献血者HBsAg阴性HBV DNA阳性血液样本电化学发光检测分析

目的对献血者血液筛查HBs Ag阴性HBV DNA阳性的样本,用电化学发光免疫分析法(ECLIA)和定量核酸(NAT)测定的结果并进行分析。方法对本血站2016年3-11月56 448例无偿献血者血液标本筛查出97例HBs Ag阴性HBV DNA定性检测阳性的样本(实验组)进行HBV DNA定量检测,再与随机抽取的100例HBs Ag和HBV DNA均阴性的样本(对照组)分别进行ECLIA检测HBs Ag和HBc Ab。结果实验组NAT定量检测HBV阳性有55例,其中病毒载量20 IU/m L有36(65.45%)例,病毒载量20 IU/m L有19(34.55%)例,病毒载量范围在(37.4~394)IU/m L(中位数41.3 IU/m L),与NAT定性阳性符合率为56.70%;实验组用ECLIA检出HBs Ag阳性15例,而对照组未检出HBs Ag阳性样本(χ2校正=14.612,P0.05);实验组的HBc Ab阳性率96.91%(94/97)明显高于对照组的38.00%(38/100)(χ2=77.284,P0.05),差异有统计学意义。结论核酸检测技术应用于献血者血液筛查可有效降低隐匿性乙型肝炎的输血传染;电化学发光免疫分析法能降低ELISA漏检HBs Ag风险;HBc Ab在HBV DNA阳性样本中的阳性率较高,可作为血液筛查的补充方法。     

核酸检测技术在血液筛查中的应用研究

目的通过对献血者血液进行酶免筛查后实施核酸检测,探讨增加核酸检测筛查的必要性。方法 2012年3月-2014年2月对酶免阴性和单试剂阳性及灰区标本进行8人份混样(pool)HBV-DNA、HCV-RNA和HIV-RNA3项联合核酸检测,阳性标本及血浆袋送卫生部临检中心进行鉴别确证试验及乙肝两对半检测,同时对核酸检测阳性献血者进行追踪随访。结果 17 690人份中检测HBV阳性37人份,阳性率为0.209%,无HCV和HIV阳性,确认阳性16份,确认阳性率为0.9‰,26例送卫生部临检中心检测的标本中16例确证为HBV-DNA阳性,乙肝两对半26例抗-HBc皆为阳性。追踪随访成功随访5例,发现HBV"窗口期"标本1例,HBs Ag阴性转阳性。结论血液酶免筛查存在一定的漏检风险,增加核酸检测可缩短病原体检出的窗口期,降低经输血传播疾病的风险,进一步保障血液安全。     

电化学免疫发光分析法联合核酸检测定量法在ELISA HBsAg-/NAT+血液样本中的应用价值

目的分析电化学免疫发光法(ECLIA)联合核酸检测(NAT)定量法在ELISA HBsAg-/NAT+血液样本检测中的应用价值。方法选择血站采集的无偿献血者血液样本22843例,酶联免疫吸附法(ELISA)检测为乙型肝炎表面抗原(HBsAg)阴性的血液样本行NAT检测,先行混合检测,后行拆分检测。选取拆分检测为初检ELISA HBsAg-/NAT+的血液样本行NAT定量检测,NAT定量检测为阳性的血液样本进一步行ECLIA联合NAT定量检测。结果经ELISA检测,22843例血液样本中HBsAg阳性65例,HBsAg阴性22778例。将ELISA检测为HBsAg阴性的22778血液样本进一步行NAT检测,经混合检测,27个混样池为阳性;经拆分检测,29例血液样本呈HBV-DNA阳性。对29例初检ELISA HBsAg-/NAT+血液样本进一步行NAT定量检测,阳性率为65.52%(19/29),其中5例HBV-DNA病毒载量≥20 IU/mL,14例HBV-DNA病毒载量<20 IU/mL。19例ELISA HBsAg-/NAT+血液样本经ECLIA检测,HbsAg、HBeAg全阴,HBsAb阳性3例(15.79%),HBeAb阳性7例(36.84%),HBcAb阳性15例(78.95%),血清模式为全阴5例(26.32%),单纯HBcAb阳性7例(36.84%)。19例ELISA HBsAg-/NAT+血液样本经ECLIA联合NAT定量检测,4例处于窗口期,15例处于隐匿性感染期。结论血站血液样本初检中存在一定的漏检现象,NAT检测可在大量ELISA阴性样本中快速筛检出HBV-DNA阳性标本,ECLIA联合NAT定量检测可帮助献血者明确自身HBV感染状态,值得临床应用和推广。     

