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。     

自体血液回收机在小儿脊柱矫形手术中的应用体会

目的探讨自体血液回收机在小儿脊柱矫形手术中应用的意义。方法将396例脊柱侧弯患儿分为两组,实验组为应用血液回收机自体输血者217例,对照组未应用血液回收机而输异体血179例。比较两组术中出血量、输血量及手术前后血红蛋白（Hb）值。结果两组术中出血量及手术前后Hb值无统计学差异（P〉0.05）;实验组输异体血量明显少于对照组（P〈0.05）。结论自体血液回收机的使用明显减少了异体血的输入,在小儿脊柱矫形手术中应用很有价值。     

Clinical benefits of autologous blood transfusion: an objective assessment

Summary Orthopaedic patients undergoing mainly hip and knee replacement surgery and who were transfused with autologous blood which they had donated prior to surgery, were compared with similar patients who had been transfused only with homologous blood, with respect to rates of wound and other infections, need for therapeutic antibiotics, and length of post-operative hospital stay. Participants in the autologous scheme spent significantly less time in hospital than the control group (mean 16 vs 21 days), and there was a trend in favour of autologous transfusion in rates of infection and antibiotic usage.     

回收式自体输血在腹部大出血术中的临床应用

目的：探讨回收式自体输血的安全性和效果。方法：将回收式自体输血技术应用于腹部大出血手术的临床实践中,观察回收血液后患者的重要功能指标变化情况,包括外周血红细胞、血红蛋白、血细胞比容、血小板数、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原和肝功能指标丙氨酸氨基转移酶、碱性磷酸酶、肾功能指标尿素氮、尿酸、肌酐及不良反应。结果：血液各项指标和肝肾功能正常,主要成分指标差异无统计学意义,不良反应少。结论：回收式自体输血操作简单方便,经血液回收机处理后的自体血安全可靠,有一定的临床推广价值。     

电视胸腔镜自体血回输治疗自发性血胸和血气胸

目的探讨电视胸腔镜手术（VATS）结合自体血回输治疗自发性血胸、血气胸的疗效。方法 25例自发性血胸和血气胸患者,采用VATS治疗,并在术中同步进行自体血回输。观察失血量和回输血量,检测术前、术后第1天及第7天的血常规、凝血功能及肾功能。结果 25例患者均经胸腔镜完成胸腔积血回收,血凝块清除;胸腔止血和肺大疱切除。术中出血量（1610＋730）ml,回收血量（1235＋485）ml,术后血红蛋白和红细胞总数均较术前有显著增加;除2例病人术后胸腔引流管放置时间较长外,全组无死亡,均痊愈出院。结论电视胸腔镜手术治疗自发性血胸和血气胸,创伤小,恢复快;结合术中自体血回输可以及时补充血容量,节约血源,显著减少各种输血并发症,增加抢救成功率。     

Processing cord blood from premature infants into autologous red-blood-cell products for transfusion

Background and Objectives The use of umbilical cord blood (UCB) for transfusion purposes has gained interest the past years. UCB transfusion could serve premature infants, who often need transfusions early in life. Material and Methods We investigated the suitability of different storage media. UCB was collected after 25 ⁰/₇–35 ⁶/₇ gestational weeks and centrifuged to concentrate red cells subsequently stored in saline–adenine–glucose–mannitol (SAGM), or in additive solution‐3 (AS‐3), or stored as whole blood in citrate–phosphate–dextrose–adenine‐1. Quality parameters were measured at 7 day intervals during 35 days and compared to the standard RBC product. Results White‐blood‐cell‐ and platelet counts were higher in the UCB products. In the fractionated units, haemolysis remained below 1·0% in 64% after 14 days, and in 30% after 21 days. Storage in SAGM or AS‐3 showed similar quality. Whole blood UCB showed better pH and haemolysis rates after 21 days. Conclusion UCB can be processed into autologous products for premature infants. Shelf‐life is limited to 14–21 days and compares unfavourably to stored whole blood. Considering the early transfusion needs in these infants, a short shelf‐life would not be a practical objection.     

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。     

Advantage of autologous blood transfusion in surgery for hepatocellular carcinoma

AIM: To evaluate the significance of autologous blood transfusion (AT) in reducing homologous blood transfusion (HT) in surgery for hepatocellular carcinoma (HCC). METHODS: The proportion of patients who received HT was compared between two groups determined by the time of AT introduction; period A (1991-1994, n = 93) and period B (1995-2000, n = 201). Multivariate logistic regression analysis was performed in order to identify independent significant predictors of the need for HT. We also investigated the ...     

