智能全自动血浆速冻机在血站的应用

随着我国成分输血技术的发展，新鲜冰冻血浆及冷沉淀的制备和应用随之被推广。冷沉淀是从新鲜冰冻血浆中提取冷沉淀物，是主要的FⅧ制剂，已是中心血站和血液中心供应临床的主要血液成分之一。     

2012-2014年宁波地区输血不良反应调查分析

目的回顾性分析宁波地区近年来临床输血患者不良反应发生情况,为临床合理用血及完善血液预警系统提供理论依据。方法对宁波地区5家综合性医院2012年10月-2014年9月期间输注各种血液成分的住院患者输血反应情况进行统计分析。结果 21 793例患者接受120 129袋红细胞悬液、冰冻血浆、机采血小板及冷沉淀成分输血,103例患者发生126人次各种输血不良反应,其中过敏性输血反应(50.8%)和非溶血性发热性输血反应(36.50%)发生率最高。4种血液成分中,输注机采血小板不良反应发生率最高,其次为冰冻血浆,红细胞悬液,冷沉淀最少。输血不良反应发生率随输血次数的增加而升高。结论严格掌握输血适应症,提高对输血不良反应的认识,对改善临床输血安全性有重要意义。     

病毒灭活冷沉淀的制备及初步评价

目的评价以亚甲蓝光化学法制备的病毒灭活血浆为原料制备冷沉淀凝血因子的可行性。方法分别以新鲜冰冻血浆和病毒灭活冰冻血浆制备冷沉淀凝血因子,用STA全自动血液凝固检测仪检测Fbg、FⅦ：C的浓度。结果病毒灭活冰冻血浆制备的冷沉淀凝血因子中Fbg、FⅦ：C的浓度有所下降,但均符合血液成分质量的国家标准。结论以病毒灭活血浆制备冷沉淀凝血因子是可行的。     

冷沉淀在临床中的应用

冷沉淀是用新鲜冰冻血浆（FFP）在1～6℃无菌条件下分离出沉淀在血浆中的冷不溶解物质,并在1h内冻结而制成的成分血,富含纤维蛋白原（FIB）、纤维结合蛋白（Fn）、FⅧ因子、血管性血友病因子（vWF）、凝血因子XⅢ（FXⅢ）等,     

冷沉淀制备过程中的关键因素探讨

冷沉淀是临床上较常用的一种血液成分,含有凝血因子FⅧ、Fib、纤维结合蛋白等5种成分,临床上主要用于治疗手术、创伤引起的凝血机制障碍[1],以及先天性或继发性甲型血友病、低纤维蛋白原血症患者在缺乏相应纯制剂凝血因子时,用于补充相应的凝血因子。冷沉淀是采用特定的方法,将保存期内的新鲜冰冻血浆在1℃~6℃融化,经离心移除大部分血浆后,剩余的冷不溶解物质于1h内速冻呈固态而制备的成分制剂[2]。为保证冷沉淀产品质量,     

采后不同时间分离的血浆所制备的冷沉淀质量分析

目的观察血液采集后不同时间段分离的血浆所制备的冷沉淀的FⅧ、Fib活性水平。方法随机抽取采集后不同时间段(8 h、8-10 h、10-12 h、12-14 h、14-18 h)成分分离的新鲜冰冻血浆,经离心法加工制备而成的冷沉淀各30份,检测其FⅧ、Fib含量。结果采集后8 h和8-10 h分离的新鲜冰冻血浆所制备的冷沉淀的FⅧ含量,符合《全血及成分血质量要求》(2012版);采集后10-12 h、12-14 h、14-18 h制备的冷沉淀的FⅧ含量,不符合《全血及成分血质量要求》。结论为了保证冷沉淀的质量,用于制备冷沉淀的新鲜冰冻血浆应选择在采集后10 h内分离的新鲜冰冻血浆作为原料浆。     