核酸检测技术在献血者血液筛查中的应用

目的评估核酸检测技术(NAT)应用于献血者血液筛查的必要性和可行性。方法采用美国罗氏诊断公司cobas s 201系统对2010年8月～2011年12月血站ELISA检测合格的献血者79 414人份血液标本进行HIVRNA-1,-2、HCV RNA和HBV DNA 3项联合核酸检测(cobas TaqScreen MPX试剂),先对6人份标本混样进行NAT,如为阴性,则直接出具结果,如出现阳性结果,再进行拆分检测;对NAT检测反应性标本进行分项确证试验。结果ELISA法共检测了98 935人份标本,抗-HIV、抗-HCV、HBsAg均为阴性的合格血液共96 923份;对79 414人份血液标本NAT共检出阳性194例,阳性率为0.24%;分项检测发现127例阳性标本,病毒类型均为HBV DNA,未检测出HCV RNA和HIV RNA,阳性检出率为65.46%(127/194)。结论 NAT能在ELISA检测阴性的献血者血液标本中筛查到HIV RNA-1,-2、HCV RNA和HBV DNA反应性标本,常规开展NAT能进一步提高血液及输血安全。     

乙肝病毒标记物阳性表型血清标本HBV-DNA检验分析的应用价值观察

目的对乙肝病毒标记物阳性表型血清标本进行HBV-DNA检验分析,探讨其在乙型病毒性肝炎诊断及治疗中的临床价值。方法抽取2014年3月~2015年11月本院接诊的460例血清检测Pres1、HBs Ab、HBs Ag、HBe Ag、HBe Ab、HBc Ab-Ig M、HBc Ab-Ig G中两项或两项以上呈阳性的患者作为研究对象,采用PCR荧光定量检测法进行HBV-DNA的测量,分析其检测结果。结果 HBe Ab、HBs Ag、HBc Ab-Ig G阳性组合的占比最高,达30.9%,其HBVDNA水平为(5.4±1.3)×104copy/ml。HBs Ag、HBe Ag、HBc Ab-Ig M阳性组合次之,占比22.8%,HBV-DNA水平为(1.2±0.3)×104copy/ml;对照组血清样本中的HBV-DNA含量显著低于研究组,组间比较差异具有统计学意义(P0.05)。结论通过采用PCR技术对HBV-DNA含量的分析可加强乙型病毒性肝炎诊断的准确性,为患者提供了更加科学可靠的诊治依据。     

番禺地区无偿献血者酶免阴性样本的核酸检测结果分析

目的通过对酶联免疫吸附实验（ELISA）反应阴性样本的核酸检测技术（NAT）的筛查结果进行分析,探讨核酸检测技术在血液筛查中的应用价值。方法先采用ELISA试剂分别对献血者标本进行HBsAg、抗-HCV和抗-HIV筛查,筛查结果阴性的样本,再用罗氏诊断cobas s 201系统进行HIV、HCV和HBV三项联合NAT检测,并对NAT联检阳性的标本进行分项确证实验。结果在8 147例经ELISA筛查阴性血液标本中检出6例NAT阳性标本,经分项确证6例均为HBV DNA阳性,阳性检出率约为0.074%。结论 ELISA筛查阴性样本中仍存在一定的HBV DNA阳性结果,采用ELISA联合NAT筛查策略,能有效降低输血感染乙肝病毒的风险。     

