常温(25℃)保存1天对血液质量的影响

目的 探索较短时间常温(25℃)放置对血液质量的影响及其继续保存的可能性。方法 以ACD全血常温放置24小时井继续4℃保存为实验组,以4℃常规保存为对照组,对ATP等10种血液保存指标进行测定。结果 实验组血液代谢有所加快,ATP、血K~ 、pH变化比较明显,红细胞保存有效期略有减少,但FHB、MCV等指标无明显变化。结论 常温放置24小时对血液质量影响不大,可以继续保存,但红细胞保存有效期减少3天,应当提前输注。     

2005年重庆市的凝血试验调查结果分析

目的了解重庆市凝血试验的检测能力,探索提高凝血试验的检测水平的思路。方法对2005年重庆市凝血试验的室间质量评价活动和现场调查结果进行分析。结果重庆市凝血试验的检测能力不理想,与凝血试验的不规范化操作有关,与仪器、试剂的溯源性工作有关。结论应加强凝血试验的溯源性和规范化工作。     

Optimizing electronic blood ordering and supporting administration workflows to improve blood utilization in the pediatric hospital setting

Background

Red blood cell wastage occurs when blood is discarded rather than transfused, and ineffective ordering results in unnecessary crossmatch procedures. We describe how a multimodal approach to redesigning electronic ordering tools improved blood utilization in a pediatric inpatient setting and how using innovative application of time series data analysis provides insights into intervention effectiveness, which can guide future process improvement cycles.

Methods

A multidisciplinary team used best practices and Toyota Production System methodology to redesign electronic blood ordering and improve administration processes. We analyzed crossmatch to transfusion ratio and red blood cell wastage time series data extracted from our laboratory information system and electronic health record. We used changepoint analysis to identify statistically discernible breaks in each time series, compatible with known interventions. We performed causal impact analysis on red blood cell wastage time series data to estimate blood wastage avoided due to the interventions.

Results

Changepoint analysis estimated an 11% decrease in crossmatch to transfusion ratio and a 77% decrease in red blood cell monthly wastage rate during the intervention period. Causal impact analysis estimated a 61% reduction in expected wastage compared to the scenario if the interventions had not occurred.

Discussion

Our results show that electronic health record design is an important factor in reducing waste and preventing unnecessary crossmatching, and that time series analysis can be a useful tool for evaluating the long-term impact of each stage of intervention in a longitudinal process redesign effort for the purpose of effectively targeting future improvement efforts.     

Availability of blood components and plasma derived medicines in Iran.

Iran is a country with advanced health care system. In 1974 government of Iran established a centralized transfusion system. Since then donations of blood may not be remunerated and therapy with blood and its components is free of charge for all Iranian patients in need of the treatment. Most of donors in Iran are educated middle age men. In 2005 Iranian donated more than 1.6 millions units of blood. Although Iran population has doubled in past three decades blood donation has increased several folds. Donations are meticulously screened through interviewing of donors and lab testing of the donations using serological methods. In contrary to blood and blood components, Iran is heavily depends on importation of plasma derived medicines. Irrational use of blood components and low surveillance on use of plasma derived medicines, which are highly subsidized by the government, is a major challenge in transfusion medicines in Iran.     

献血者血液筛查ALT异常结果分析

[目的]对初复检献血者标本ALT异常与HBV和HCV感染的关系进行分析。[方法]应用IFCC推荐的速率法测定ALT，HBsAg和anti-HCV应用ELISA方法测定。[结果]6057份初检标本中ALT升高191份，占总异常率的53.7％（191／356），HBV和HCV标志物阳性分别仅占ALT升高标本的5.8％（11／191）和2、1％（4／191）；47590份复检标本巾ALT升高500例，占总异常率的70.4％（500／710），HBV和HCV标志物阳性分别仅占0.4％和1.8％；HBsAg和anti-HCV阴性的单纯ALT升高在初复检标本中分别占总ALT升高标本的92.1％和97.8％。[结论]ALT升高是导致血液报废的主要原因，目前献血者采用的ALT筛查标准（40U／L）无助于提高血液安全质量。     

Seroprevalence and molecular detection of Toxoplasma gondii in healthy blood donors in southwest Iran

Background

Toxoplasmosis is a cosmopolitan parasitic disease caused by Toxoplasma gondii (T. gondii). Blood transfusion is a probable route of T. gondii transmission. Due to lack of information about seroprevalence of T. gondii in healthy blood donors, this study was aimed to determine the chronic and acute infection using serological and molecular methods.

