临床成分输血分析

目的 通过对临床成分输血的分析,指导临床科室树立现代输血观念,做到科学、合理用血,推广成分输血.方法 分析我院近5年(2001～2005年)临床用血情况及各年度我院临床输血总量、成分输血率和各成分血所占比例.结果 用血量:红细胞、血小板、血浆使用率均逐年上升,全血细胞、白细胞的使用率则逐年下降,与现代国内外输血相比,我院在血浆、冷沉淀、红细胞的使用上还存在着一定的差距和不合理性.结论 通过我院临床成分输血分析,为合理配置成分血提供依据,推广成分输血.     

临床成分输血与护理

输血是将血液（全血或成分血）通过静脉或动脉输入体内的技术，是急救或平时创伤和疾病治疗的重要手段之一。自上世纪60年代开始，世界已进入成分输血时代。首先是血细胞分离机的出现，推动了血液成分单采和转换术的巨大发展，还有计算机在输血工作中的应用以及血液保存技术的发展，使成分输血迈向一个新的台阶。     

原位肝移植围手术期成分输血相关问题的探讨

目的　探讨成人原位肝移植围手术期出凝血功能的变化及输血对手术预后的影响。方法　对肝移植术前肝功能Child分级均为C级 ,出凝血功能均存在异常的 19名患者通过补充凝血因子、血小板等成分进行纠正。无肝期采用体外静脉转流 ,术中动态监测血流动力学、出凝血功能变化及出血量 ,根据无肝前期、无肝期、新肝期各项出凝血功能指标的变化 ,给予相应的输血处理 ,分别以术后生存情况和围手术期输血量分组 ,分析各种输血因素对移植术中、术后的影响。结果　在术前肝功能分级、出凝血功能、手术方式、方法、时间无明显差异的情况下 ,输血总量、红细胞用量、冰冻血浆用量与术后存活率呈明显负相关 ,偏相关系数分别为 - 0 .75 18(P <0 .0 1)、- 0 .710 4 (P<0 .0 1)、- 0 .5 14 4 (P <0 .0 5 )。死亡组输血量明显高于存活组 ,差异显著 (P <0 .0 5 ) ;输血量≥ 10 0 0 0ml组死亡率明显高于输血量 <10 0 0 0ml组 ,差异显著 (P <0 .0 5 ) ;所有病例中无一发生输血后巨细胞病毒 (CMV)感染、颅内出血。结论　术前充分纠正出凝血功能异常 ,术中进行动态监测 ,及时通过各种血液成分在品种和剂量上的合理输注进行调控及应用去白细胞输血等新技术 ,可保证原位肝移植手术顺利进行 ,有效降低输血总量 ,减少术后并发症。     

Emergency department blood transfusion predicts early massive transfusion and early blood component requirement

BACKGROUND: The purpose of this study was to evaluate the ability of uncrossmatched transfusions in the emergency department (ED) to predict early (<6 hr) massive transfusion (MT) of red blood cells (RBCs) and blood components. STUDY DESIGN AND METHODS: All patients admitted to a Level 1 trauma center between July 2005 and June 2007 who received any transfusions and were transported directly from the scene of injury were included. Early MT was defined as the need for 10 U or more or RBCs in the first 6 hours. Early MT plasma was defined as 6 U or more of plasma in the first 6 hours. Early MT platelets (PLTs) were defined as two or more apheresis transfusions in the first 6 hours. Univariate and multivariate analyses were performed. RESULTS: A total of 485 patients (34%) received ED transfusions (ED RBC+) and 956 (66%) did not receive ED transfusions (ED RBC–). ED RBC+ patients were younger, were more likely to be male, and arrived with more severe injuries. Multivariate regression identified ED transfusion of uncrossmatched RBC as an independent predictor of requiring early MT of RBCs (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.36‐7.59; p = 0.001), plasma (OR, 2.7; 95% CI, 1.66‐4.39; p < 0.001), and PLTs (OR, 1.9; 95% CI, 1.08‐3.41; p = 0.025). CONCLUSION: Patients receiving uncrossmatched RBCs in the ED are more than three times more likely to receive early MT of RBCs. Additionally, patients transfused with ED RBCs are more likely to receive 6 units or more of plasma and two or more apheresis PLT transfusions. Given these findings, ED transfusion of uncrossmatched RBCs should be considered a potential trigger for activation of an institution's MT protocol.     

Evolution in indications for blood component transfusion.