核酸检测技术在南昌地区无偿献血血液筛查中的应用

目的病毒核酸检测技术(Nucleic Acid Technology,NAT)应用于献血者血液筛查,探讨缩短病毒检测"窗口期"的检测方法,保障临床输血安全。方法将2011年9月至2012年5月我站14203例无偿献血标本经血清学筛查合格的标本进行HBV、HCV和HIV三项联合NAT检测,并对NAT筛查阳性标本做确证试验。结果 HBsAg、抗HCV、抗HIV ELISA检测均为阴性的血液标本13843例,NAT共检出阳性25例,阳性率为0.18%。其中HIV-DNA检出1例,HBV-DNA检出24例。结论核酸检测技术应用于献血者血液筛查中,有效地缩短了病毒检出"窗口期",有力地保障了临床输血安全。     

室间质评样本混样核酸检测模式的探讨

目的 探索血站病毒核酸检测质评样本混样核酸(MP-NAT)检测的最佳工作模式.方法 应用罗氏COBASs201核酸检测系统及配套的TaqScreen MPX试剂,采用6混样核酸检测(MP-6-NAT).将质评样本采用2种混样模式进行平行检测,模式1:质评样本与常规待检献血者标本混样(pool),混样无反应性报告阴性,反应性pool进行拆分检测(单样本检测);模式2:质评样本与已知NAT阴性献血者标本混样,混样无反应性报告阴性,反应性pool只对质评样本进行单样本检测.比较2种混样检测模式检测结果的一致性,血液放行时间,试剂消耗量.结果 核酸检测室间质评次数为12次,检测标本120份,共检出84份阳性标本,36份阴性标本,得分100分,2种混样模式的检测结果一致.模式1的血液放行时间比第2种大约延长5h.模式1的试剂消耗量为3 744个测试,模式2的试剂消耗量为1 824个测试.结论 室间质评样本与已知NAT阴性标本混样检测的工作模式,符合质评样本按常规标本对待的原则,节约试剂成本,加快血液放行速度.     

石家庄地区2012-2014年献血人群NAT检测情况分析

目的为进一步提高血液安全性,降低输血感染风险,分析在石家庄地区献血者中开展血液传染病毒核酸检测(NAT)的必要性和可行性。方法应用浩源核酸检测系统,对经ALT及两遍HBs Ag、抗-HCV、抗-HIV、梅毒螺旋体ELISA检测结果均呈非反应性的287 728份标本,进行HBV DNA、HCV RNA和HIV-1 RNA-3项联合NAT筛查,初筛采用8人份混样法,对检出某项有反应性的混样池进行单人份拆分检测。结果 ELISA检测非反应性的287728份标本,共检测42 472个混样池,检出209个HBV DNA反应性混样池,混样池阳性率为4.92‰;拆分结果为84例HBV DNA阳性,检测阳性率为0.29‰,所有标本中无HCV RNA和HIV-1 RNA的检出。结论核酸检测可缩短血液病毒的检测"窗口期"并有效降低隐匿性乙型肝炎病毒感染(OBI)的发生几率,进一步提高血液安全性。     

酶联免疫吸附试验、核酸扩增技术检测在无偿献血者血液筛查中的应用

目的 探讨酶联免疫吸附(ELISA)试验、核酸扩增技术(NAT)检测在无偿献血者血液筛查中的应用。方法 选取2019年1月至2019年12月血站采集的无偿献血者血液标本76 854例,均采用两种不同厂家的ELISA试剂进行血清学检测,包括人类免疫缺陷病毒抗体(抗-HIV)、乙型肝炎表面抗原(HBs Ag)、丙型肝炎抗体(抗-HCV),血清学检测合格标本再次进行NAT检测,分析ELISA、NAT检测结果。结果 76 854例样本中血清学检测合格75 563例(98. 32%),不合格1 291例(1. 68%),75 563例血清学检测合格样本中经NAT检出HBV-DNA阳性90例; 75 563例血清学检测合格献血者中,不同性别HBV-DNA阳性检出率比较,差异未见统计学意义(P0. 05);重复献血者HBV-DNA阳性检出率高于初次献血者(P 0. 05);随着年龄增长,HBV-DNA阳性检出率呈增长趋势(P 0. 05)。结论 ELISA试验对无偿献血血液标本感染性指标具有较高检出率,但仍存在漏诊风险,辅以NAT检测,能有效降低临床输血感染残余风险,有助于进一步保障输血安全。     