Preparation of packed red blood cell units in the blood bank: Alteration in red blood cell deformability

BackgroundDonated blood is stored in the blood bank as packed red blood cell units. In the process of packed cells preparation, the red blood cells (RBCs) are subjectedto high level of shear stress, which can induce alterations in their properties.In the present study, we examined the effect of packed RBCs preparation (which included leuko-filtration) on red cell deformability.MethodsBlood samples were collected from 25 healthy donors and from corresponding units of packed RBCs. The portion of undeformable cells (%UDFC) was determined for each sample.ResultsThe median value of %UDFC was equal to 6.75 ± 0.70 %, for freshly-donated RBCs, and to 6.36 ± 0.51 %, for packed cells. Wherein, %UDFC may increase or decrease following packed cells preparation, depending upon the initial portion of undeformable cells.ConclusionLikely, exposure of RBCs to high shear stress, during packed cells preparation, induces opposing effects: (a) removal/destruction of rigid (undeformable) cells, thereby reducing their total amount (i.e., decreasing the %UDFC) on the one hand, and (b) mechanical damage to the cell membrane and subsequent reduction of the cell deformability (thereby increasing the %UDFC) on the other. As a consequence, the final impact of packed cells preparation is primarily determined by the initial state of erythrocytes in the blood of the donor.     

2005-2015年上海市猩红热流行病学特征分析

目的 了解2005-2015年上海市猩红热流行病学特征及其变化规律,为进一步做好猩红热防控,开展相关研究提供依据。方法 对《国家传染病报告信息管理系统》中2005-2015年上海市猩红热报告发病资料进行描述性分析。结果 2005-2015年,上海市累计报告猩红热发病数为19 510例,2010年发病率最低（2.19/10万）,2015年发病率最高（19.41/10万）,2015年的报告发病数和发病率分别是2005年的6.40倍和4.69倍。每年3-6月以及11月至次年1月合计报告发病数所占比例均79.00%;每年合计报告发病数中3~15岁所占比例均93.00%,且合计报告发病数中幼托儿童和学生所占比例均90.00%;累计报告猩红热发病数男女性别比为1.69 :1;2011年后的报告发病数中,实验室确诊病例的构成比维持在50.00%左右。结论 2005-2015年上海市猩红热报告发病数和发病率整体呈上升趋势,建议加强猩红热的菌株型别、毒力和药敏检测等病原学监测以掌握其流行变化规律。     

2005-2015年云南省乙型病毒性肝炎流行特征分析

目的 分析2005-2015年云南省乙型病毒性肝炎（乙肝）的流行特征,为乙肝防控策略和措施的制定提供科学依据。方法 采用描述性流行病学方法,对2005-2015年云南省乙肝流行特征进行分析,对不同地区的乙肝年均发病率进行聚类分析。结果 云南省2005-2015年累计报告261 496例乙肝病例,年均发病率为51.99/10万,男女性别比为1.64∶1,乙肝发病集中于15~59岁,占总病例数的82.66%,职业构成以农民为主（61.52%）。累计报告病例居前三位地区为昆明市（51 913例）、昭通市（32 738例）和曲靖市（24 046例）。按年均发病率高低分为高、中、低三类地区,高发地区为昆明市、临沧市和西双版纳州,中发地区为保山市、昭通市、丽江市、文山州、怒江州和迪庆州,低发地区为曲靖市、玉溪市、普洱市、楚雄州、红河州、大理州和德宏州。结论 云南省2005-2015年乙肝发病率男性高于女性,职业以农民高发,年龄以青壮年为主,应加强重点地区、重点人群的防控策略。     

