贫血大熊猫同种异体输血及交叉配血初探

人工饲养大熊猫“榕榕”患急性胰腺炎和肠道霉菌感染 ,在治疗过程中出现了严重贫血 ,经综合治疗后 ,贫血无明显好转 ,故采用了同种异体输血治疗方案。为了扩大供血源 ,还对另两种熊科动物———小熊猫和黑熊进行了血型检定并与“榕榕”的血进行了交叉配血 ,现将输血前的血型检定及交叉配血等情况报告如下。1　材料与方法1 1　受血大熊猫榕榕 ,雌性 ,年龄 11岁。1.2　供血者　福州大熊猫研究中心人工饲养的 3只大熊猫(分别称大熊猫A、B、C)和 4只小熊猫 (分别称小熊猫 1～ 4号 )以及 3只黑熊 (分别称黑熊 1～ 3号 )。1.3　试剂　目前尚无大…     

同种异体输血对受血者机体免疫调节作用的研究进展

同种异体输血作为临床重要的治疗手段之一，是抢救急性失血等危重患者最行之有效的方法，也是各种外科大手术能顺利进行的重要保证。一直以来，人们非常重视同种异体输血可能引起的一些传染性疾病，采取了多种严格措施加以防范，并取得了令人满意的效果。直到20世纪70年代Opelz首先提出同种异体输血对受血者机体免疫功能具     

减少同种异体输血的方法研究进展

关于输血的安全问题,长期以来是人们所关注的.在20世纪80年代早期,艾滋病的发现使公众更加关心输血的安全问题.在1985年最初开始了献血者的HIV抗体的常规检测,极大地减少了输血传播艾滋病的威胁[1],然而输血潜在的危险仍然存在.输血后引起丙型肝炎的事件,又增加了公众对输血的不信任.每种新的输血传播的疾病,比如成人T淋巴细胞性白血病,只要新闻媒介稍有报道,都可以成为公众关注的热点.这迫使人们重新评价同种异体输血技术,并开始寻求一些避免同种异体输血的更科学、更安全的替代治疗方法,现在发展起来的替代方法主要有如下几种.     

同种异体输血对肝癌患者术后免疫功能的影响

同种输血是临床治疗的重要手段之一，对严重出血、贫血、多种血液性疾病、晚期肿瘤有辅助治疗作用，对外科复杂手术的顺利进行起到了保障作用。但近年来发现同种输血可能会导致部分肿瘤患者术后复发率增加，5年生存率下降^[1],并初步认为与同种输血引起机体免疫功能下降有关。为了研究血液中何种成分影响免疫功能，笔者选择原发性肝癌患者作为研究对象，观察不同成分输血后肝癌患者细胞及体液免疫功能的变化，以探讨解决同种输血的副作用。     

临床输血科疑难配血现状及配血方案的对策与展望

在临床实际工作中,医院输血科经常会遇到一些血型不能正确判断或交叉配合试验不符合等疑难问题,或者是难以解释的异常实验室结果 ,常导致患者不能得到现、分析并解决临床疑难交叉配血及时有效的输血治疗,这一系列问题就是临床疑难输血病例,其在延误病情的同时也增加了患者的痛苦^[1]。所以正确发问题,对于保证患者临床输血安全意义重大。     

临床输血申请单及配血标本质量分析

目的分析输血申请单及配血标本的质量,发现其中存在的问题。方法按卫计委《临床输血技术规范》关于输血申请单及配血标本采集的质量要求,对该院2013年6月至2014年12月1 768份输血申请单及对应的配血标本进行核查。结果1 768份申请单中,合格1 661份,占93.95%,不合格107份,占6.05%,共计139处不合格;1 768份配血标本中,合格1 718份,占97.18%,不合格50份,占2.82%,共计83处不合格。结论输血申请单和配血标本存在不符合要求的情况。有必要采用各种措施保证输血治疗各环节的质量管理,确保用血安全。     

交叉配血及安全输血的探讨

目的分析交叉配血不合的原因及应采取的措施。方法采用DiaMed血型配血(微柱凝胶)系统,进行交叉配血,手工聚凝胺法作为交叉配血对照。对交叉配血不合者经抗体筛查作直接抗人球蛋白试验,放散试验和青霉素药物试验,并结合病史分析。结果 4720例次交叉配血微柱凝胶(MGT)法检出112例交叉配血不合。假阳性42例(37.5%),钙拮抗剂(DAT)阳性56例(50.0%),青霉素试验阳性14例(12.5%);输血史58例,妊娠史36例,相关药物史30例。结论交叉配血不合的影响因素包括标本、温度、疾病及输血史、妊娠史、大剂量抗菌药物史等;发现交叉配血不合,要分析原因,应重复试验并选适宜配血方法。     

多供者同种异体输血对手术患者细胞免疫功能的影响

目的研究多供者同种异体输血(multiple allogeneic blood transfusion,MABT)对手术患者细胞免疫功能的影响。方法回顾性对比分析手术前后单供者同种异体输血(single allogeneic blood transfusion,SABT)患者(SABT组)与MABT患者(MABTⅠ组、MABTⅡ组)及对照组(未输血组)血液T淋巴细胞亚群及NK细胞的变化。结果术后2 d:各组患者CD3+、CD4+、NK细胞数均下降(P0.05)而CD8+上升(P0.05),但MABTⅠ组、MABTⅡ组变化更明显(P0.01)且与SABT组、未输血组比较有统计学差异(P0.01);术后7 d:MABTⅠ组、MABTⅡ组CD3+、CD4+、NK细胞数低于术前(P0.05)而CD8+上升(P0.05);术后2 d、7 d:MABTⅠ组、MABTⅡ组CD4+/CD8+均低于术前(P0.05),MABTⅡ组CD3+、CD4+又低于MABTⅠ组(P0.05),CD8+高于MABTⅠ组(P0.05)。结论 MABT可通过加强细胞免疫抑制而增强输血相关免疫调节作用。     

正确选用配血方法,防止输血事故的发生

<正> 我院从1986年7月至今的两年多内,用菠萝酶及抗人球蛋白法(AGT)配血,多次避免了由不完全抗体引起的输血事故,其中2例抗体都为抗-c+E,现报道如下。病例简介病例1:患者陈××,女性,50岁,1978年     

Allogeneic blood transfusion and postoperative duration of mechanical ventilation.