3228例临床用血调查分析及对策探讨

目的了解临床应用输血指证情况,发现临床输血所存在的问题,进一步规范安全、有效、合理用血。方法收集2013年我院住院患者的输血病例,统计各种血液制品使用情况及输血指证应用不合理情况。结果 3 228份病例中输注红细胞、冰冻血浆、血小板和冷沉淀不合理使用的比例分别为14.9%,29.1%,4.7%,28.5%。其中血小板合理使用情况最好,冰冻血浆和冷沉淀不合理使用情况比较严重。除冷沉淀外,外科不合理用血情况普遍比内科严重。红细胞、冰冻血浆、血小板使用不合理主要是超输血指证输血,冰冻血浆输血前无评估比例最高,达19.2%。冷沉淀不合理使用主要是符合输血指证但输注剂量不足,内科高达55.2%,外科35.4%。结论部分临床医生凭经验用血,对输血指证仍未引起足够的重视,其中血浆和冷沉淀不合理输血现象较严重。在符合输血指证的情况下对输注剂量的判断也存在一定问题。还需加强临床合理用血的知识,进一步保障用血供求和输血安全。     

冷沉淀制备过程的质量控制和去冷沉淀血浆的临床应用价值探讨

目的通过控制冷沉淀的制备过程,分析去冷沉淀血浆的质量,为临床应用提供依据。方法采用离心法制备冷沉淀,检测同一献血者来源的新鲜冰冻血浆、去冷沉淀血浆、普通血浆标本中凝血因子FⅤ、FⅦ、FⅧ、FⅨ水平,以及纤维蛋白原和总蛋白水平并进行比较分析,同时检测冷沉淀中FⅧ与纤维蛋白原水平。结果去冷沉淀血浆的纤维蛋白原、总蛋白及FⅧ水平均低于新鲜冰冻血浆与普通冰冻血浆,且其FⅨ水平同样低于新鲜冰冻血浆,组间比较差异均有统计学意义(P0.05)。结论去冷沉淀血浆在临床上不能等同于新鲜冰冻血浆和普通冰冻血浆使用,应通过对冷沉淀制备过程的有效控制,根据实际情况进行选择。     

成分疗法概况

一.成分疗法简介在输血中心全血可被分离为以下成分:红细胞、白细胞、血小板、血浆、冷沉淀及冷沉淀上清液。对缺乏某种血液成分的患者给予其所需的成分血比给予全血更能有效地利用血液,且疗效更佳。自无菌塑料联袋系统出现后,才能在完全无菌的系统中分离各种血成分。现采用一种四联袋系统可从一单位血中分离出红细胞、血小板、冷沉淀及冷沉淀上清液,进一步可制备红细胞、白细胞、血小板及血浆。但对白细胞的临床价值尚存疑虑。另一个重要进展是向红细胞浓缩物中加入“添加液”。添加液降低了红细胞浓缩物的粘滞度,减少了输注时阻塞的危险。另外添加液能更好地保存红细胞,使其保存期限延长至5周(无添加液的红细胞最多贮存3周)。再者,使用添加液能从每单位血中获取更多的血浆,增加了血浆蛋白(包括因子Ⅷ)的产量。     

护理人员现代护理观与基础护理认识现状及两者之间的相关性分析

目的探讨紧急大剂量输血的观察及护理要点，保证患者紧急大剂量成分输血的安全性、有效性、及时性。方法对33例急性大失血患者均采用少白细胞红细胞、新鲜冰冻血浆、冷沉淀及血小板等成分输血，根据病情调整不同成分输入的顺序、剂量及速度，输血过程密切观察患者体温、尿液、血压及伤口出血情况的变化。结果本组循环血量得到有效补充、血压及组织供氧恢复者26例；循环血量未得到有效补充、血压及组织供氧未有效恢复者7例。结论对紧急大失血患者采用成分输血可取得较好疗效，护士应了解各种血液成分制品的特点，在输血过程中密切观察患者的体温、尿液、血压及伤口出血情况的变化，以保证紧急大剂量成分输血患者的安全。     

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.     

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.     