The use of cord blood for transfusion purposes: current status

Although the use of umbilical cord blood (UCB) for transfusion purposes has been proposed decades ago, the employ is still limited. In this article we review studies evaluating UCB collection efficiency and sterility, examine processing and storage of UCB-derived red blood cells (RBC) and discuss clinical studies in which UCB was used for transfusion purposes.
Efforts to provide preterm newborns with autologous RBC derived from UCB have not been very successful. UCB collected after full-term deliveries can however easily be processed into RBC products and could be used autologous in case surgery of the neonate is indicated early after birth, or for allogeneic small volume paediatric transfusions. To harvest enough UCB volume, immediate clamping of the umbilical cord is commonly used as standard practice. Although delayed cord clamping has shown to improve the iron status in full-term infants; for small-for-gestational-age infants this has not been demonstrated. In addition, an increased need for phototherapy after delayed clamping exists. Altogether, we could find no disencouraging evidence to collect UCB, which could be processed into an easily available RBC product for paediatric transfusion in resource-restricted countries.     

Transfusion transmitted Yersinia enterocolitica infection in New Zealand

Abstract Aims: To update and summarise cases of transfusion-transmitted Yersinia enterocolitica infection in New Zealand and to evaluate critically suggested methods to reduce this rare but frequently fatal complication of blood transfusion.
Methods: Case reports of four recent transfusion-transmitted Y enterocolitica infections in New Zealand are given and previous reports reviewed. Literature review and evaluation of proposed methods to decrease the incidence of transfusing yersinia contaminated blood.
Results: There have been eight cases of transfusion-transmitted Y enterocolitica infection in New Zealand in the past five years. Four of the five deaths have been directly caused by the transfusion. This gives a transfusion incidence rate of one:65,000 and a fatality rate of one: 104,000 units transfused. This fatality rate is more than 80 times higher than that reported in the United States.
Conclusions: Why the incidence of transfusion-transmitted yersinia is so high is not clear, since we do not store blood as long as many other countries, particularly the United States. In Auckland, however, the cases came at a time when the number of yersinia isolates from the community is reported to be rising.
Many suggestions for the prevention of this problem have been put forward reflecting the fact that there is as yet no perfect solution. Those which are easy to implement and cheap to perform are largely already in place and investigation is continuing into the other alternatives.     

Cellular immune response to autologous blood transfusion in hip arthroplasty: whole blood versus buffy coat-poor packed red cells and fresh-frozen plasma

BACKGROUND AND OBJECTIVES: Transfusion-induced immunomodulation by autologous blood is probably related to the buffy coat. Hence, in the present study, phagocytotic and oxidation activities of peripheral blood cells were investigated in hip arthroplasty patients exposed to autologous blood. MATERIALS AND METHODS: Blood from 60 autologous donors was allocated at random to storage as whole blood (WB) or as buffy coat-poor packed red cells and fresh-frozen plasma (RCP). Phagocytotic and oxidation activities of neutrophils and monocytes, incidence of infections and length of hospital stay were compared among the groups of transfused (WB and RCP) and non-transfused (NT) patients. RESULTS: Phagocytotic activities of neutrophils and monocytes were not significantly different among the WB, RCP and NT groups. CONCLUSION: In the perioperative setting, a specific cellular immune response to autologous transfusion is not detectable.     

恶性肿瘤患者自体输血

目的：探索恶性肿瘤患者自体输血的可行性。方法：分析自体输血和异体输血对择期手术恶性肿瘤患者的影响。结果：肿瘤患者自体输血较异体输血,输血反应发生率、感染率和输血费用低。结论：对恶性肿瘤患者实施自体输血是可行的,既可节约血源又减少输血反应的发生和疾病传播,而且不需要检测血型和交叉配血,减少患者经济负担。     

Transfusion of ABO non-identical platelets does not influence the clinical outcome of patients undergoing autologous haematopoietic stem cell transplantation

