成都军区总医院近三年临床用血情况分析

目的:探讨《献血法》实施以后临床用血品种、季节分布变化的特征。方法:回顾性分析成都军区总医院2000~2004年临床用血情况。结果:临床使用全血比例逐年下降,成分血比例逐年升高,2004年成分输血率达到97.61%;机采血小板用量接近总用血量的40%;年用血高峰在8~9月。结论:我院推广成分输血已取得了初步成果。     

成分输血在我院的临床应用情况分析

目的:了解成分输血在我院的应用情况,指导临床科学,合理用血.方法:对我院2002～2008年使用全血及各种成分血的情况进行统计分析.结果:我院成分血使用率逐年提高,但血浆有滥用现象.结论:我院成分输血率已达到国内先进水平,血浆存在滥用现象,血小板,冷沉淀等成分需进一步提高使用有效率.     

成分输血在我院的临床应用情况分析

目的：了解成分输血在我院的应用情况，指导临床科学，合理用血。方法：对我院2002～2008年使用全血及各种成分血的情况进行统计分析。结果：我院成分血使用率逐年提高，但血浆有滥用现象。结论：我院成分输血率已达到国内先进水平，血浆存在滥用现象，血小板，冷沉淀等成分需进一步提高使用有效率。     

我院5年临床成分用血分析

目的通过对临床用血情况进行分析,提倡合理使用各种血液成品。方法对2003—2007年本院用血情况进行统计分析。结果五年来本院成分输血率由92.2%提高到99.8%,病人增加1倍而用血量仅增加6%,人均用血量逐渐下降,各血液成分血量百分比依次为红细胞、血浆、血小板、全血。结论及时分析、掌握医院成分输血情况,加大宣传力度,严格制度,对指导临床合理安全的使用血液成分具有重要意义。     

青海省采供血机构成分血制备现状调查分析

目的：调查了解青海省成分血制备现状，掌握其薄弱环节，进而采取有效措施，提高全省成分血制备规模。方法：对全省9家采供血机构（简称血站）的成分血制备现状展开调研。调研内容主要为人员、成分血品种、设备配置、成分血制备、高海拔对成分血制备的影响。结果：全省开展成分血模式：去白悬浮红细胞+冰冻血浆4家；去白悬浮红细胞+病毒灭活冰冻血浆3家；去白悬浮红细胞+病毒灭活冰冻血浆+冷沉淀凝血因子1家；去白悬浮红细胞+病毒灭活冰冻血浆+手工浓缩血小板+冷沉淀凝血因子+洗涤红细胞+冰冻解冻去甘油红细胞1家。2014年—2019年全省成分血制备量逐年上升。除省血液中心外，其余8家中心血站均存在人员、设备配置不足，另外由于高海拔地区人体红细胞压积及脆性增加、血小板平均水平较平原地区低等特点，因此需对成分血制备提出更高的要求。结论：随着近几年青海省输血事业的发展，全省成分血制备规模逐年扩大，但要满足当前成分血制备需求，仍需加大人员、设备的投入，基层血站血液品种有待进一步开展。     

我院地震伤员成分血使用情况分析

目的 通过对地震伤住院患者的成分血输注情况进行分析,为指导临床科学、合理用血提供依据.方法 对我院2008年5月12日～6月12日收治住院的进行过成分血输注的121例地震伤患者进行分析.结果 红细胞悬液用量为859.5 U,血浆用量为20400 U,血小板用量为240 U,冷沉淀用量为121U,全血用量为0.成分血使用率为100%.结论 本次地震造成的伤员成分血使用率符合规定,但成分血使用不尽合理,血浆使用量偏大.     

大量输血病例分析

目的 分析1991年1月-2003年5月临床输血在3000ml以上的252例病例用全血和各种成分血的构成比,让输血发挥最佳治疗效果。方法 查阅配发血记录本和计算机管理系统(军字I号工程)及病历资料,以术前Hb<80g／L为A组,术前Hb>80g／L为B组,分组观察用血量、用血后血红蛋白(Hb)、血细胞比容(血球比积)(Hct)和血小板计数(Plt)的变化,用计算机程序作统计分析。结果 252例中,1998年以前80例,共计用血434436ml,全血占91.9％,1999年后172例,用血951055ml,全血占3.3％,红细胞制品占59.2％,血浆占29.8％。输血后,Hb从53.8-95.6g／L升高至88.9-132.1g/L,Hct从16.5％-29.8％升高至26.8％-39.0％,Plt从(9.7-12.3)×109／L升高至(13.8-25.2)×109／L。1999年后成分输血比例达96.7％,节约原料血281 510ml,死亡率两组比较无明显差异。结论 对大出血病人可选用红细胞制品维持Hb在80g／L以上,红细胞与血浆按2:1比例输注,按需要补充血小板等成分,以维持凝血功能是可行的。     

