不同的红细胞制品输注治疗儿童重型地中海贫血的不良反应

目的探讨不同的红细胞制品输注治疗儿童重型地中海贫血的不良反应。方法将68例重型地中海贫血患儿按治疗方法的不同分为A组、B组、C组和D组,每组17例。A组输注普通红细胞,B组输注洗涤红细胞,C组输注年轻红细胞,D组输注去白红细胞。比较4组不良反应[非溶血性发热性输血反应(FNHTR)和免疫介导的输血不良反应、输血传播的感染及输血性铁过载]发生率。结果 4组均未发生输血传播的感染。C、D 2组FNHTR和免疫介导的输血不良反应、输血性铁过载发生率均明显低于A、B 2组(均P<0.05)。结论年轻红细胞输注和去白红细胞输注治疗儿童重型地中海贫血能够降低感染及不良反应的发生率,对去铁治疗有促进作用,值得临床上进一步推荐和应用。更多还原     

安全输血的护理探讨

输血是临床重要的治疗措施之一,尤其是血液病的治疗。目前尚无可完全替代其功能的生物制品,因而输血仍是治疗血液病成功与否的关键因素之一。而输血可能引起相关不良反应、传播传染病性疾病以及引起医疗纠纷等,使输血存在不安全因素。为确保安全输血,护理上应做到在取样、处理、储存、核实、管理等方面准确无误,输血前执行告知制度,进行输血全程监控,规范输血程序,准确记录,使输血治疗尽可能达到安全水平。     

郑州地区免疫性输血反应调查

输血是临床治疗的重要组成部分,是抢救和防治疾病的主要手段之一,但输血也可引起不良反应,甚至是非常严重的不良反应.在输血不良反应中最常见的是输血免疫反应.因为人类的血型抗原相当复杂,红细胞、白细胞、粒细胞、血小板以及血浆蛋白等,估计血型抗原高达1017,这就使得输血免疫反应成为输血治疗的严重问题.为了预防这类免疫性输血反应的发生,我们调查了郑州地区各类血液成分输血反应的发生情况,结果报告如下.     

不规则抗体检验对临床输血安全的影响

目的 探讨不规则抗体检验对临床输血安全的影响。方法 选取2018年2月～2020年2月我院输血治疗的住院患者260例,根据输血前有无进行不规则抗体检验情况分为A组(进行不规则抗体检验)130例和B组(未进行不规则抗体检验)130例,比较2组输血不良反应,并分析不规则抗体检测阳性情况及抗体筛查结果。结果 输血期间,A组不良反应发生率显著低于B组,差异有统计学意义(P0.05);不规则抗体检查者阳性筛查结果主要为抗-M和抗-E,抗-D、抗-S、抗-K、抗-C占比较低。结论 不规则抗体检验能有效降低临床输血反应,提升输血安全性。     

输血所致急性肺部并发症

作为一种治疗手段已广泛应用于临床实践中,但输血也可导致许多严重不良反应及相关性疾病.尤其是输血所致急性肺部并发症时有发生.现将输血所致的4种急性肺部并发症发病机制、临床特点与防治方法做一简要叙述. 1 输血所致肺支气管痉挛 1.1 病因输血所致肺支气管痉挛多数原因是由血浆蛋白过敏所致.当过敏体质的受血者接触抗原(如:全血、血浆等)后,在B淋巴细胞介导下,浆细胞产生大量IgE,后者附着肥大细胞和嗜碱粒细胞上.当再次接触抗原(如:血浆蛋白),钙离子进入肥大细胞内,细胞释放组胺、嗜酸粒细胞趋化因子等,使支气管平滑肌立即发生痉挛.此时,支气管壁内有大量炎症细胞( 巨噬细胞、嗜酸粒细胞、中性粒细胞等),释放出多种炎症递质,如白三烯、前列腺素、血栓素和血小板活化因子等,引起微小血管渗漏、支气管粘膜水肿、腺体分泌增加以及渗出物阻塞气道,有的甚至形成粘液栓,导致通气道障碍和气道高反应性.输血刺激受血者也可产生抗IgA的抗体,当再次输血同样可引起支气管痉挛[1].另外,免疫球蛋白多聚体以及对输注器械如:输血器使用的镍钢针过敏等均可导致支气管痉挛.     