The Cost of Blood Collection in Greece: An Economic Analysis

Objective

The goal of this study was to estimate the cost of production of 1 unit of blood from a National Health Service perspective in Greece.

Methods

In agreement with guidelines, the cost of blood production in this study accounted only for the resources expended for collection, processing, laboratory testing, and storage. Hence, the costs associated with donor recruitment, pretransfusion preparation, transfusion administration, follow-up management of adverse events, and other long-term relevant costs were not taken into consideration. The indirect cost of blood donations for donors (productivity loss) was also considered. A questionnaire was used to collect data regarding personnel time, annual blood quantities collected, percentage of wastage, utilization of consumables, institutional overhead, information technology expenditure, medical equipment utilized, nuclear acid tests, and other factors. Data gathered by 53 hospitals across the country were assessed. A model was constructed with economic data collected by the National School of Public Health and the Ministry of Health. All data refer to the year 2013.

Results

The weighted mean direct cost of producing 1 unit of blood was estimated at €131.49 (SD, €22.12; minimum/maximum, €94.96–€239.20). The mean total indirect cost was estimated at €34 per unit of blood. The cost distribution was positively skewed (skewness, 1.642 [0.327]). The major cost component was the cost of personnel, accounting for 32.5% of total costs, and the average of blood unit wastage was estimated at 4.90%. There were no differences between the cost of producing 1 unit of blood in Athens compared with the rest of the country (Mann-Whitney test, P = 0.341).

Conclusions

This study suggests that the cost of producing 1 unit of blood is not insignificant. These figures need to be complemented with those concerning the cost of transfusion to have a complete picture of producing and using 1 unit of blood locally.     

南京市急救用血安全库存量调查

目的通过对南京市属医院的急救用血进行调查,建立针对各类抢救的血液安全库存量。方法将2012年1月-2013年12月南京市各医院急救用血的病种、血型、血量分类统计,计算各病种安全库存量和急救用血占总用血比例,并分析三级医院与二级医院的病种差异。结果多发伤、产科大出血、消化道大出血、主动脉瘤破裂及其它手术中意外大出血,红细胞用量分别为(8.24±5.53)U、(8.63±6.31)U、(7.30±5.0)U、(12.85±8.08)U、(8.08±8.64)U。消化道大出血红细胞用量略低于其它病种,主动脉瘤破裂的红细胞用量明显高于其它病种。结论根据二、三级医院的病种分布不同,制定准确的应急储备血量可更好地保障危重患者的生命安全。     

A survey of autologous blood transfusion practices in Germany

This survey was designed to evaluate the use of autologous blood transfusion techniques in Germany in 2000 and to identify how the use of these techniques has changed over the past 5 years. Questionnaires were mailed to the chief anaesthesiologists of 400 randomly selected German hospitals with > or =25 surgical beds. Information was sought about the current and past use of preoperative autologous blood donation (PABD), acute preoperative haemodilution and peri-operative blood salvage. Data were requested for the calendar year 2000. Three hundred and forty-three (86%) completed questionnaires were returned. PABD, haemodilution and peri-operative blood salvage were used by 85, 54 and 67% of respondents, respectively. Thirty-seven per cent of PABD users reported that PABD use declined, 28% reported that it increased and 34% reported that it remained unchanged over the past 5 years. The proportions of those reporting declining vs. increasing use of PABD did not differ significantly (P = 0.09). Sixty per cent of users of haemodilution reported that its use declined, 10% reported that it increased and 29% reported that it remained unchanged over the past 5 years. Sixteen per cent of hospitals that were equipped with cell-washing devices reported that the use of these devices declined, 47% reported that it increased and 37% reported that it remained unchanged over the past 5 years. The results indicate that autologous blood transfusion techniques were widely used in Germany in 2000, with PABD being the most common technique. The use of PABD did not change significantly, the use of haemodilution declined markedly and the use of peri-operative cell salvage increased markedly during the past 5 years before the survey.     

