全与不规则抗体筛选

观察临床9857例输血患者不规则抗体筛查实验结果,检测出抗体阳性32例,降低并有效避免了溶血反应的发生.因此,对输血前患者进行不规则抗体筛选是必要的,在保证临床输血安全、减少溶血性输血反应方面具有重要意义.     

滤除白细胞输血技术临床应用观察

目的 观察使用国产一次性滤除白细胞输血器的临床应用效果.方法 2007年6月～2007年12月调查河源市人民医院需要多次输血的地贫患者20例,男8例,女12例;年龄9～25岁.观察组使用国产一次性滤除白细胞输血器.同时调查此20例患者在2004-2007年6月期间输注来过滤的添加红细胞发生非溶血性发热性输血反应情况.结果 使用普通输血器组非溶血性输血反应发生率为20.0%(4/40),而应用白细胞滤器组仅为5%(1/20),差别具有统计学显著性意义(P=0.024).结论 白细胞滤器的应用能显著降低非溶血性输血反应发生率.     

洗涤血小板的质量检验和临床疗效观察

目的探讨洗涤血小板的制备方法、质量和临床应用效果。方法采用改良的全自动血细胞分离机制备洗涤血小板制剂。并应用生化方法、血细胞分析法和流式细胞技术对洗涤血小板中蛋白清除率、白细胞清除率、血小板回收率、血小板粘附聚集功能和CD62P、PAC-1的表达情况进行检测；观察输注洗涤血小板的临床疗效、过敏反应和非溶血性发热反应的发生情况。并与单采浓缩血小板比较。结果洗涤血小板的蛋白清除率为99％，白细胞清除率为85％，血小板回收率达95％；血小板洗涤前后的粘附率、聚集率、CD62P＋和PAC-1^＋表达率无统计学意义；临床输注后有效率达83％，与单采浓缩血小板输注有效率90％相比较无统计学意义。并且非溶血性发热反应和过敏反应的发生率分别下降了94．12％（16／17）和100％（13／13）。结论经该方法制备的洗涤血小板质量符合要求，血小板功能未受影响，临床输注后过敏反应和非溶血性发热反应明显下降，临床疗效肯定。     

对输血不良反应认知及预防的调查研究

目的：调查研究不同血液制品输血不良反应的发生概率、规律,并对此提出有效的预防措施。方法随机抽取我院2011年4月~2013年4月收治的住院输血的患者6000例为研究对象,统计分析输血不良反应的情况和原因。结果研究结果发现,6000例输血患者的输血发生不良反应的有140例,发生概率为2.33%,患者输血不良反应几乎全部为发热和过敏,其中输注血浆不良反应最高,血小板其次。在输血患者中,有输血史、妊娠史的患者更易引发输血不良反应。结论在患者接受输血的过程中,注重患者的输血史和妊娠史,针对患者做出特殊的输血护理,可以有效减少不良反应的出现。     

120例急性输血反应的临床分析

目的通过对120例急性输血反应发生的情况及其预防、处理方式进行总结分析．为临床减少输血反应、有效处理输血反应提供参考。方法统计分析我院2007年1月至2008年12月各类血液成分的输血反应情况;比较输血前常规用药是否能预防输血反应的发生i并通过对120例输血反应的处理进行分析,总结较为安全有效的处理方式。结果总的输血反应率为2．0％,各类血液成分输血反应率有一定区别．差异有统计学意义（x2=12．54,P〈0．05）;输血前用药组与非用药组比较,其输血反应发生率无统计学意义（X2=0．096,0．11,0．015,0．342,P〉0．5）;地塞米松、冰敷、121服百服宁等对治疗非溶血性发热性输血反应（febrilenon—hemolytictransfusionreactions,FNHTR）有效,非那根对治疗FNHTR无效,地塞米松、非那根及扑尔敏等抗组胺药对过敏反应有效。结论输血前用药预防输血反应的作用不明显;非那根等抗组胺药对治疗FNHTR无效。明确输血反应的种类并对症治疗,是处理输血反应的有效手段。     

114例抗菌药物不良反应报告分析

目的为了解药物不良反应(ADR)发生的原因及规律,促进临床合理用药提供参考。方法采用回顾性研究的方法,对医院2008年~2010年各种抗菌药物所致不良反应患者的性别、年龄、抗菌药物种类及临床表现进行分析。结果抗菌药物所致ADR的发生率最高的是喹诺酮类占36.84%,其次为头孢菌素类占21.93%。临床上ADR主要表现为过敏反应,其次为消化系统反应。结论医院应加强抗菌药物的使用管理,以达到安全、合理地使用抗菌药物,减少ADR的发生。     

临床分析输血检验流程的环节质量控制

目的：对输血检验流程的各环节质量控制进行分析。方法在我院2013年6月~2014年6月进行输血的患者中随机选取100例,将其均分成两组,对照组患者实施常规输血,观察组患者对输血各环境质量均进行有效控制。结果观察组患者的传染病发生率、医患纠纷发生率均明显低于对照组,差异显著(P<0.05),具有统计学意义。结论临床对输血检验流程中各环节质量进行有效的控制,能够对患者临床传染病发生率和医患纠纷发生率进行有效的降低,从而提高患者的输血安全,值得在临床中加大推广应用。     