多次成分血输注致HLA基因分型结果无法判定1例

目前临床用血多为成分输血,成分血分离自全血,不可避免会残留少量白细胞或血小板。而有核细胞或血小板表面存在的HLA会随着输血进入患者体内,异体HLA抗原可对患者的HLA分型判定产生干扰。现报道1例接受过多次大量成分血输注治疗的重型再生障碍性贫血患者,由于未严格按HLA分型血标本规定时间间隔进行血标本采集,导致HLA低分辨基因分型结果无法判定,提示临床医师引起重视。     

全血、成分血质量控制及部分细节问题的探讨

加强血液质量控制是安全输血的保证 ,为提高临床用血质量、保障献血者和用血者的身体健康 ,必须对采血、检验、贮血、成分制备、配血、发血和输血等过程实施全程质量控制[1] 。结合军队实际 ,我们根据GB 184 6 9- 2 0 0 1《全血及成分血质量要求》国家标准 ,参照军队第四版《医疗护理技术操作常规》中《输血科常规》部分和总后勤部卫生部转发国家卫生部《临床输血技术规范》 ,制定了本中心的全血及成分血质量控制内容及标准。本文就此作一介绍并对实施质量控制中部分项目的细节进行探讨 ,针对存在的一些问题提出建议。1　全血及成分血质量…     

临床输血出现的一些新问题及对策探讨

随着我国无偿献血制度的不断完善,科学合理用血理念已为广大医务人员普遍接受,成分输血比率逐年上升,临床不合理用血得到有效遏制,许多医院临床用血量出现稳中有降的可喜局面。自2011年6月起,我们对医院临床用血进行了逐月监测,发现临床用血规范程度有明显好转,内科病人不合理用血基本杜绝,但也出现了一些新的问题,其中以"误用安全输血概念"最为严重,怕"引发纠纷"是许多外科医师出现过度输血、不合理输血的重要原因。作者从临床医师的角度对临床用血现存的一些倾向性问题及改进措施进行了总结。     

Blood transfusion therapy at the Military Medicine Academy--present possibilities

Blood component therapy refers to the transfusion of the specific part of blood that a patient needs, as opposed to the routine transfusion of whole blood (WB) in the past. This not only maintains blood resources, but also provides the optimal method of transfusing patients who require large amounts of a specific blood component. Since this concept have been accepted, the Institute of Transfusiology of Military Medical Academy (MMA) possess appropriate equipment for blood collection and processing of WB in components. Mainly, all kind (except frozen) of packed red cells (RBCs), platelet concentrates (random-donor buffy coat or apheresis donation), single-donor (apheresis) or random-donor (buffy coats) granulocytes, fresh frozen plasma (FFP), single-donor cryoprecipitate are prepared. Recently, fibrin glue (obtained by recycled cryoprecipitation from single-donor or autologous plasma), and some of new generation of blood components: hematopoietic stem and progenitor cells (fresh or cryopreserved), collected from bone marrow or harvested from peripheral blood after mobilization and donor-specific mononuclear cells for cell therapy, i.e. immunomodulation during relapse of leukemia after bone marrow transplantation, have become the routine. Analysis of blood component therapy done at the MMA during the past 11 years (1989-1999) showed that: a) participation of WB transfusion in the group of surgical clinics was permanently decreased (from 59.60% in 1989 to 0.37% in 1999); b) WB transfusion (in the last few years) practically was not used in the group of internal medicine clinics (0.82% in 1993 and 0.45% in 1999); c) overall WB transfusion in MMA is extremely rare (0.37%).     

