贮存式自体输血在Rh（D）阴性孕妇分娩中的应用

目的：了解贮存式自体输血在Rh（D）阴性孕妇分娩中的实际应用情况。方法：产前1～3周采集并贮存孕妇自身血液,分娩时或分娩后回输给产妇。结果：产前45例贮存自体血的Rh（D）阴性孕妇中,有10例在分娩中或分娩后回输了自体血（未输异体血）,未见不良输血反应发生,母婴状况良好,Apgar评分多为10分。另外有7例产妇除了回输自体血外,又输注了一定量的异体血。比较采血前后、回输前后、回输与未回输组以及回输自体血与回输自异体血四组血液指标变化情况,均显示差异无统计学意义（P〉0.05）。结论：贮存式自体输血在Rh（D）阴性孕妇分娩中是行之有效的输血方式,既解决了血源紧张的问题,尤其是对稀有血型患者,减少异体血的输注,又提高了输血的安全性和合理性,对母婴不会造成危险,值得推广。     

2011—2012年用血比较分析

目的：比较分析2011-2012年三峡大学仁和医院临床用血情况,探讨医院用血规律和存在的问题。方法：收集近2年输血科输血管理系统统计资料,统计分析。结果：2年来共有3326例住院患者输异体血,异体用血总量11798U,用血最多的科室是外科,其次是ICU,主要成分是红细胞和血浆,其次是冷沉淀。结论：随着自体输血有序开展,异体用血总量显著下降。输血科一方面严格掌控输血指征,另一方面积极推动手术科室开展多种形式的自体输血,进一步加强异体输血和自体输血的管理,促进临床科学合理用血,降低输血风险。     

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。     

自体输血对肠肿瘤者免疫球蛋白的影响研究

目的：探讨对肠肿瘤患者术中行等容稀释性自体输血（ANH）对患者围术期机体免疫球蛋白的影响。方法：选择肠肿瘤根治术患者30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400ml,同时经静脉输入相当容量的羟乙基淀粉,术中或术后根据情况将患者自身血回输;（Ⅱ组）根据术中情况输异体悬浮红细胞2～3U。分别于术前、术后1、5d抽取静脉血,用单向免疫扩散法测定免疫球蛋白含量。结果：术后1d,IgA、lgG、IgM2组均减少,Ⅰ组术后5d各测定值基本恢复至正常水平,Ⅱ组术后5d仍然低下;IgM2组变化不显著,差异无统计学意义。结论：自体输血对肠肿瘤患者免疫球蛋白影响较小,而异体输血对肠肿瘤患者免疫球蛋白影响明显。围手术期自体输血较异体输血具有明显的优越性。     

自体输血的临床研究进展

临床输血包括自体输血和异体输血两大类,人们日常所讲的临床输血通常是指异体输血。随着社会和医学领域对异体输血存在潜在的疾病传播的巨大风险的认识不断深入,以及血液资源严重短缺的局面又非常难以解决,自体输血的作用和意义凸显重要。自体输血是指采集受血者自身血液,或回收手术野或创伤区无污染的血液再进行回输,     

异位妊娠术中洗涤式自体输血的应用研究

目的:探讨异位妊娠术中洗涤式自体输血的应用价值。方法:以2011-03-2015-06采用自体血液回收机进行自体血回输的33例异位妊娠急诊手术患者为自体输血组,以同期行异体血输注的同类患者45例为异体输血组。记录2组患者术中出血量、回收血量、异体血输注量、不良反应及输血费用等;观察自体输血组围术期心率(HR)、收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)、中心静脉压(CVP)等生命体征指标的变化情况;以及白细胞(WBC)、血红蛋白(Hb)、血细胞比容(HCT)及纤维蛋白原(FIB)、血小板(PLT)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)及血氧饱和度(SpO2)等指标变化情况;对2组患者进行术后随访和预后比较。结果:1自体输血组在异体血输注量、输血反应发生率和输血费用显著低于异体输血组(P0.05);2自体输血组回输后及术后24hSBP、MAP及CVP明显升高(P0.05),HR明显下降(P0.05),WBC、Hb、HCT、PLT、SpO2明显升高(P0.05);3自体输血组伤口拆线时间(5.0±1.9)d,住院时间(5.7±2.1)d,明显少于异体输血组的拆线时间(6.6±2.2)d和住院时间(7.4±3.1)d,差异有统计学意义(P0.05)。结论:采用血液回收机对异位妊娠急诊手术患者进行自体血回输,不但可快速回收回输自体血,还可显著减少输血反应和输血费用,缩短住院时间,具有重要的血液保护和临床应用价值。     

2005-2009年莆田市输血不良反应原因的探讨

目的：输血可以引起输血不良反应与输血相关疾病.现将我市两家三级医院2005至2009年的输血反应进行临床分析,以引起重视并提高输血的安全性.方法：通过对我市两家三级医院2005至2009年总共33278人次的输血情况进行回顾分析.结果：33278人次输血中共有181人次出现输血反应,总的输血反应率为0.54%.在我站提供的六种血液成分中引起输血反应率最高的是全血,为2.16%,最低的是洗涤红细胞1325例中没有1例出现输血反应.结论：输注成分血能有效的减少输血反应同时又可以节约血液资源.     

