慢性贫血病人的成分输血

贫血不是一种独立的疾病，而是由许多不同原因或疾病引起的一组临床综合征。由于慢性贫血有不同的临床特点和代偿机制，并且病人所患基础疾病不同，使得成分输血较为复杂。慢性贫血应针对病因治疗，输血治“标”不治“本”，能不输者尽量不输。如必需输血，只能输注红细胞...     

红细胞参数及血红蛋白成分分析与地中海贫血基因分型的关系探讨

目的通过检测受检人员血常规参数、红细胞渗透脆性及血红蛋白成分分析,探讨其与地贫基因分型的关系。方法采用ABX120血液分析仪检测血常规参数,"红细胞一管法"检测红细胞渗透脆性,VARII血红蛋白成分分析仪进行血红蛋白成分分析,PCR结合反向点杂交法进行地贫基因检测。结果在147例地贫基因受检者中,确诊为地贫基因患者77例,阳性率为52.4%,其中α-地贫56例,β-地贫16例,α-地贫复合β-地贫5例,且不同类型的地贫患者红细胞参数及血红蛋白成分分析结果表现各有不同,有统计学意义。结论血常规参数、红细胞渗透脆性及血红蛋白成分分析在地贫筛查中发挥着重要的作用,且可初步鉴别地贫的类型。     

内科贫血患者成分输血的选择及评估

目前，慢性贫血患者越来越多，为提高输血疗效，减少输血不良反应，成分输血是临床治疗贫血患者的重要措施之一，现就内科贫血患者的输血分析报道如下。     

成分输血及红细胞类输血指征在基层医院应用调查

目的：了解基层医院临床用血状况。方法：对某二级医院已输血病例的输血类别、数量及输血前血红蛋白进行统计。结果：近5 a成分输血率均达到卫生部标准,5 a间成分输血率比较差异显著;红细胞和血小板占成分血应用的73.0%,少白细胞红细胞及冷沉淀未用于临床,红细胞悬液/浓缩红细胞占红细胞类99.6%;内科Hb〉70 g/L、外科Hb〉100 g/L的输血分别占30.0%和34.3%。结论：该院临床用血已实现成分输血化,但成分血的科学合理应用亟待提高;输血指征偏宽缺乏控制措施和监督机制。     

促红细胞生成素对减少失血后贫血患者输血需求的临床探讨

目的 探讨应用促红细胞生成素（EPO）减少输血量的临床研究。方法 对中重度贫血患者,在综合评估患者对贫血的耐受程度后决定是否输血。对可以不输血但贫血较严重的患者,给予EPO治疗。通过不同的给药方式及铁剂的应用来观察不同情况下EPO的疗效。结果 至3周末,使用EPO的疗效与输血的效果相同（P〉0．05）,且EPO经皮下注射和加用铁剂可以提高疗效。结论 治疗失血后贫血时,输血指征不仅应考虑贫血的严重程度,还要注意患者对贫血的耐受性。利用EPO可促进造血,并加快贫血的纠正。     

慢性再生障碍性贫血患者红细胞输注的临床疗效初探

目的探讨慢性再生障碍性贫血(CAA)患者红细胞输注的临床疗效。方法回顾分析1995年1月-2007年8月住院的425名CAA患者无效输血的发生情况及其与年龄、性别、输血前血红蛋白(Hb)浓度、输血次数及既往输血量的关系。结果425名CAA患者中,出现无效输注者39名(912%);输注的1 416U红细胞制剂中,249U(17.6%)为无效输注。无效输注与患者年龄、性别和输血前Hb浓度无关,与输血次数和既往输血量有关。结论CAA患者的无效输血与其输血次数及既往输血量有关。输血次数越多,既往输血总量越大,则无效输注的发生率越高。     

输血新技术——重症病人的贫血和红细胞输注

重症病人的定义并不是很明确，但大多数临床医生指的重症病人是那些伴有器官衰竭的急性病人。在英国，伴有多器官衰竭的病人在ICU（重症监护室)医治。贫血是重症病人的常见并发症。在ICU内，对贫血的治疗是输注异体红细胞。除禁止输血治疗的病人外，进入ICU的患者大概有40％接受过红细胞输注。输血实际操作过程中存在的多种不确定因素，直接关系到输血的安全性、有效性及输血指征。     

贫血患者120例网织红细胞血红蛋白含量分析

目的探讨网织红细胞血红蛋白含量（Ret-He）在不同类型贫血中的分布特点。方法我院2008~2009年住院治疗的贫血患者120例,采用SYSMEX-XE2100全自动血细胞分析仪检测血常规及网织红细胞血红蛋白含量,探讨Ret-He检测在贫血的鉴别诊断的价值。结果正常对照组、缺铁性贫血患者组、地中海贫血患者组和肾病性贫血患者组的Ret-He平均值分别为30.03 pg、23.84 pg、29.82 pg和31.32 pg;缺铁性贫血患者组Ret-He低于其余各组,差异具有统计学意义（P〈0.001）,其余各组Ret-He差异均无统计学意义。结论 Ret-He在缺铁性贫血的诊断和鉴别诊断中有一定的应用价值,可应用于贫血的诊断和鉴别。     

Early changes in hemoglobin and hematocrit levels after packed red cell transfusion in patients with acute anemia