2012-2015年山东省东营市个体和团体无偿献血者的血液不合格影响因素分析

目的 探讨山东省东营市个体和团体无偿献血者的血液不合格影响因素的差异,从而保证献血者和血液安全.方法 选择2012年1月至2015年12月东营市中心血站的91 534例无偿献血者作为研究对象.按照献血者的献血组织模式不同,将其分为个体献血者组(n=66 012)和团体献血者组(n=25 522).按照《血站技术操作规程》(2012版、2015版),《血站质量管理规范》(2006版)及《血站实验室质量管理规范》(2006版)的相关规定,对献血者的血液进行丙氨酸氨基转氨酶(ALT)、乙型肝炎表面抗原(HBsAg)、抗-丙型肝炎病毒(HCV)、抗-梅毒螺旋体(TP)及抗-人类免疫缺陷病毒(HIV)5项血液检验性因素项目进行检测.按照《全血及成分血质量要求》(GB 18469-2012)及国际输血协会(ISBT)的相关规定,对血液的采血量、脂肪血发生情况,以及献血者的献血反应3项非血液检验性因素项目进行调查.并且采用x2检验和趋势x2检验的统计学方法对各个项目的不合率进行比较.结果 ①2012-2015年,东营市献血者血液的ALT、HBsAg、抗HCV、抗-TP、抗-HIV、献血反应、脂肪血及采血量不足项目不合格率基本稳定,差异均无统计学意义(x2趋势=0.25、-0.14、-0.12、0.09、0.13、0.41、0.83、0.28,P＞0.05).5项血液检验性因素项目中,ALT的不合格率最高,为3.31％(3 032/91 534),并且差异有统计学意义(x2=127 560.72,P＜0.05);3项非血液检验性因素项目中,脂肪血的不合格率最高,为6.52％(5 969/91 534),并且差异有统计学意义(x2=169 443.63,P＜0.05).②个体献血组血液检验性因素项目的总不合格率为3.90％(2 573/66 012),低于团体献血组的5.70％(1 455/25 522),并且差异有统计学意义(x2=138.20,P＜0.05);2组献血者ALT、HBsAg、抗-HCV、抗-TP、抗-HIV的不合格率分别比较,差异亦均有统计学意义(x2 =345.42、31.31、24.55、14.22、4.01,P＜0.05).③个体献血组非血液检验性因素项目的总不合格率为9.26％(6 115/66 012),低于团体献血组的15.9％(4 067/25 522),并且差异有统计学意义(x2=828.72,P＜0.05);2组献血者献血反应、脂肪血、采血量不足项目的不合格率分别比较,差异亦均有统计学意义(x2 =162.47、603.23、828.72,P＜0.05).结论 针对个体献血者,应加强对其献血前健康征询,从低危人群中采集更为安全的血液.针对团体献血者,建议采取减少每次献血人数,或者增加采血车及工作人员的方式进行血液采集,杜绝人员过于集中的采集方式,降低献血反应和采血量不足;并且加强团体献血前的注意事项宣传,降低脂肪血和ALT不合格率.     

Rh缺失型D(-)(-)血清免疫学和基因分析及在输血中的应用

目的 通过对1例Rh缺失型D--血型进行检测分析,探讨该血型的临床输血应用价值.方法 选择2010年3月送滨州市中心血站检测血型的1例Rh缺失型D-患者为研究对象.采用血型血清学、流式细胞术分析其血型血清学特点及红细胞膜D抗原变化.采用序列特异性引物-PCR技术检测RHCE基因外显子,并分析其基因变化情况.在本例患者之后,临床急需这一稀有血液时,自体内采集的400 mL Rh缺失型D-成功救治1例同型危重患者.结果 本例患者血型为A型、D-,RhD抗原表达量超出正常个体1倍以上;基因检测定型为D-SH表型,为国内首次报道基因型.采用其血液成功抢救1例同型危重患者,该同型危重患者接受输血后,血红蛋白水平由24 g/L上升至38 g/L.结论 Rh缺失型D--血型血清学较易鉴定,但易漏检.从先证者家系中筛查及动员先证者健康时献血是解决这一罕见血型供血的有效方法.     

Awareness about Coronavirus (COVID-19) and challenges for blood services among potential blood donors

BackgroundThe Coronavirus- 19 disease pandemic had a significant impact on the blood supply around the world. Physical distancing measures and many other factors contribute to this impact. Misinformation about methods of disease transmission and lack of knowledge among potential blood donors may contribute to this.AimTo assess the knowledge and awareness of blood donors about COVID-19 as well as their reasons and fears that prevent them from donating blood during this period.MethodsThis is an exploratory; survey based cross sectional study targeting Saudi population.ResultsA total number of 3841 persons responded to the survey; 58 % were between the ages of (31–50) years. Most participants 74.5 % were males. More than 60 % of participants donated blood previously, and many were repeat donors. The majority of participants were concerned about the transmission of the virus during the blood donation process mostly secondary to concerns about contact with other blood donors.ConclusionFear of contracting COVID-19 during donating blood is an important concern for potential blood donors. Blood collection facilities must take optimum precautionary measures to minimize this risk and are encouraged to communicate these efforts to potential donors for reassurance to maintain an adequate and safe blood supply.     

Epidemiology of Toxoplasma gondii among blood donors in Iran: A systematic review and meta-analysis

Introduction

Asymptomatic Toxoplasma gondii transmitted from blood donors to receiving patients has become a concern. Numerous articles have been published on the epidemiology of T. gondii in blood donors in Iran and a systematic review of the results shows quite different findings, hence this study was conducted to determine the seroprevalence of T. gondii in Iranian blood donors using meta-analysis.