Nuclear medicine gastrointestinal bleeding examination utilizing an UltraTag kit reveals unusual bone marrow and hepatic uptake: a case study report

In vitro gastrointestinal (GI) bleed testing such as the UltraTag kits has been successfully used for a number of years. None of the research studies identified reported any significant bone marrow and liver uptake. An 80-y-old male patient was admitted to the hospital for rectal bleeding. An initial GI bleed study using the UltraTag kit was normal. Two days later, a second GI bleed scan was performed while the patient was undergoing blood transfusion with packed red blood cells. The technologist withdrew a blood sample from the blood transfusion bag. The second GI bleed test demonstrated unusual liver and bone marrow uptake. We believe that this liver uptake might have been caused by the labeling of fragmented red blood cells or oxidation of pertechnetate in the form of technetium dioxide.     

An ultrafiltration technique for labeling red blood cells with Tc-99m

This method automates the preparation of autologous Tc-99m labeled red blood cells utilizing the Amicon on-line column eluate concentrator to separate the plasma from the red blood cells. The red blood cells were pre-tinned with stannous diphosphonate and continuously recirculated over a 0.6 filter until all of the plasma was removed and the red blood cells remained suspended in a solution of 0.9% sodium chloride. Once the plasma has been removed the red blood cells are incubated with Tc-99m pertechnetate. The above Tc-99m red blood cells were compared to Tc-99m red blood cells produced in a similar manner except that centrifugation was used to separate the red blood cells from the plasma. Both preparations had a tagging efficiency of 98% or greater and rat distribution studies demonstrate that both preparations are equally stable as an in vivo intravascular agent.     

血液病血小板输注疗效分析

目的分析血液病患者血小板输注无效（platelet transfusion refractoriness,PTR）原因,以提高血小板输注率。方法分析血液病患者胛R的临床特征,比较输注单采血小板＋少白细胞红细胞（少白组）、单采血小板＋悬浮红细胞（悬浮组）、单采血小板（单采组）患者的血小板输注疗效。结果93例血液病患者盯R率平均为25．0％。少白组、悬浮组、单采组的胛R率分别为21．2％、32．7％、26．7％（X2=5．66）,结果无统计学意义,但少白组有低于其他两组的趋势。结论影响血液病患者PRT原因虽然有非免疫性因素,而减少输入白细胞数量可提高血小板输注。     

外周血中性粒细胞/淋巴细胞比值及其与成分输血不良反应的关系

 目的 分析外周血中性粒细胞/淋巴细胞比值(neutrophil to lymphocytes ratio,NLR)及其与成分输血不良反应的关系。方法 选取2015-05至2020-05武警兵团总队医院接受成分输血且发生不良反应69例患者的临床资料,作为发生组;并选取同期接受成分输血且未发生不良反应72例患者的临床资料,作为未发生组。输血前检测并比较两组中性粒细胞、淋巴细胞及NLR,采用回归分析检验输血前NLR对成分输血患者发生不良反应的影响,并绘制ROC曲线预测成分输血不良反应风险的价值。结果 发生组输血前中性粒细胞水平、淋巴细胞及NLR均高于未发生组(P<0.05);回归分析结果显示,输血前NLR过表达是成分输血患者发生不良反应的影响因素(OR＞1,P<0.05);绘制ROC曲线结果显示,输血前NLR预测成分输血患者发生不良反应的曲线下面积(AUC)为0.834,预测价值较理想。结论 成分输血患者治疗期间不良反应的发生风险可能与外周血NLR过表达有关。     

An ultrafiltration technique for labeling red blood cells with Tc-99m.

This method automates the preparation of autologous Tc-99m labeled red blood cells utilizing the Amicon on-line column eluate concentrator to separate the plasma from the red blood cells. The red blood cells were pre-tinned with stannous diphosphonate and continuously recirculated over a 0.6 mu filter until all of the plasma was removed and the red blood cells remained suspended in a solution of 0.9% sodium chloride. Once the plasma has been removed the red blood cells are incubated with Tc-99m pertechnetate. The above Tc-99m red blood cells were compared to Tc-99m red blood cells produced in a similar manner except that centrifugation was used to separate the red blood cells from the plasma. Both preparations had a tagging efficiency of 98% or greater and rat distribution studies demonstrate that both preparations are equally stable as an in vivo intravascular agent.     