BackgroundThere are ABO antigens on the surface of platelets, but whether ABO compatible platelets are necessary for transfusions is a matter of ongoing debate. We retrospectively reviewed the ABO matching of platelet transfusions in a subset of patients undergoing autologous haematopoietic progenitor cell transplantation during a 14-year period. Our aim was to analyse the characteristics and outcomes of patients who received platelet transfusions that were or were not ABO identical.ResultsThe patients received a total of 2,772 platelet concentrates, of which 2,053 (74.0%) were ABO identical and 719 (26.0%) ABO non-identical; of these latter 309 were compatible and 410 incompatible with the patients’ plasma. Considering all transplants, 36 (6.5%) did not require any platelet transfusions, while in 246 (44.5%) cases, the patients were exclusively transfused with ABO identical platelets and in 47 (8.5%) cases they received only ABO non-identical platelet transfusions. The group of patients who received both ABO identical and ABO non-identical platelet transfusions had higher transfusion needs and worse clinical outcomes compared to patients who received only ABO identical or ABO non-identical platelets.DiscussionIn our hospital, patients undergoing autologous haematopoietic stem cell transplantation who received ABO identical or ABO non-identical platelet transfusions had similar transfusion and clinical outcomes. The isolated fact of receiving ABO non-identical platelets did not influence morbidity or survival.     

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.     

自体血液回输在心脏瓣膜替换手术中的应用

目的 探讨术中血液回输技术的安全性和效果,评价其在心脏瓣膜替换手术中的应用价值.方法 本研究共选人单个心脏瓣膜替换手术32例,随机分为2组.所有患者均于全身麻醉和体外循环下行心脏瓣膜替换手术.对两组患者术中出血量.术中自体血液回输量,异体血输入量,手术前、输血前、输血后血常规和动脉血气分析结果进行观测,记录输血并发症的情况.结果 两组术中出血量差异无统计学意义;两组患者术前、输血前、术后血红蛋白（HGB）、红细胞比积（HCT）比较,差异均无统计学意义;两组血气分析的pH值、血钾、乳酸比较差异无统计学意义（P〉0.05）;而两组库血输入量差异有统计学意义（P〈0.01）.两组均未观察到有输血并发症发生.结论 在体外循环下心脏瓣膜置换术中自体血液回输可有效地减少围术期自体血的丢失,补充血容量,维持有效循环,同时明显减少异体血的用量及并发症发生,是安全、有效的,有很高的临床应用价值.     

Comparison of results of autologous versus homologous blood transfusion in open-heart surgery

Background

The aim of this study was to determine a method to decrease the use of homologous blood during openheart surgery using a simple blood-conservation protocol. We removed autologous blood from the patient before bypass and used isovolumetric substitution. We present the results of this protocol on morbidity and mortality of surgery patients from two distinct time periods.

Methods

Patients from the two surgical phases were enrolled in this retrospective study in order to compare the outcomes using autologous or homologous blood in open-heart surgery. A total of 323 patients were included in the study. The autologous transfusion group (group 1) comprised 163 patients and the homologous transfusion group (group 2) 160 patients. In group 1, autologous bloods were prepared via a central venous catheter that was inserted into the right internal jugular vein in all patients, using the isovolumetric replacement technique. The primary outcome was postoperative in-hospital mortality and mortality at 30 days. Secondary outcomes included the length of stay in hospital and in intensive care unit (ICU), time for extubation, re-intubations, pulmonary infections, pneumothorax, pleural effusions, atrial fibrillation, other arrhythmias, renal disease, allergic reactions, mediastinitis and sternal dehiscence, need for inotropic support, and low cardiac-output syndrome (LCOS).

Results

The mean ages of patients in groups 1 and 2 were 64.2 ± 10.3 and 61.5 ± 11.6 years, respectively. Thirty-eight of the patients in group 1 and 30 in group 2 were female. There was no in-hospital or 30-day mortality in either group. The mean extubation time, and ICU and hospital stays were significantly shorter in group 1. Furthermore, postoperative drainage amounts were less in group 1. There were significantly fewer patients with postoperative pulmonary complications, pneumonia, atrial fibrillation and renal disease. The number of patients who needed postoperative inotropic support and those with low cardiac output was also significantly less in group 1.

Conclusion

Autologous blood transfusion is a safe and effective method in carefully selected patients undergoing cardiac surgery. It not only prevents transfusion-related co-morbidities and complications but also enables early extubation time and shorter ICU and hospital stay. Furthermore, it reduces the cost of surgery.