Levels of tissue inhibitor of metalloproteinases-1 in blood transfusion components

Blood transfusion during surgery for solid tumors may reduce patient survival because of various bioactive substances present in blood preparations. The antiproteolytic protein tissue inhibitor of metalloproteinases-1 (TIMP-1) present in large quantities in platelets has been shown to stimulate cell growth and to inhibit apoptosis and may therefore be considered to influence tumor progression. We measured TIMP-1 levels in blood transfusion preparations, especially in plateletcontaining preparations, before and after leucofiltration and at different timepoints during storage. The mean TIMP-1 levels in whole blood (WB) and plateletrich plasma (PRP) were slightly reduced by leucofiltration; WB: 41.6 mug/L versus 34.9 mug/L, PRP: 139.8 mug/L versus 127.2 mug/L. However, with prestorage leucofiltration, TIMP-1 levels in buffy-coat-derived platelet (BCP) pools were significantly reduced from 134.2 mug/L to 102.2 mug/L (p=0.0013). In saline-adenineglucose-mannitol (SAG-M) blood preparations in which the platelet content is reduced by more than 99%, TIMP-1 could not be detected. Extracellular TIMP-1 accumulated significantly in non-filtered WB and in aferesis platelet concentrates (APC), but TIMP-1 was at no time detectable in SAG-M blood during storage. In conclusion, TIMP-1 is present in various platelet-containing blood preparations, but not in platelet-free preparations such as SAG-M, indicating that most of the TIMP-1 measured in blood preparations originates from platelets. Furthermore, TIMP-1 levels increased during storage in preparations containing platelets, which suggests a continuous disintegration of platelets. These data imply that information on preoperative blood transfusions should be taken into account when evaluating plasma TIMP-1 levels in patients.     

2011～2015年某院肺炎克雷伯菌的分布特点及耐药性分析

目的：探讨2011～2015年海军总医院肺炎克雷伯菌的临床分布情况及耐药性变迁,为临床用药提供参考依据。方法选取海军总医院2011～2015年临床分离出的肺炎克雷伯菌,分析其检出率、科室分布情况、标本来源、抗菌药物耐药性及对碳青霉烯类抗菌药物耐药性的变化趋势。结果2011～2015年肺炎克雷伯菌的检出株数和分离率呈逐年上升趋势,标本主要来源于重症监护室、高压氧科、呼吸内科、放射肿瘤科、肾脏病科等10个科室,其中高压氧科检出率最高,其次是呼吸内科、重症监护室;送检标本以痰液和尿液为主,分别占送检标本的59．7％和21．4％;2011～2015年肺炎克雷伯菌耐药性呈逐年上升趋势。该菌对哌拉西林、氨苄西林、氨苄西林／舒巴坦和头孢呋辛酯耐药率较高,对阿米卡星、亚胺培南、美罗培南和妥布霉素的耐药率较低;对碳青霉烯类抗菌药物亚胺培南和美罗培南的耐药率逐年不断上升,泛耐药肺炎克雷伯菌呈快速上升趋势。结论肺炎克雷伯菌耐药现象严重,尤其耐碳青霉烯类抗菌药物的肺炎克雷伯菌近年来明显增加,应加强对其耐药性监测,指导临床合理用药。     

2008~2012年东莞市无偿献血者血液筛查的不合格结果分析

目的分析东莞市无偿献血者血液筛查的不合格结果,为提高血液筛查效率提供参考依据。方法对2008～2012年共358080例为谳血前经HBsAg以及／或ALT初筛合洛的献血者衄蘅斯引伪啼查（包括ALT、HBsAg、抗．HCV、抗．HIV、抗-TP）,再对327761例常规筛查合格献血者应用核酸扩增技术（NAT）作进一步筛查。结果ALT初筛后ALT异常仍为首要不合格因素;HIV确证阳性率呈上升趋势;除抗．HIV不合格率外,其他不合格率随文化程度的上升而下降;男性献血者的总不合格率、HBsAg不合格率以及抗-HIV不合格率高于女性,抗．HCV不合格率无性别差异,女性献血者抗-TP不合格率高于男性;18～25周岁献血者的总不合格率最低;NAT筛查共检出265例HBVDNA阳性献血者,HBVDNA阳性率为0．081％（265／327761）。结论制定适合的ALT初筛阈值,招募低危献血者,开展NAT筛查。     

Asymptomatic human blood donors carriers of Leishmania infantum: Potential reservoirs for visceral leishmaniasis in northwestern Iran

Background

Little is known regarding transfusion-transmitted leishmaniasis (TTL) and the real global incidence of visceral leishmaniasis (VL) among blood donors as carriers of Leishmania spp. in endemic VL foci including Iran. Recent epidemiological evidences indicate that blood donor may be harbor of Leishmania infantum (L. infantum) infection in Iran.

肾脏血氧水平依赖性成像研究进展

肾脏是机体保持内环境稳定、调节水和电解质平衡状态、排出体内代谢物的关键器官,肾实质氧合状态在其生理功能发挥、疾病发生发展中具有重要意义。血氧水平依赖性成像作为无创性评价肾内氧代谢功能技术,可实现生理研究从解剖展示向代谢、功能和分子水平迈进,对肾病诊断、鉴别与疗效评估发挥日益明显的作用,本文就近年血氧水平依赖磁共振成像对肾脏研究展开综述。