Indications for blood components are changing but continue to be based on a combination of clinical assessment and laboratory data. In the perioperative setting, some decisions must be made before laboratory data are available. To prevent the inappropriate usage of blood components, prophylactic or expectant treatment should be limited. In red cell transfusion, physiologic indices of oxygen utilization may soon supplement hemoglobin/hematocrit levels in clinical decision making. Less progress has been made in transfusion for hemostasis. Well-designed clinical studies are needed to answer remaining questions; in the interim, nationally accepted guidelines are available to assist clinicians in their decisions.     

Seroprevalence of Trypanosoma cruzi infection in at-risk blood donors in Catalonia (Spain)

BACKGROUND: The increasing arrival of Latin Americans to Europe and, particularly, to Spain has led to the appearance of new pathologies, such as Chagas disease, a zoonotic infection endemic to rural areas of Central and South America. In the absence of the triatomid vector, one of the main modes of transmission of Chagas disease in nonendemic regions is through blood transfusion. STUDY DESIGN AND METHODS: The Catalonian Blood Bank has implemented a screening program for Chagas disease in at‐risk blood donors and has performed a study to determine the seroprevalence of Trypanosoma cruzi infection in the donor population. The two commercial tests used in all samples were the ID‐PaGIA Chagas antibody test (DiaMed) and the bioelisa Chagas assay (Biokit). RESULTS: Overall seroprevalence was 0.62 percent, with 11 donors confirmed positive among the 1770 at‐risk donors studied; the highest rate (10.2%) was in Bolivian donors. Interestingly, 1 of the 11 positive donors was a Spaniard who had resided various years in a Chagas disease endemic area. Furthermore, 1 of the positive donors presented detectable parasitemia. CONCLUSION: The results of this study emphasize the need for T. cruzi screening in at‐risk blood donors in nonendemic countries. An important finding is the relevance of including in the at‐risk category persons who have resided in, but were not necessarily born in, an endemic region. If T. cruzi screening is not routinely performed in all donations, it remains highly dependent on proper identification of at‐risk donors during the predonation interview.     

成分血和全血输注在产科大出血抢救中的效果评价

目的：评价成分输血和输全血在产科大出血急救治疗中的效果。方法将解放军第457医院符合临床大出血输血指征的29例患者分为两组,一组为成分输血治疗组（22例）,根据《临床输血技术规范》制订成分输血综合治疗方案,按比例输注悬浮红细胞和血浆、血小板、凝血因子等血液制品;另一组（7例）在抢救过程中给予全血输注。两个治疗组在输血前和输血2～4 h 内分别采血进行血常规和凝血功能测定,监测输血治疗的效果。结果成分输血组在血红蛋白、血细胞比容和血小板的改善效果明显好于全血治疗组（P ＜0．05）;凝血功能在输血后的降低程度,成分输血组明显小于全血治疗组（P ＜0．05）;成分输血组使用红细胞总量和住院天数均明显低于全血治疗组（P ＜0．05）。结论成分输血较输全血在产科大出血的抢救中具有更加良好的治疗效果。     

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。     

联合应用成分血输注成功救治股动脉断裂1例

应用冷沉淀因子、冰冻血浆、少白细胞红细胞救治一名股动脉断裂大出血患者,为今后临床合理使用成分血提供了借鉴依据。成分输血是把人血液中各种有效的血液成分进行分离、加工、浓缩,分别制成各种高浓度和高纯度的血液制品。然后医生根据患者病情需要,有针对性地输注某一种或几种血液成分以达到治疗目的的一种输血措施。冷沉淀因子是在控制条件下融化新鲜冰冻血浆而采集的凝血因子,它主要包含FⅧ因子、vWF因子、FⅫ因子、纤维结合蛋白及纤维蛋白。     

The use of trauma transfusion pathways for blood component transfusion in the civilian population: a systematic review and meta-analysis

This study was undertaken to determine if, amongst civilian trauma patients requiring massive transfusion (MT), the use of a formal trauma transfusion pathway (TTP), in comparison with transfusion without a TTP, is associated with a reduction in mortality, or changes in indices of coagulation, blood product utilisation and complications. A systematic review of three bibliographic databases, reference lists and conference proceedings was conducted. Studies were included if comparisons were made between patients receiving transfusion with and without a TTP. Data were extracted by two independent reviewers on population characteristics, transfusion strategies, blood product utilisation, indices of coagulation, clinical outcomes and complications. Data were pooled using a random effects model and heterogeneity explored. Seven observational studies met all eligibility criteria. Amongst 1801 patients requiring MT, TTPs were associated with a significant reduction in mortality (RR 0·69, 95% CI 0·55, 0·87). No significant increase in the mean number of PRBC transfused between TTP and control patients was seen (MD -1·17 95% CI -2·70, 0·36). When studies assessing only trauma patients were considered, TTPs were associated with a reduction in the mean number of units of plasma transfused (MD -2·63, 95% CI -4·24, -1·01). In summary, the use of TTPs appears to be associated with a reduction in mortality amongst trauma patients requiring MT without a clinically significant increase in the number of PRBC transfused and a potential reduction in plasma transfusion. Effects of TTPs on platelet transfusion, indices of coagulation and complications remain unclear. A randomised controlled trial is warranted.     