成分输血的推广与输血安全性的探讨

<正>临床输血是抢救生命、治疗疾病的重要医疗手段,但当前临床输血仍面临着风险以及难以预料的后果,如血液同种免疫、输血不良反应的发生、血源性疾病的传播等副作用,直接危及患者健康。随着现代科学技术的进步,传统输血的观念和手     

输血不良反应8532例情况分析

目的 分析各种血液成分输血反应情况,探讨有效减少输血不良反应发生的措施.方法 对2009～2010年8 532例接受输注血液成分的输血反应回报单进行统计分析.结果 8 532次输血治疗中共有121人次发生输血不良反应,发生率为1.42%,其中机采血小板发生率最高,为3.55%,冷沉淀1.83%,悬浮红细胞1.73%,血浆0.97%.输血不良反应主要表现为发热及过敏反应,其中输注悬浮红细胞以引起发热反应为主,发生率为1.15%,输注血浆的不良反应以过敏反应为主,发生率为0.79%,无溶血性输血不良反应发生.结论 输血不良反应主要表现为发热及过敏反应,其中输注悬浮红细胞以引起发热反应为主,输注血浆的不良反应以过敏反应为主,根据各种血液成分输血反应情况采取有效的预防措施有利于降低输血不良反应发生率.     

B(A)血型鉴定及临床输血策略探讨——附1例B(A)02/O01血型报道

目的探讨降低B(A)亚型漏检率及其临床紧急输血流程。方法对1例急诊手术患者,采用血清学方法进行血型鉴定,根据鉴定结果初步确认为ABO亚型,后采用2种方法进行交叉配血。运用PCR(聚合酶链式反应)对该患者的ABO血型基因扩增并测序,明确基因型。结果该患者血型血清学结果显示正反定型不符,正定型为A弱B强,血清中存在较弱的抗-A1,H抗原较B细胞明显增强;术中输注B型洗涤红细胞4U、AB型血浆600mL,无输血不良反应。患者ABO基因测序结果与A101标准序列比对,符合(A)02/O01基因型。结论 B(A)血型的血清学特征不明显,血清学检测必须严格遵守标准化操作流程,降低漏检率。本研究对B(A)患者制定了紧急输血流程,保证临床用血。同时其明确鉴定需进一步结合分子生物学检测,ABO基因测序联合单克隆测序可以有效明确其分型,必要时可选择二代测序的方法。     

异体输血对恶性肿瘤患者的影响

目的探讨输血与恶性肿瘤及其复发、转移的关系。方法收集313例恶性肿瘤病例,将其分为A、B、C组,A组（n=58）患者输注去白细胞血液,包括红细胞、血浆、血小板和冷沉淀;B组（n=35）患者为自体输血;C组（n=220）为未输血患者。观察其输血不良反应、术后感染、3年内转移复发率、5年生存情况。结果 A组患者发生输血不良反应、术后感染、3年内转移复发率、5年生存情况分别为3.45%、10.30%、31.00%和48.20%;B组分别是2.86%、5.72%、17.10%和68.50%;C组分别是0.00%、6.37%、23.10%和66.80%。A组分别与B、C两组比较,差异有统计学意义（P〈0.05）,而B、C两组间比较,差异无统计学意义（P〉0.05）。结论对肿瘤患者输血要权衡利弊,严格掌握输血指征,尽量选用自体输血和血液替代品,提高输血治疗质量。     

成分制剂在临床失血患者中的应用研究

目的：回顾分析260例血液病患者成分输血的输注指征,指导临床合理输血。方法选择藤县妇幼医院2012年1月至2013年12月收治的260例经临床失血患者的临床资料,所有患者共发生660例次输血情况,对260例患者的660例次成分输血的输注效果、不良反应进行统计分析。结果输注血小板治疗 DIC 的有效率为91．67％,其不良反应发生率为8．33％;输注冷沉淀治疗妇产科大量失血有效率100％,几乎无不良反应发生;输注红细胞治疗贫血的有效率为98．74％,其不良反应发生率为0．63％;输注去白红细胞治疗血液病的有效率为100．00％,未见输血不良反应发生;输注新鲜冷冻血浆治疗贫血的有效率为90．9％,不良反应发生率为5．45％;含血浆成分的血液成分制剂比不含血浆成分的血液制剂输血不良反应比较有统计学意义。结论成分输血治疗血液病的有效率高,不良反应低,提示对于血液病患者尽可能不输血含血浆或白细胞血液成分制剂,以减少或避免输血不良反应的发生。     

Safety of a universal, virus-inactivated and prion-depleted, pharmaceutical-quality plasma: a randomized, double-blind, clinical trial in healthy volunteers