Effets indésirables transfusionnels de nature allergique en pédiatrie, étude sur 3 ans

Purpose of the studyIn the transfused patients, in France, in 2011, allergy ranked as the third adverse transfusion reaction. In order to evaluate the incidence and symptomatology of allergic adverse transfusion reactions in the paediatric people, a study was performed.Patients and methodsIt was focused on patients under 18 years of age cared for in hospitals of the Rhone-Alpes area. The national haemovigilance database (e-FIT) reports of allergic transfusion reactions were reviewed.ResultsFrom January 1st 2009 to December 31st 2011, among 2,165 reports, 141 (6.5%) adverse transfusion reaction reports were collected in paediatric patients. Sixty-eight (48.2%) indicated allergic reactions and corresponded to 64 recipients. As regards clinical manifestations, forty-eight (70.6%) indicated cutaneous signs only, 3 (4.4%) mentioned pulmonary signs only and 9 (13.2%) reported both. Urticaria was observed in 38 cases (55.9%). Bronchospasm was notified in 4 cases but there was no angioedema. As for the severity of reactions, one adverse transfusion reaction was severe (grade 2) and 2 were life-threatening (grade 3). The most involved blood component was the apheresis platelet concentrate (40 cases, 58.8%) followed by the red blood cell concentrate (17 cases, 25.0%) and the methylene blue-treated fresh-frozen plasma (11 cases, 16.2%).ConclusionThis study shows that among paediatric recipients, cutaneous signs are predominant in allergic adverse transfusion reactions and that the apheresis platelet concentrate is the most frequently involved blood component.     

输血质控督查问题及解决对策

目的 通过抽查输血病案,发现临床输血管理不规范行为,探索解决方案。方法 对2017年1月~2018年12月我院输血科和医务处抽检的720份输血病案进行督查,按照我院《临床用血管理考核实施细则》进行考核,包括输血标本的采集、交叉配血是否符合要求、输血前评估、输血申请审核、大量用血审批、输血治疗知情同意书、输血前感染性标志物检测、血液交接、血液运输冷链管理、输血过程监控、不良反应回报等。结果 存在缺陷的输血病案共182份,占受检总数25.28%;缺陷病历排名前5位分别为输血申请不规范（64例）、输血后疗效评价欠缺（44例）、输血治疗同意书填写不完整（26例）、输血病程记录不完整（12例）、血液冷链运输不符合要求（8例）,占缺陷病案的84.62%;手术科室输血病案存在问题占缺陷病案总数62.64%,非手术科室缺陷输血病案占37.46%;医生记录的缺陷占缺陷病案总数91.75%,护理人员记录仅占7.02%。结论 我院临床医生记录的输血病案存在问题较多,建议严格按照临床操作技术规范执行,确保输血各个环节质量,以保证患者的用血安全。     

Effets indésirables receveurs à l’hôpital Ibn Sina de Rabat : bilan 1999–2013

Purpose of study

The declaration of the recipients adverse reactions (RAR) is one of the field haemovigilance activities. It provides an evaluation of transfusion side effects and thus prevents their appearance. The aim of this study is to analyze, over 14 years, the RAR supports reported in Rabat Ibn Sina hospital.

Adverse transfusion reactions with neurological signs in transfused patients

ObjectivesMany transfused patients present severe, sometimes critical, clinical conditions. The occurrence of adverse transfusion reactions may cause the clinical condition to deteriorate. A study was conducted aimed at establishing whether the presence of neurological signs during an adverse transfusion reaction increases its severity.MethodsFrom 1 January 2010 to 30 June 2019, adverse reactions with neurological signs were extracted from the French haemovigilance database system. Two signs observed at the time of the reaction were analysed: unconsciousness and convulsions. Stroke was excluded. The type of reaction, its severity, the blood product involved and its imputability were all studied.ResultsDuring the study period, 10,670 reactions were reported, including 20 (0.19%) imputed to the transfusion with unconsciousness and/or convulsions. Unconsciousness without convulsions was frequently observed (14 reports, 70.0%). Convulsions were reported in 5 cases (25.0%), with 1 case being associated with unconsciousness. Unconsciousness and/or convulsions were present in 9 allergic reactions (45.0%) and 4 transfusion-associated circulatory overloads (20.0%). Nine reactions were severe (45.0%), 7 were life-threatening (35.0%) and 1 case resulted in the recipient's death (5.0%). A red blood cell and a platelet concentrate transfusion were involved in 8 reactions (40.0%) each, although the imputability of the blood product was certain in only 2 of the reactions.ConclusionUnconsciousness and/or convulsions were rarely observed in adverse reactions reported in transfused patients. Nevertheless, the presence of these signs highlights the severity of the adverse reactions (17 reactions, 85.0%).     