2004～2010年某院临床用血情况分析

目的 通过对临床成分用血现状分析,指导临床合理用血.方法 对2004～2010年该院治疗患者总数、手术总数、临床用血总量和各种血液制品用量占本年度用血总量比例进行统计.同时对2008～2010年用血量较大的科室各种成分血输血率进行分析.结果 2004～2010年间该院门诊患者数、住院患者数和手术数量呈逐年递增趋势,临床用血总量和红细胞使用量无明显变化,全血使用量逐年减少,血小板和冷沉淀使用量逐年上升,成分输血率均达99%以上,但仍存在一定的不合理性.2004～2007年间血浆为临床输血主要成分,2008～2010年红细胞为临床输血的主要成分,血浆用量逐年递减,血小板和冷沉淀用量逐年增多.结论 该院成分输血逐步向科学化、合理化和规范化的方向发展,成分输血结构明显改善.     

某院2007～2011年临床输血情况调查分析

目的：通过相关资料调查分析,了解临床输血情况,为提高合理用血提供参考。方法对成都市第三人民医院2007～2011年临床输血总量、成分用血情况、内科及外科用血情况等进行调查分析。结果成都市第三人民医院临床用血总量呈逐年上升趋势,成分血使用比例一直维持在99％以上;存在血浆用量偏高现象。结论虽临床成分输血比例高,但仍存在用血不合理现象,需加强相关人员培训,以期进一步提高临床输血质量。     

Blood cell microRNAs: what are they and what future do they hold?

The advent of blood component storage revolutionized health care by allowing for a managed supply of transfusion quality blood products. During storage, blood components undergo a series of physiological changes that affect the product quality, which ultimately can interfere with the safety and efficacy of such products after transfusion. Despite continuous improvements in blood component quality and safety, it is still desirable to have in vitro standard markers of measurable characteristics that predict blood component safety and efficacy in vivo following their transfusion. Over the last decade, research on the feasibility of using microRNAs as biomarkers for various clinical manifestations and cellular pathologies has exploded. Here, we review the literature on blood cell microRNAs and discuss the potential of these molecules to act as measurable characteristics (product biomarkers) for stored blood component quality and safety.     

Intrarenal Distribution of Blood Flow in the Transplanted Dog Kidney: Effect of Denervation and Rejection

Serial measurements of intrarenal distribution of blood flow have been recorded in anesthetized dogs with the (133)xenon "washout" technique. The results showed that normal kidneys redistributed their blood flow after laparotomy and mobilization of the kidney. This alteration consisted of a diminution in percentage of total renal blood flow supplied to the fastest flowing component, and a diminution of renal mass supplied by that component. This effect lasted for as long as 7 days. Thereafter, the blood flow distribution remained stable.Autotransplanted kidneys had a stable distribution of blood flow between 0 and 77 days after operation, the values being identical with the stable normal kidney. Homotransplanted kidneys had the same intrarenal distribution of blood flow after operation as the autotransplanted kidneys. Whereas the intrarenal distribution of blood flow of the autotransplanted kidneys remained stable, a redistribution occurred in the homotransplanted kidneys as rejection progressed. This phenomenon occurred before marked elevation of blood urea nitrogen.The redistribution was due to a decrease in percentage of blood flow supplied to the fastest flowing component, and a relative reduction of tissue mass perfused by this component.Radioautography of the kidneys before rejection demonstrated that the cortex was homogeneously perfused by the fastest flowing component of blood flow. As rejection progressed, a reduced area of cortex was perfused by this component. Terminally, the fastest flowing component was located in the outer medulla.It is suggested that the reduction in cortical blood flow produced by immunological mechanisms may play a prominent role in the ensuing renal failure.     