全自动血型分析仪在血站血型筛查工作中的应用

目的探讨并评价全自动血型分析仪应用于血站献血者血型筛查的可行性。方法采用全自动血型分析仪(全自动法)对20 335例献血者标本进行ABO及Rh(D)血型鉴定、盐水不规则抗体初筛,并与U型微板法(半自动法)进行比对试验。结果全自动法与半自动法比较,ABO血型1次准确定型率:99.93%98.84%,差异无统计学意义(P0.05);Rh-D血型鉴定正确率均为100.0%;O细胞凝集阳性率:0.13%0.06%,差异有统计学意义(P0.05);可保持反定型检测准确度达100.0%的血浆稀释倍数为1∶64,高于1∶4;脂血标本和溶血标本导致的误判率差异有统计学意义(P0.05)。结论全自动血型分析仪具有较高的准确度、灵敏度及抗干扰能力,更易发现盐水不规则抗体,适合于血站开展献血者血型筛查工作。     

广西三级医院临床用血有关问题的调查研究

目的了解广西三级医院临床输血现状,研究今后监管的方向。方法严格按照国家颁布的相关法律法规、技术操作规程与规范,对42家广西三级医院的临床安全用血进行调查。结果合格率为92．86％。结论并非所有三级医院都能认真按《临床输血技术规范》开展工作,距卫生部相关要求仍有距离。     

外周血细胞计数与形态学检查对常见白血病诊断的重要性

目的探讨血象检查在白血病诊断中的参考价值。方法选取1979~2013年间常见白血病1 480例,参照2008年世界卫生组织(WHO)形态学标准对其进行重新阅片诊断,随机双盲法比较各常见白血病检出情况及其血常规主要参数特征。另选取同时进行血涂片与骨髓涂片检查的急性白血病136例,采用双盲法比较血涂片与骨髓涂片中白血病细胞数,研究血涂片形态学特征。随机选取血涂片与骨髓涂片白血病细胞数均超过20%的59例急性白血病,采用双盲法进行单一的血涂片或骨髓涂片镜检,比较两者诊断符合率。结果不伴成熟型急性髓细胞白血病(AML)、伴成熟型AML、急性单核细胞白血病与慢性淋巴细胞白血病(CLL)的白细胞计数(WBC)以(>10~50)×109/L为主,急性早幼粒细胞白血病(APL)与急性红白血病(AEL)的WBC以小于或等于4×109/L为主,慢性粒细胞白血病(CGL)的WBC以大于100×109/L为主。镜检发现几乎所有患者外周血涂片中白血病细胞形态较骨髓涂片中成熟,当血涂片与骨髓涂片白血病细胞数均超过20%时,单一血涂片与单一骨髓涂片镜检诊断急性白血病的符合率差异无统计学意义(P>0.05)。结论血常规主要参数对白血病的诊断具有较好提示作用,当血涂片中白血病细胞数较高时,单一血涂片检查对常见白血病诊断亦具有较高符合率。     