抗Rh（D）抗体制备的研究进展

RhD抗原是表达在人类红细胞表面的血型抗原,其在免疫原性和临床上的应用仅次于ABO血型系统,相应的抗Rh（D）抗体在血型鉴定和预防新生儿溶血等方面均具有重要意义。传统的抗Rh（D）多克隆抗体来自健康人的血清,由于来源受限和血浆制品的安全问题,人们开始了抗Rh（D）的单克隆抗体和基因工程抗体的研究。国外研制的抗Rh（D）的单克隆抗体已成功用于血型鉴定,但到目前为止,还没有一个单克隆或者基因工程抗Rh（D）抗体作为多克隆抗Rh（D）抗体的替代品,在临床上用于预防Rh（D）免疫和新生儿溶血。本文对抗Rh（D）抗体制备的研究进展进行了综述。     

Diagnose akuter Transfusionsreaktionen

The erroneous transfusion of AB0-incompatible red cells may result in hemolysis and complement-mediated shock (acute hemolytic transfusion reaction, AHTR), leading to death in less than 10%. The mistake will be detected by re-checking the patient’s and the blood product’s identity. Evidence of the incompatible transfusion is supplied by serology and, in cases of a fatal outcome, by immunohistochemistry. Differential diagnoses to be distinguished from AHTR are other immunologically mediated events like the most important transfusion-related acute lung injury (TRALI), febrile non-hemolytic transfusion reaction (FNHTR), allergic transfusion reactions, along with a variety of nonimmunologic incidents like transfusion-transmitted bacterial infections, hypervolemia, and other rare events such as citrate reaction, air embolism, and foreign body embolism. If the outcome is lethal, the question of causality has to be answered by a comprehensive evaluation including the clinical data as well as serological, microbiological, autoptic, and histological findings.     

Blood usage in rotor-wing transport

INTRODUCTION: Blood transfusion for hemorrhagic shock is standard therapy. The purpose of this study was to document the development of protocols for administering red blood cells and review the experience with inflight blood transfusions. SETTING: This study was conducted at a hospital-based rotor-wing (RW) program whose service area is a large rural area in southeastern Minnesota. A BK 117 with a flight nurse/flight nurse configuration was used. METHODS: The RW registry was accessed during a 3-year period (August 1993 to July 1996), and 2131 records were reviewed to retrospectively analyze blood use during transport. Blood bank records and protocols also were reviewed. RESULTS: This helicopter program maintains a refrigerator with 4 units of O-negative blood that is kept in the hangar and serviced by the blood bank. Blood was taken on all appropriate transports (91% interfacility, 9% scene), and 94 of 2131 patients (4%) were transfused. Criteria for blood transfusion included Hgb < 10, persistent hypotension after resuscitation, and clinical signs of shock. Medical conditions consisted of trauma (48% of patients), gastrointestinal (GI) bleed (25%), abdominal aortic aneurysm (AAA) (17%), and other (10%). The mean Hgb before and after transport was 8.9 and 10.2, respectively; 38% of the patients received an average of 3 units before transport. Overall, 2 units red blood cells were given in flight and another 12 units during hospitalization. No complications occurred with blood transfusions. CONCLUSIONS: Selected RW patients will benefit from in-flight blood transfusions. Proximity of blood storage to the helicopter is mandatory to avoid delays in transport. A close working relationship with blood bank personnel ensures ready availability of current O-negative blood.     

Diagnostic approaches to acute transfusion reactions

The erroneous transfusion of ABO-incompatible red cells may lead to life-threatening hemolysis and complement-induced shock, resulting in death in less than 10% of cases (acute hemolytic transfusion reaction, AHTR). Identification of the cause of an erroneous transfusion is accomplished in nearly all incidents merely by checking the identity of the patient, blood sample and blood bag. The erroneous transfusion is confirmed by serological and—in the case of a fatality- immunohistochemical methods. The differential diagnosis should rule out transfusion-related acute lung injury (TRALI), other immunologically triggered causes such as febrile nonhemolytic transfusion reaction (FNHTR) or allergic reactions, but also nonimmunological causes such as bacterial contamination of the blood components, transfusion-associated circulatory overload (TACO) and other rare events such as citrate overload or embolism (by air or debris). In the case of a fatality, evaluation of a patient′s medical records, serological and microbiological analyses, autopsy and histology, taken together, clarify questions of causality.