某院2008～2010年成分输血分析

目的 分析该院过去三年成分输血情况,指导临床科学、合理用血.方法 对该院2008～2010年用血量进行统计,计算出各种成分输血率.结果 成分输血使用量逐年增加,以红细胞、血浆为主,血浆的应用比例逐年下降.结论 该院成分输血率已达较高水平(≥99.9%),但是临床血浆的滥用情况应该得到进一步遏制,仍需继续加强对成分输血的监督管理,强调血小板和冷沉淀的配合使用,以便节约有限的血液资源.     

Symptomatic parvovirus B19 infection caused by blood component transfusion

BACKGROUND: Although a risk of transfusion‐transmitted human parvovirus B19V (TT‐B19V) infection has been a concern, there have been very few reports of clinically relevant TT‐B19V caused by the transfusion of a B19V‐containing blood component. It has therefore been a matter of debate whether a universal B19V screening with an appropriate sensitivity is required. STUDY DESIGN AND METHODS: Through the Japanese Red Cross hemovigilance system, clinical reports on possible TT‐B19V were collected from 1999 to 2008, during which B19V donor screening (sensitivity, 10¹⁰ IU/mL) was conducted and repository blood samples from donors were available. RESULTS: Eight patients with TT‐B19V caused by component transfusion have been identified. Four patients developed sustained anemia and pure red blood cell (RBC) aplasia and one patient developed pancytopenia. The underlying diseases in these five patients were either hematologic malignancy or hemolytic diseases. The viral loads of the responsible components for these cases ranged from 10³ to 10⁸ IU/mL. Two patients who underwent surgical treatment without any hematologic disorder exhibited only moderate symptoms. The B19V DNA sequence identity between a patient and the linked blood donor was confirmed in five of the eight patients. All of the components responsible for the eight cases were positive for anti‐B19V immunoglobulin (Ig)M. CONCLUSION: Vulnerability to serious B19V‐related hematologic disorders depended on the patient's underlying disease state of an enhanced erythropoiesis, not on the viral load of the component transfused. To prevent clinically relevant TT‐B19V, a strategy is suggested in which patients at risk of acquiring RBC aplasia or pancytopenia are targeted.     

Breakthrough cancer pain: prevalence and characteristics in patients in Catalonia,Spain

Breakthrough pain (BTP), a transitory exacerbation of pain superimposed on a background of persistent, usually adequately controlled pain, has been reported to occur in 50% to 75% of cancer patients. However, a 23% prevalence of BTP was recently reported in a study of Spanish patients with advanced cancers, showing probably a low detection rate of this clinical problem. The purpose of the present study was to determine the prevalence of BTP among oncology patients managed by palliative care teams in Catalonia, Spain, and to characterize the frequency, intensity, and treatment of BTP episodes. Sixty-two teams studied 397 patients on a predetermined index day. BTP was reported by 163 (41%) patients, with a total of 244 episodes (mean 1.5 episodes/patient/day). Mean (SD) intensity of BTP episodes was 7.3 (2.0), compared with 2.9 (2.7) for persistent pain (both 0-10 scales). Morphine was used to treat 52% of BTP episodes, while 25% were untreated. These findings indicate that BTP remains underrecognized and undertreated in Spain.     

成份输血在抢救产科DIC中的应用

弥散性血管内凝血(DIC)是指由多种疾病引发的血管内凝血的中间病理过程。产科DIC是导致严重产后出血的主要原因之一，也是导致孕产妇死亡的主要原因之一。若能及时、有效治疗产科DIC，就能有效降低孕产妇死亡率。     

成分输血抢救弥散性血管内凝血出血的初步探讨

目的　探讨成分输血抢救DIC出血的临床疗效。方法按照血站技术操作规程制备冷沉淀、机采浓缩血小板、红细胞悬液、新鲜冰冻血浆等血液成分 ,对确诊的 7名DIC出血病人在积极治疗原发病的同时 ,根据病人的出血情况及时输注适量的血液成分和肝素 ,并进行相关实验室检测。结果经成分输血抢救 ,7名病人的出血症状均得到控制 ,除 1例严重溶血性输血反应于肾衰外 ,6例均获得良好疗效 ,有关实验室检测结果基本恢复到正常水平。结论成分输血抢救DIC出血可获得良好止血效果 ,为其它治疗措施提供时机