贮存式自体输血开展对优化妇科手术用血结构的影响

目的:总结本院2011-2013年贮存式自体输血开展前后,妇科手术用血异体少白细胞红细胞和自身贮血的应用情况。方法:对本院妇科手术台次,异体少白细胞红细胞及贮存式自体血液的使用人数、量及比例分别进行统计。结果:最近3年妇科手术台次逐年上升,异体少白细胞红细胞用量从463.5U下降至320.5U,自体输血量上升至161U。异体输血比例由手术人次的33.61%下降至19.80%,自体输血比例由0上升至22.61%。人均异体少白细胞红细胞使用量由0.783U下降至0.450U,人均自体全血用量由0上升至0.226U。结论:贮存式自体输血开展,使妇科手术用血结构得到优化,其对临床节约用血的影响,得到了规模性,量化体现。     

回收式自体输血与异体输血对心脏手术患者凝血功能及血液流变学指标的影响

目的 观察回收式自体输血与异体输血对心脏手术患者凝血功能及血液流变学的影响。方法 回顾性分析,采集我院2019年6月至2022年1月期间收治的心脏手术患者的基线资料,异体组（45例,异体血回输）,回收组（45例,回收式自体输血）,对比两组凝血功能、血液流变学及不良反应。结果 回收组输血后1 d、5 d活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、D-二聚体（D-D）表达低于异体组,纤维蛋白原（FIB）高于异体组（P<0.05）;输血后1 d,异体组高切全血黏度（HSBV）、低切全血黏度（LSBV）、全血黏度及血细胞比容均下降（P<0.05）,回收组HSBV、LSBV、红细胞聚集指数（EAI）、全血黏度及血细胞比容下降（P>0.05）;回收组总发生率低于异体组（P<0.05）。结论 回收式自体输血对心脏手术患者凝血功能及血液流变学影响均较小,且安全可靠。     

稀释式自体输血与少白细胞红细胞输注对肿瘤患者围术期T淋巴细胞亚群、NK细胞影响的比较

目的　探讨输入异体全血、异体少白细胞红细胞和等容血液稀释自体输血对围术期 T淋巴细胞亚群、NK细胞的影响。方法　选择胃癌、结肠癌或直肠癌根治手术患者 60例 ,随机均分为 3组。1H1组 :术中输异体全血 40 0～ 60 0 m l;2 H2 组 :术中输异体少白细胞红细胞 2～ 3单元 ;3 A组 :于麻醉后手术切皮前经桡动脉放血 40 0～ 60 0 ml,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。分别于术前、手术后即刻、术后 1天、术后 5天抽取静脉血 ,用流式细胞仪测定 T细胞亚群和 NK细胞的数量。结果　三组术后第 1天 CD3、CD4、 CD4/ CD8、 NK细胞较术前显著减少 (P <0 .0 5或 P <0 .0 1) ,其中 H1组和 H2 组较 A组减少更明显 (P <0 .0 5)。术后第 5天异体输血组 CD3、 CD4、 CD4/ CD8、 NK细胞仍较术前显著减少 ,而 H2 组和 A组均基本恢复正常 ,且 A组 CD3、 CD4、高于 H2 组 (P <0 .0 5)。结论　围术期异体输血严重抑制患者免疫功能 ,少白细胞红细胞和等容血液稀释自体输血对患者的免疫功能抑制轻 ,且术后恢复较快 ,自体输血更优于少白细胞红细胞     

Patterns of Autologous Blood Use in Elective Orthopedic Surgery: Does the Availability of Autologous Blood Change Transfusion Behavior?

We studied the orthopedic surgery service at our institution to determine whether the mere availability of autologous blood (AB) affected transfusion practice. As a group, patients who had AB available received an average of 1.11 fewer red cell units per hospitalization than did patients with only homologous blood (HB) available. At every transfusion episode, those patients having AB available received fewer red cell units than did patients without AB available. Predeposit of autologous red cells was effective in protecting 77.6% of patients from HB exposure. The availability of autologous red cells resulted in an overall more conservative approach to transfusion.     