Transfusion requirements in obstetric patients with placenta accreta

BACKGROUND: Providing transfusion support for patients with placenta accreta is a challenging task. There is no consensus on predelivery transfusion planning for these patients and the prevalence of massive transfusion is unknown. With little published experience, it is difficult to predict blood component usage accurately. Therefore, this retrospective study spanning 14 years quantified blood usage and clinical outcome in a group of patients with placenta accreta. STUDY DESIGN AND METHODS: A retrospective medical record review identified 66 patients with placenta accreta who presented for delivery. Data were extracted from the patients' medical records related to patient demographics, pathology diagnosis, blood component usage, operative course, and clinical outcome. Selected variables were analyzed for statistical association with total blood component usage. RESULTS: The range of blood component usage was 0 to 46 red blood cell (RBC) units, 0 to 48 random‐donor platelet unit equivalents, 0 to 64 plasma units, and 0 to 30 cryoprecipitate units. The incidence of transfusion was 95% (mean RBC use, 10 ± 9 units; median, 6.5 units), with 39% of patients requiring 10 or more RBC units and 11% requiring 20 or more RBC units. Blood component use did not differ significantly between the pathology‐defined placenta accreta subtypes. Potential clinical laboratory variables that would predict increased blood component use were not identified. CONCLUSION: The delivery of patients with placenta accreta is a high‐risk procedure that requires multidisciplinary planning and adequate resources to optimize outcome. Transfusion services should have a protocol for managing these cases that addresses preoperative blood component preparation and intraoperative management, should massive hemorrhage occur.     

Practical guidelines for applying statistical process control to blood component production

Legislation, guidelines and recommendations for blood components related to statistical process control (SPC) and the selection of a quality monitoring (QM) sampling regimen are subject to misinterpretation and lack practical guidance on implementation. The aim of this article is: to review and interpret applicable European legislation and guidelines and to develop an SPC strategy that meets these requirements; and to provide practical guidance on the selection and application of appropriate techniques and the interpretation of resultant blood component QM data. A methodology is presented which utilizes: an algorithm to select an appropriate quality-monitoring strategy for the blood component parameter under consideration; a range of straightforward, validated SPC techniques for variable data and an assessment of process capability (Cpk) and blood component parameter 'criticality' to determine the sampling regimen. The methodology was applied to routine National Health Service Blood and Transplant (NHSBT) blood component data for 2005–2006. Cpk values ranged from 0.22 to >3 and their predicted non-conformance rates were close to those observed (23 to <0.001%). Required sample size ranged from 0.01 to 10%. Chosen techniques identified significant deviation from 'as validated' performance within an appropriate time-scale. Thus the methodology was straightforward to apply and prompted the choice of a clinically and operationally appropriate sampling regimen and analysis for each blood component parameter. This evidence-based, targeted use of SPC for blood component monitoring provides an essential focus on processes with a low capability in achieving their specifications.     

某地区推广成分用血10年情况回顾与发展分析

目的 分析四会市地区临床10年用血情况,各种成分用血的使用量和增长率,以及临床主要用血的应用特征.探讨临床用血合理性和未来发展的需求趋势,回顾临床成分用血的使用量,能够更加的准确地反映临床用血的实际情况.科学合理的预测、制定年度工作计划提供科学依据,同时发现用血需求大幅波动时应积极调查原因,及时纠正.方法 对2001～2010年间本地区用血情况进行数据分析.结果 临床成分用血不断增加,达到国际先进水平,合理用血不断提升,输血不良反应率逐年下降.结论 及时分析、掌握本地区成分用血情况,严格执行安全用血管理制度,加大宣传力度,对指导临床合理安全的成分用血和输血技术发展具有重要意义.     

Implementation of a blood irradiation program at a community cancer center

BACKGROUND: Blood component irradiation is an accepted method of preventing transfusion-associated GVHD. Previous publications have largely focused on the technical aspects of the irradiation process itself, but relatively little attention has been paid to the details associated with the implementation of a blood irradiation program at the level of a community cancer center. STUDY DESIGN AND METHODS: An observational study was performed, detailing the specific operational, documentation, and quality assurance measures employed in providing a blood component-irradiation service within the institutional context of a community cancer center. RESULTS: The Montgomery Cancer Center irradiated 589 units of blood components in 1998 and 1999 to provide a local blood bank with an alternative for procurement of irradiated blood components while complying with applicable quality assurance and regulatory requirements. CONCLUSION: Blood component irradiation is within the scope of most well-equipped and adequately staffed community cancer centers. Establishment of a blood component irradiation program requires scrupulous physics and dosimetry support, both to ensure the quality of the irradiated component and to satisfy governmental agency regulatory requirements.