Adverse reactions following transfusion of blood components,with a focus on some rare reactions: Reports to the International Haemovigilance Network Database (ISTARE) in 2012–2016

ObjectivesThe International Haemovigilance Network's (IHN) ISTARE database collects surveillance data on all adverse reactions (AR) associated with transfusion of blood and blood components, facilitating the sharing of best practice and benchmarking for improving blood safety and quality. Up to 2012, no publications discussed certain rare AR. The aim of this study is to examine ISTARE data on AR from 2012 to 2016, focusing on hypotensive reactions, post-transfusion purpura (PTP), transfusion-associated graft versus host disease (TA-GvHD), hyperkalemia and hypocalcemia.Materials and methodsNational Haemovigilance Systems (HVS), provided aggregate annual data on AR by type of reaction, severity, imputability to transfusion, and blood component implicated. Twenty-nine HVS provided 104 annual reports covering 107,778,290 blood units issued.ResultsAmong AR reported, 25% were serious, including 368 deaths. The 284 transfusion-transmitted infections included 187 bacterial infections, 84 viral and 13 parasitic or fungal; nine deaths resulted. AR related to the respiratory system transfusion-associated circulatory overload, transfusion-related acute lung injury and transfusion-associated dyspnoea accounted for 8.3% of all AR, 20.1% of serious, and 52.2% of deaths. Of 1634 rare AR, 1565 were hypotensive, 38 PTP, 17 GvHD, 9 hyperkalemia and 5 hypercalcemia. Half were serious and 16 fatalities were recorded (13 hypotensive, 2 GvHD, one PTP). Among 14 countries that reported any hypotensive AR, incidences diverged widely.ConclusionsARs in this group are frequently severe or life-threatening. Hypotensive AR are the most common, but may have been overlooked and counted under allergic and other AR presenting with hypotension. Compliance with the ISBT definition may be suboptimal, thus its real incidence may be higher. Data on GvHD may contribute to clarifying the role of leukodepletion with or without irradiation. ISTARE continues to be a useful surveillance tool for all transfusion AR and provides relevant insights into overlooked and rare AR, thus offering important contributions towards maximising transfusion safety.     

Platelet transfusion in adults: An update

Many patients worldwide receive platelet components (PCs) through the transfusion of diverse types of blood components. PC transfusions are essential for the treatment of central thrombocytopenia of diverse causes, and such treatment is beneficial in patients at risk of severe bleeding. PC transfusions account for almost 10% of all the blood components supplied by blood services, but they are associated with about 3.25 times as many severe reactions (attributable to transfusion) than red blood cell transfusions after stringent in-process leukoreduction to less than 10⁶ residual cells per blood component. PCs are not homogeneous, due to the considerable differences between donors. Furthermore, the modes of PC collection and preparation, the safety precautions taken to limit either the most common (allergic-type reactions and febrile non-hemolytic reactions) or the most severe (bacterial contamination, pulmonary lesions) adverse reactions, and storage and conservation methods can all result in so-called PC “storage lesions”. Some storage lesions affect PC quality, with implications for patient outcome. Good transfusion practices should result in higher levels of platelet recovery and efficacy, and lower complication rates. These practices include a matching of tissue ABH antigens whenever possible, and of platelet HLA (and, to a lesser extent, HPA) antigens in immunization situations. This review provides an overview of all the available information relating to platelet transfusion, from donor and donation to bedside transfusion, and considers the impact of the measures applied to increase transfusion efficacy while improving safety and preventing transfusion inefficacy and refractoriness. It also considers alternatives to platelet component (PC) transfusion.     

Adverse transfusion reactions in recipients transfused in out-of-hospital

Objectives

Transfusion in environments other than inpatient hospitalisation requires a specific management of the patient, particularly concerning adverse transfusion reactions. A three-year study was carried out in order to appreciate the nature of adverse transfusion reactions and their incidence in these patients.

Les complications respiratoires de la transfusion

Respiratory complications of blood transfusion have several possible causes. Transfusion-Associated Circulatory Overload (TACO) is often the first mentioned. Transfusion-Related Acute Lung Injury (TRALI), better defined since the consensus conference of Toronto in 2004, is rarely mentioned. French incidence is low. Non-hemolytic febrile reactions, allergies, infections and pulmonary embolism are also reported. The objective of this work was to determine the statistical importance of the different respiratory complications of blood transfusion. This work was conducted retrospectively on transfusion accidents in six health centers in Champagne-Ardenne, reported to Hemovigilance between 2000 and 2009 and having respiratory symptoms. The analysis of data was conducted by an expert committee. Eighty-three cases of respiratory complications are found (316,864 blood products). We have counted 26 TACO, 12 TRALI (only 6 cases were identified in the original investigation of Hemovigilance), 18 non-hemolytic febrile reactions, 16 cases of allergies, 5 transfusions transmitted bacterial infections and 2 pulmonary embolisms. Six new TRALI were diagnosed previously labeled TACO for 2 of them, allergy and infection in 2 other cases and diagnosis considered unknown for the last 2. Our study found an incidence of TRALI 2 times higher than that reported previously. Interpretation of the data by a multidisciplinary committee amended 20 % of diagnoses. This study shows the imperfections of our system for reporting accidents of blood transfusion when a single observer analyses the medical records.