BACKGROUND: Universal plasma is intended to be transfused irrespective of the blood group. We compared the safety and tolerability of a novel, universal blood group–independent plasma with an ABO‐matched plasma. STUDY DESIGN AND METHODS: In this randomized, double‐blind, active‐controlled, crossover, Phase I trial, 30 healthy adult volunteers (blood group A, B, or AB) were randomly assigned to transfusion of 1200 mL of Uniplas LG and 1200 mL of Octaplas LG (both Octapharma AG) or vice versa. In both periods, plasmapheresis (PPh, 600 mL) preceded the infusion. Blood samples were drawn before and after PPh and 15 minutes, 2 hours, 24 hours, and 7 days after end of plasma transfusion, to assess safety and efficacy. The primary safety outcome was change in hemoglobin (Hb) concentration; secondary safety outcomes were direct antiglobulin test (DAT), complement activation, free Hb, haptoglobin, and indirect bilirubin. Efficacy was assessed by evaluation of coagulation variables. RESULTS: Variations of Hb concentration were similar between treatments and within normal range; 90% confidence interval was within predefined limits of equivalence. No subject exhibited a positive DAT. All other secondary variables which could reflect hemolytic transfusion reactions (HTRs) fell within normal range; this suggests that no HTRs occurred. Most adverse events were of mild intensity; two subjects experienced dyspnea, leading to the withdrawal from the study of one subject. CONCLUSION: Universal plasma was equivalent to ABO‐matched plasma with respect to safety and tolerability. Eliminating the risk of ABO incompatibility, this universal plasma represents an advance over blood group–specific plasma.     

用α-半乳糖苷酶制备可供输注的人通用型O型红细胞

研究的目的是将人群中28％的B型血改造成通用O型血,提高O型血的储存和使用比例,以缓解战争、恐怖袭击、突发事件等紧急状态下对O型血的大量需求用α-1.3半乳糖苷酶作为B→O血型改造的工具酶,摸索改造一个使用单位B型血红细胞(100m1)的最佳条件,结果实现了在密闭、无菌条件下使用50U／ml工具酶．pH5．6,26℃ 2小时,进行B→O的血型改造。结论：改造后的通用型O型血红细胞符合生物制品检定规程的要求．并可在4℃存放21天     

Universal white blood cell reduction in Europe: has transmission of variant Creutzfeldt-Jakob disease been prevented?

Universal white blood cell (WBC) reduction was introduced in Europe to prevent transmission of variant Creutzfeldt-Jakob disease (vCJD) by transfusion. Findings from rodent models indicate that WBC reduction should not prevent vCJD transmission because the residual plasma infectivity suffices to infect transfusion recipients even under optimistic infectivity assumptions. Although infectivity in human blood may not partition in the manner in which it is distributed in rodents, prion-reduction filters remove the residual plasma infectivity in rodent models. Precautionary introduction of prion filtration in the UK--for patients without dietary exposure to bovine spongiform encephalopathy and in the absence of a reported case of vCJD transmission attributable to infectivity residing in plasma--is consistent with the (already in place for such subjects) precautionary importation to the UK of fresh frozen plasma from low-risk countries. Thus, implementation of prion filtration in the UK does not imply that universal WBC reduction--as currently practiced in Europe--does not abrogate transmission of vCJD. Because neither a human case of vCJD transmission through transfusion of WBC-reduced red blood cells nor a case of experimental bovine spongiform encephalopathy transmission by WBC-reduced transfusion to sheep has been reported, it cannot be concluded that ordinary WBC reduction is ineffective in preventing transfusion transmission in humans. Accordingly, universal WBC reduction for the prevention of vCJD in Europe should continue.     

Universal fresh frozen plasma (Uniplas): a safe product in open-heart surgery

Objective To test the tolerability and safety of the universal plasma Uniplas [solvent/detergent (SD)-treated plasma], infused regardless of the patient's blood group.Design Prospective, parallel group, controlled and observer-blinded study, randomized with respect to patients requiring plasma transfusion.Setting Cardiothoracic operating room and ICU in a university hospital.Patients Eighty-four patients undergoing open-heart surgery comparing three parallel treatment groups and one control group.Interventions The Uniplas treatment group was subdivided into patients with blood group A, B or AB, and group O. The treatment group receiving Octaplas of type AB, was not subdivided. Patients who did not require any plasma transfusion served as control.Measurements Complement activation (C3bc, TCC), direct antiglobulin test (DAT) and other immunohaematological tests, tests for haemolysis, and relevant clinical observations during treatment phase. Blood samples were collected again after 6 months for evaluation of viral safety.Results Of the 84 patients, 29 served as control group. Uniplas was transfused in 36 of the patients (1–23 units). Octaplas was transfused in 19 patients (1–11 units). During the study no clinical adverse events related to plasma transfusion were observed. The degree of complement activation C3bc and TCC, a recommended test for biocompatibility, did not show any increased activation after Uniplas or Octaplas transfusion. No haemolytic reactions, positive DAT-tests or viral transmissions were observed after Uniplas transfusion.Conclusion In open-heart surgery, Uniplas, which can be transfused regardless of a patient's blood group, was well-tolerated and gave no adverse drug reactions.     