BACKGROUND: Equilibration of hemoglobin concentration after transfusion has been estimated to take about 24 hours, but some studies have shown that earlier measurements reflect steady-state values in persons who have not bled recently. This study was aimed at assessing the changes over time in hemoglobin concentration after transfusion in acutely anemic patients because of recent bleeding. STUDY DESIGN AND METHODS: Thirty-two normovolemic patients recovering from an acute bleeding episode who were no longer thought to be bleeding and who received a 2- unit red cell transfusion were studied. At baseline and 15, 30, 60, and 120 minutes and 24 hours after transfusion, hemoglobin concentration and hematocrit values were measured. RESULTS: The administration of 2 units of packed red cells elicited a 24-hour increase of 22.4 +/− 6.8 g per L in hemoglobin concentration. Hemoglobin values were not different at any of the defined posttransfusion times. Hematocrit levels experienced similar changes over time. Agreement between 15-minute and 24-hour values was excellent, as only 6 percent of patients exhibited a clinically significant difference (> 6 g/L) between the hemoglobin measurements. CONCLUSION: Hemoglobin and hematocrit values rapidly equilibrate after transfusion in normovolemic patients who are recovering from an acute bleeding episode. This fact would allow a rapid assessment of the effects of transfusion and of the recurrence of bleeding in patients remaining at risk.     

不同输血方法在自身免疫性溶血性贫血患者中应用研究

目的观察应用不同输血方法在自身免疫性溶血性贫血患者中的临床疗效。方法将41名AIHA患者按不同输血方法分为3组:A组16例AIHA接受三洗红细胞输血;B组15例AIHA接受去白红细胞悬液输血;C组10例AIHA接受三洗红细胞输血联合血液置换治疗。所有入组患者均于输血前后进行血红蛋白、红细胞、网织红细胞、血清胆红素检测并进行比较。结果 1)各组输血后血红蛋白、红细胞均高于输血前,胆红素、网织红细胞均低于输血前(P<0.05);2)输血后:A组与C组的血红蛋白、红细胞、网织红细胞、胆红素指标比较有显著差异;3)A组与C组输血治疗总有效率比较差异有显著性,各组输血反应率比较均无显著差异。结论在AIHA患者中选择输血治疗时,不一定首选洗涤红细胞,选用去白悬浮红细胞也能达到同样的效果。选用联合血液置换的输血治疗对AIHA患者疗效更佳。     

Hematologic and clinical responses in patients with sickle cell anemia after chronic extracorporeal red cell carbamylation.

In eight patients with sickle cell anemia, weekly extracorporeal carbamylation of about 20% of the circulating red cell mass was carried out for 2 yr or longer. At each visit, a mean of 1.3+/-0.2 mol of cyanate were incorporated per mole of hemoglobin in the carbamylated erythrocytes. Within 3 mo, a stable level of about 35-50% of the circulating erythrocytes was carbamylated. This quantity and degree of hemoglobin carbamylation produced a decrease in mean whole blood P50 from 33 to 26 mm Hg. During the first 3 mo of carbamylation, the mean hemoglobin increased from 6.4 to 9.1 g/100 ml, while mean absolute reticulocytes decreased by 58% and circulating irreversibly sickled erythrocytes decreased by 65%. The mean red cell life span increased from 13 days before treatment to 21.6 days after 3 mo of carbamylation. Beyond the 3rd mo of carbamylation, blood P50, hemoglobin, and reticulocytes remained quite stable. No toxic effects of extracorporeal carbamylation of erythrocytes were noted. The capacity of blood to release oxygen at 30 mm Hg PO2 increased from 4.3 to 5.0 cm3/100 ml blood during carbamylation. The overall frequency of severe painful crises decreased by about 80% during carbamylation. Before carbamylation, 34% of the crises were induced by a concomitant illness, usually an infection. During carbamylation, the incidence of induced crises decreased 50% while spontaneous crises virtually disappeared. The marked improvements in hematologic parameters and the decreased frequency of severe painful crises observed during this study offer sufficient promise to warrant further exploration, hopefully using more efficient techniques, of the clinical efficacy of extracorporeal erythrocyte carbamylation in sickle cell anemia.     

尿毒症合并贫血患者输注悬浮红细胞和红细胞生成素疗效对比研究

目的探讨输注悬浮红细胞和红细胞生成素两种方法对晚期尿毒症合并贫血患者生存质量改善的差异。方法对45例晚期尿毒症合并贫血患者随机分为输注悬浮红细胞治疗组（Ⅰ组）和红细胞生成素治疗组（Ⅱ组）,比较两组患者生存质量改善的差异。结果在Ⅰ组和Ⅱ组患者之间,体力水平和日常活动的改善几乎相似,差异无统计学意义（5．9±2．1 vs 5．3±2．3和7．5±2．47vs7．1±2．6,t=0．6和t=0．2,P〉0．05）。但在Ⅱ组患者,总生存质量的改善显著优于Ⅰ组输注悬浮红细胞的患者,差异有统计学意义（11．5±3．4vs3．1±1．6,t=2．3,P〈0．05）。结论输注悬浮红细胞和红细胞生成素对尿毒症合并贫血治疗均安全有效。     

贫血及围手术期输血的脑出血患者预后分析

目的：探讨贫血和围手术期输血的脑出血患者术后并发症和病死率情况，为临床提供参考。方法回顾性分析实施开颅手术的脑出血患者223例的临床资料，比较输血患者与未输血患者，中重度贫血患者与无中重度贫血患者术后住院时间、术后并发症及术后病死率情况。结果27例中重度贫血患者与196例无中重度贫血患者术后住院时间、术后感染、急性呼吸衰竭、急性肾衰竭及术后病死率比较差异有统计学意义（ P＜0.05）；56例输血患者与167例未输血患者术后住院时间、术后感染、急性呼吸衰竭、急性肾衰竭及术后病死率比较差异有统计学意义（ P＜0.05）。结论中重度贫血及围手术期输血的脑出血患者预后差。