Autologous blood transfusion in elective heart surgery: prospective study of 189 consecutive patients

Blood autotransfusion has entered a new phase in blood transfusion technique, since it represents an important alternative in eliminating the risks connected with blood transfusion: viral hepatitis, AIDS, blood transfusion reactions, and alloimmunization. Transfusion requirements during cardiac surgical procedures have steadily decreased; nowadays most adult patients require no transfusion during surgery. Patients (pts) receiving bank-blood may develop infectious diseases (hepatitis, AIDS, etc.). We have studied how to avoid the risk of infections with homologous blood transfusions. We present our experience of day-hospital pre-operative autologous blood collection. One-hundred-eighty-nine patients undergoing primary myocardial revascularization or valvular replacement were submitted to the drainage of 350 ml of blood three times every four days before surgery. The blood was centrifuged at once, to separate red cells from plasma. Surgeries were performed 21 days after the first drainage; iron therapy was recommended. After surgery pts received blood only if haematocrit was lower than 28%. The following data were recorded: no. of pts who received homologous blood; blood loss and homologous total blood volume used for each pt. Average blood loss was 1230 cc for ischemic pts and 701 cc for valvular pts. Non-A non B hepatitis occurred in 3/189 pts (1.5%). All of them had received homologous blood transfusions. Our data show clearly that autotransfused pts had a better post-operative period; less bank-blood and fewer transfusions have been used. No pt had collateral effects such as angina or hypotension from blood drawing. Our data show that severe cardiac diseases do not represent an absolute contraindication to heavy blood drainage.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of erythropoietin therapy in cardiac surgery using autologous blood transfusion

Autologous blood transfusion in cardiac surgery is currently widely practiced to avoid homologous blood transfusion. To assess the benefit of recombinant human erythropoietin (rhEPO), the authors studied 72 patients (53 men, 19 women) who underwent elective cardiac surgery over a 15-month period and agreed to this protocol. Of these, 47 had coronary artery bypass grafting, 19 had valve replacement, and 6 had other procedures. Each patient was scheduled to preserve more than 800 mL of autologous blood preoperatively. They received rhEPO (100 to 40 U/kg) IV 3 times weekly during a 2 to 3-week preoperative period. During surgery, an autotransfusion system was also applied. During the preoperative period, 49 patients (68.1%) increased their hemoglobin by more than 1.0 g/dL, and 66 patients (91.7%) had their operation without homologous blood transfusion. This is a significantly high incidence compared with the group who had neither preoperative preservation nor rhEPO (55 of 109 patients; 50.5%). The authors conclude that rhEPO is effective in preserving autologous blood safely before elective surgery, and most elective cardiac surgery can be done without homologous blood transfusion by preoperatively preserving autologous blood with the aid of rhEPO and employing intraoperative autotransfusion.     

The Impact of Preoperative Autologous Blood Donation on Orthopaedic Surgical Practice

We have conducted a retrospective 3-year analysis of our autologous blood donation program to assess its impact on orthopaedic surgery. We conclude: (1) utilization has increased from less than 5% of eligible patients in the first audit interval to nearly 50% in the last audit interval; (2) in the last audit interval, autologous blood donation resulted in a reduction of homologous blood transfusion from 41% in nonautologous blood patients to 14% in autologous blood donors; (3) increasingly conservative transfusion practice is seen for all patients undergoing elective orthopaedic surgery; (4) regional blood centers are responding to increasing requests for autologous blood with programs that are effective in attracting autologous blood donors; (5) on the basis of utilization and efficacy, preoperative autologous blood donation as an alternative to homologous blood transfusion now represents a standard of practice for elective orthopaedic surgery.     

Autologous Blood Donation Elective Surgery in Children

Studies were made on 59 children (cardiac 42, orthopaedic 13, miscellaneous 4) scheduled for autologous blood donation before elective surgery. The donor-patients' ages ranged from 3 to 15 years (mean 9.9 years) and their weights from 13 to 70 kg (mean 34 kg). All patients received 50–100 mg of oral iron sulphate per day. As a rule, about 10% of intravascular blood volume was drawn once a week. Before surgery, an average of 720 ml of autologous blood per patient was prepared. Two patients failed to donate autologous blood because of anxiety about the procedure; however, none of the donors was deferred due anaemia assoicated with the phlebotomy. Of the 53 patients undergoing surgery and participating in autologous predonation, 50 (94%) were able to avoid homologous blood transfusion. 600 ml of homologous blood were transfused to each of 2 orthopaedic patients and 400 ml to 1 cardiac patient. We conclude that a predeposit autologous transfusion programme is logistically possible in small children when the patients are cooperative.     