不同性别脑梗塞性激素、血脂与脂蛋白亚组分的变化及相关性

目的:探讨性激素失调、血脂与脂蛋白亚组分的变化与脑梗塞的关系。方法:采用放射免疫法测定急性CI患者及健康对照者的血清性激素水平,采用沉淀漂浮酶联法及乙酰丙酮显色法测定血脂与脂蛋白亚组分。结果:男性CI患者E2 显著高于正常对照组(P<0 .0 1) ,E2 / T值也明显高于对照组(P<0 .0 5 ) ,女性CI患者E2 明显低于对照组(P<0 .0 1) ,FSH、L H均明显高于对照组(均P<0 .0 5 ) ;CI组TC、L DL- C明显高于对照组;男性E2 与TC、L DL- C呈正相关(均P<0 .0 5 ) ,与HDL- C、HDL2 - C、HDL3- C呈负相关(均P<0 .0 5 ) ;E2 / T与TC、L DL- C呈正相关(均P<0 .0 5 ) ,与HDL- C、HDL2 - C、HDL3- C负相关(均P<0 .0 5 ) ,女性E2 与TC、L DL- C呈负相关(均P<0 .0 5 ) ;与HDL- C、HDL2 - C呈正相关(均P<0 .0 1)。结论:脑梗塞性患者存在严重的性激素失调及脂质代谢异常,性激素及血脂代谢紊乱参与了脑梗塞的发病机制。     

血细胞分析仪对外周血有核红细胞计数性能的评价

目的评价Sysmex XE-2100血细胞分析仪计数外周血有核红细胞（NRBC）的性能。方法选择门诊与住院患者乙二胺四乙酸二钾抗凝血标本,采用Sysmex XE-2100血细胞分析仪与手工显微镜方法计数NRBC,并对结果进行比较。结果血细胞分析仪与手工显微镜方法之间相关性良好,相关系数为0.938 4;58份标本仪器法NRBC在0.00%～0.99%标本中14份（24.1%）手工法NRBC结果为0.00%。24份仪器法NRBC结果为0.00%的标本中22份（91.2%）手工法小于或等于1.00%;仪器法重复性明显好于手工法,NRBC平均CV为8.0%。结论 Sysmex XE-2100血细胞分析仪与手工显微镜法之间相关性较好;仪器法重复性明显好于手工法;尽管出现少量仪器法与镜检法不一致结果,但均伴有其他白细胞和（或）血小板异常报警提示,也进行了显微镜复核。     

This article has been retracted: Trends in the frequency of blood donors donating blood to be tested for HIV in Shiraz from 2004 to 2006

RETRACTION The following article from Transfusion Medicine, ‘Trends in the frequency of blood donors donating blood to be tested for HIV in Shiraz from 2004 to 2006’ by L. Kasraian and published online on November 3, 2009 (DOI: 10.1111/j.1365-3148.2009.00975.x ), in Wiley InterScience ( www.interscience.wiley.com ), has been retracted by agreement between the author, the journal Editor in Chief, and Blackwell Publishing Ltd. The retraction has been agreed due to inclusion of data without prior approval. Professor Jean‐Pierre Allain
Editor in Chief
Transfusion Medicine REFERENCE L. Kasraian (2009). Trends in the frequency of blood donors donating blood to be tested for HIV in Shiraz from 2004 to 2006. Transfusion Medicine. [E‐pub ahead of print, DOI: 10.1111/j.1365‐3148.2009.00975.x] A number of studies have indicated that some blood donors may donate blood in order to obtain an HIV test. These particular donors pose a serious hazard to the health care system by increasing the risk of HIV being transmitted through the donated blood. The study was undertaken to discover the effectiveness of new measures introduced to reduce the number of donors using blood donation centres to obtain an HIV test. The measures included increased educational information regarding the hazards of HIV transmission through donated blood, and the availability of special HIV clinics offering free services and anonymity. A survey of blood donors was undertaken over a period of 3 years, from 2004 to 2007. The cross‐sectional survey involved 14 752 volunteers and all the participants were asked to complete a questionnaire which covered areas such as demographic characteristics and their motivation for donating blood. During the first year of the survey, it was discovered that 14· 2% of donors donated blood in order to be tested for HIV, and in the following 2 years it was 11· 2 and 9· 3%, respectively. A significant decrease was shown during the survey (P < 0· 05). The majority of these particular donors were found to be young, single, men with poor educational backgrounds and first‐time blood donors. Over the period of this study, a reduction in the number of donors using blood donation centres in order to be tested for HIV was clearly evident. This positive downward trend may be attributed to the success of the new measures introduced.