Repeat ABO-incompatible platelet transfusions leading to haemolytic transfusion reaction

A 65-year-old woman, blood group A RhD positive, who had completed her first course of induction chemotherapy for acute myeloid leukaemia was transfused with apheresis platelets over a number of days. On three occasions she received group O RhD positive units, which had been screened and found not to contain high-titre anti-A,B isoagglutinins. Following the third unit, she developed a haemolytic transfusion reaction and died soon thereafter. This has led to change in policy of the supplying centre in testing for high-titre anti-A,B isoagglutinins. Blood group O apheresis platelets and fresh-frozen plasma units are now labelled as high titre with a cut-off of 1/50 as compared to the previous cut-off of 1/100 for anti-A,B isoagglutinins. A universal approach to testing donations for high-titre anti-A,B isoagglutinins, better compliance of guidelines and monitoring of patients is necessary.     

Use of additive solutions and pathogen inactivation treatment of platelet components in a regional blood center: impact on patient outcomes and component utilization during a 3‐year period

BACKGROUND: The Etablissement Français du Sang Alsace (EFS Alsace) successively implemented universal use of platelet additive solutions (PASs) and pathogen inactivation (PI) for platelet components (PCs). To assess the impact of these changes, EFS Alsace evaluated PC use, red blood cell (RBC) component use, and transfusion‐related adverse events after implementation of these new technologies. STUDY DESIGN AND METHODS: EFS Alsace prospectively collects data on production, distribution, and response to transfusion of all blood components with greater than 99.5% data acquisition. Adverse events attributed to platelet (PLT) transfusions were collected through a mandatory, active hemovigilance program. A retrospective review of prospectively collected data was conducted covering three periods: 1) apheresis and whole blood–derived PCs in plasma, 2) apheresis and whole blood–derived PCs with PAS, and 3) PCs prepared with PI and PAS. Data on component utilization were analyzed for all patients receiving PCs in each period and for the subset of hematology‐oncology patients to evaluate PC use in an intensely transfused population. Values for all continuous variables were summarized as mean and standard deviation, median, and range. RESULTS: Approximately 2000 patients received PCs in each period. PLT and RBC use per patient was not increased after PI (analysis of variance, F = 1.9 and 2.9, respectively) and the incidence of acute transfusion reactions was significantly reduced (p < 0.001). CONCLUSIONS: Universal use of PI was implemented without impacting component use, as indicated by total dose of PLTs per patient, and outcomes to transfusion were improved.     

Anti-A1 in the plasma of platelet concentrates causing a hemolytic reaction

A patient with acute leukemia who typed as AintB received 10 packs of platelets of group 0. Subsequent transfusion of A1B blood resulted in a hemolytic transfusion reaction. Anti-A1 was detected in the serum and on the red blood cells of a post-transfusion sample. This anti-A1 reacted with the transfused A1B red blood cells and other A1 cells, but not with the patient's pretransfusion red blood cells. The plasma of the transfused platelet concentrates had a high titer of immune anti-A.     

Massive transfusion associated with a hemolytic transfusion reaction: necessary precautions for prevention

CASE REPORT: A 45‐year‐old male presented in severe hypovolemic shock after a thoracoabdominal gunshot wound. The massive transfusion protocol (MTP) was activated and the patient was taken to the operating room. His major injuries included liver, small bowel, and right common iliac vein. Hemorrhage was stopped and a damage control laparotomy was completed. He received a total of 113 blood products. During his postoperative course he received a group B blood transfusion on Hospital Days 2 and 7 based on incorrect blood typing late in his massive transfusion and repeat testing on Day 4. RESULTS: He succumbed to multiple organ failure on Day 8. MTPs are standard in most trauma centers during which universal donor red blood cells are initially used. As hemorrhage is controlled, the patient undergoes a complete type and cross according to blood banking protocols. These typing results are used to continue transfusions once the MTP is no longer needed. In contacting other blood banks servicing Level I trauma centers, the policy of when to switch from universal donor blood to crossmatched blood is variable. CONCLUSION: Our case illustrates a potential blood typing problem that had a disastrous outcome. We identified changes in policy that will make MTPs safer.     

中国汉族人群通用血浆制备方法研究

目的探讨我国人群通用血浆制备的最佳配比方案。方法用试管凝集法确定A、B、AB型血浆两两之间的最佳比例，然后计算出三种血型的搭配比例，以血浆比例、时间、温度3个因素进行正交设计。观察3个因素对混合血浆抗体效价的影响。结果三种血型血浆两两之间的最佳比例分别是A：B=3：1、B：AB=1：3、A：AB=1：2；正交试验结果表明将A：B的比例定位于3：1附近，再按照B：AB=1：3、A：AB=1：2去补偿，抗体效价可降到通用血浆的标准，且时间、温度对血浆抗体效价无影响。结论实验结果表明，A、B、AB三种血型血浆按照接近中国人血型比例6：2．5：1混合，于22℃孵育1h可以得到抗血型抗体IgM效价符合标准的混合血浆。