Risk factors for massive blood loss during liver resection for hepatocellular carcinoma in patients with cirrhosis

BACKGROUND/AIMS: Liver resection for hepatocellular carcinoma in patients with cirrhosis carries risk of major hemorrhage and sometimes requires blood transfusion. We investigated risk factors for massive blood loss during liver resection and indications for storing blood for autologous intraoperative transfusion. METHODOLOGY: We analyzed clinical records of 100 patients with cirrhosis who underwent liver resection for hepatocellular carcinoma. Autologous blood was stored preoperatively for 19 patients. RESULTS: Intraoperative blood loss ranged from 5 to 3000 mL (mean, 640). Liver resection was performed without transfusion in 67 patients and with autologous blood storage in 17 patients not receiving homologous blood. In the other 16 patients, homologous blood was transfused. Univariate analysis identified youth, large tumors (> 4cm), major hepatectomy, portal tumor involvement, hepatic vein involvement, and prolonged operation time as risk factors for massive blood loss; multivariate analysis identified portal involvement and hepatic vein involvement as independent risk factors. Blood loss exceeded 1000 mL in the 4 transfused group B patients and 3 of the 4 patients had hepatic vein involvement. CONCLUSIONS: Portal involvement and hepatic vein involvement were risk factors for massive blood loss during liver resection for hepatocellular carcinoma in patients with cirrhosis. Autologous blood storage is indicated in patients with such risk factors.     

Feasibility of a Predeposit Autologous Blood Donation Program in Colorectal Cancer Patients: Results from a Randomized Clinical Study

The hematologic and transfusion data of a multicenter randomized trial investigating the effect of blood transfusions on the 5-year survival were used to study the feasibility of an autologous blood donation program in colorectal cancer patients. Three hundred and ten patients were randomized for autologous blood transfusions (predeposition of 2 units) or homologous blood transfusions, and transfusion rules were standardized. The Hb level in the patients who donated blood decreased by 20.1 +/- 1.3 g/l (mean +/- SEM) preoperatively and 4.5 +/- 1.8 g/l postoperatively, and in controls 3.7 +/- 1.1 g/l and 16.5 +/- 1.9 g/l (significantly different between the two groups, both pre- and postoperatively: p less than 0.01). Because blood loss and number of transfusions were similar in both groups, this indicated that either preoperative or postoperative erythropoiesis is stronger in patients who had donated blood. Twenty-three percent of the autologous patients and 61% of the homologous patients were exposed to homologous blood. The effectiveness of the procedure differed per tumor localization. In patients with a right-sided colon carcinoma, 22% of the control patients needed homologous blood, compared to 10% of the autologous patients. In patients with other colon carcinomas, this was 52 and 16%, respectively, and in patients with a rectal carcinoma 85 and 41%. We conclude that predeposition of 2 units of blood for colorectal cancer surgery is feasible and useful to prevent homologous blood usage in a significant number of patients with left colon carcinoma or rectal carcinoma.     

Transfusion of bone marrow red cells during bone marrow harvests

Large volumes of bone marrow may be required for certain types of autologous bone marrow transplants. The present study was done to determine whether red cells obtained during a bone marrow harvest would be useful in reducing homologous transfusion requirements. A group of patients receiving standard transfusion support during the harvest (group 1) was compared to a group that received processed bone marrow red cells (PBMRBC) (group 2). Using the Cobe 2991 cell processor, 90% of the harvested bone marrow red cells were extracted and transfused during the procedure. Group 2 received a median of 1500 ml of blood processed from the bone marrow or 413 ml (volume of marrow processed x hematocrit) of red cells. Infusion of the PBMRBC reduced the homologous transfusion requirement from 6.5 units to 3.0 units (p = 0.02). In addition, group 1 had a 20% decrease in hematocrit following transfusion compared to the pre-harvest hematocrit, as opposed to an 8% decrease in group 2 (p = 0.02). This study indicates that PBMRBC can reduce the homologous transfusion requirements during an autologous bone marrow harvest.     

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 ...     

冠状动脉旁路移植术后自体血液回输减少血液制品的应用经验

目的总结非体外循环下冠状动脉旁路移植术（OPCABG）后应用自体血液回输以减少血液制品的经验。方法将2007年8月至2011年8月北华大学第二附属医院心脏外科44例OPCABG患者随机分为自体血回输组（试验组）和异体血输血组（对照组）,每组各22例。试验组应用非洗涤过滤式自体引流血回输;对照组未用自体引流血回输。结果试验组自体引流血液回输量（774．9±278．7）ml,输异体红细胞悬液（744．4±．375．5）ml;对照组输异体红细胞悬液（1200．0±357．9）ml。试验组回输自体血量占输血总量的27．8％～96．0％,平均减少了47．9％以上的异体血输入量。术后随访1个月,两组无一例新桥梗阻及血栓形成,无一例再发心绞痛症状。试验组与对照组输异体血量差异有统计学意义（P〈0．01）,而输异体血浆差异无统计学意义（P〉0．05）。结论OPCABG术后应用一次性回输器回收自体引流血可以显著减少异体血输入量。