BACKGROUND: In patients having open heart surgery, allogeneic blood transfusion (ABT) may be related to an enhanced inflammatory response and impaired pulmonary function, resulting in the need for prolonged mechanical ventilation. STUDY DESIGN AND METHODS: The records of 416 consecutive patients undergoing coronary artery bypass graft surgery at Massachusetts General Hospital were reviewed. Possible predictors and the number of days of postoperative ventilation, as well as the number of RBC units transfused and the length of their storage, were recorded. The association between mechanical ventilation after the day of operation and the number of RBC units transfused was calculated by logistic regression analysis. RESULTS: The number of RBC units transfused, but not the length of their storage, differed (p<0.0001) among patients ventilated for 0, 1, 2, 3, or 4 or more days after the day of operation. Patients taken off ventilation on the day of operation received (mean +/- SE) 2.01 +/- 0.14 RBC units; patients kept on ventilation for 4 or more days received 9.45 +/- 1.83 units. After adjusting for the effects of 18 confounding factors, the number of RBC units transfused was not a significant predictor of ventilation past the day of operation. There was, however, a trend suggesting that the likelihood of such ventilation might increase by 26 percent per RBC unit transfused (p = 0.0628). CONCLUSIONS: Future studies of the outcomes of ABT should examine further the possibility of a relationship between the number of transfused RBCs and the likelihood of postoperative ventilation after the day of operation.     

Allogeneic blood transfusion as a risk factor for the subsequent development of non-Hodgkin's lymphoma

In summary, it is impossible to reconcile the contradictory results of the studies of the association between previous blood transfusion and subsequent development of NHL (Figs 1 and 2). Most of the studies were of high quality, and the authors discussed the possible sources of bias that might have generated a spurious association or concealed a true relationship. Although recall bias, detection bias, and allogeneic blood transfusions given because of the onset of NHL could be responsible for the reported positive associations, these explanations were considered by the investigators, and they seem unlikely. Multiple comparisons may account for the association between transfusion history and NHL in individual studies, but they are less likely to explain the association noted in all the positive studies considered together. Random misclassification and Berkson's bias might explain some of the null results, but they are unlikely to account for disagreements of the magnitude shown in Figures 1 and 2. Alexander discussed the superior quality of the design of the case-control study of Adami et al but was unable to explain the disagreements among the reported studies (Figs 1 and 2). He concluded that there is no proof that allogeneic blood transfusion does not increase the risk of NHL; one can, however, be reassured that the evidence so far points to--at worst--a doubling of risk, and--at best--no increase in risk after a previous transfusion. Along these lines, Figure 1 shows the results of the 3 cohort studies, which were remarkably consistent in reporting a 2-fold increase in the risk of developing NHL after a blood transfusion; and Figure 2 shows the results of the 6 case-control studies, which usually observed no increased risk. If allogeneic blood transfusion does have an immunosuppressive effect, this effect is probably transient and weak, compared with the severity of the immunosuppression encountered in the posttransplantation situation. Immune impairment may be the common determinant for the increased risk of NHL observed in transplanted and transfused patients, and--if this were the case--the difference in the duration and intensity of the immunosuppressive state would be logically congruent with the observed patterns of lymphoma development: that is, the risk of NHL is increased 20- to 120-fold in the transplanted patients, as compared with only 2-fold in the previously transfused patients. The association between allogeneic blood transfusion and subsequent development of NHL is biologically plausible, whether the mechanism is transfusion-associated immunosuppression, transmission of oncogenic viruses, or viral activation in a setting of transfusion-associated immunosuppression. Also, if allogeneic blood transfusion is a risk factor for the subsequent development of NHL, the increased use of allogeneic blood transfusion since the 1950s might account, at least in part, for the increase in the incidence of NHL over the last half of this century. Blood transfusions are commonly used worldwide, and--based on at least some studies--they show a weak association with NHL (i.e., at worst, a doubling of risk; Fig 1). Common exposures that have a weak association with NHL are more likely to account for the current epidemic of NHL in the elderly, compared with rare exposures that increase the risk of NHL by manyfold. However, no evidence regarding a causal relationship between history of an allogeneic blood transfusion and the subsequent development of NHL has been presented. The available studies are observational, and they cannot determine whether any increase in risk, observed in association with allogeneic blood transfusion, is due to the transfusion itself or to other factors occurring in association with the transfusion. In conclusion, allogeneic blood transfusion from healthy donors may be associated with a small increase in the risk of development of NHL after the transfusion. This hypothesis is biologically plausible and is     

Use of blood transfusion in management of anemia.

Transfusion of red blood cells is useful in restoring oxygen-carrying capacity in patients with symptomatic anemia. In general, physicians should avoid transfusing blood based on hemoglobin concentration alone. Instead, they should focus on the impact of anemia on the patient's symptoms and level of activity. The concern for HIV infection and viral hepatitis has only served to highlight the potential risks associated with homologous transfusion therapy. These concerns should be carefully considered, along with possible alternatives, before a decision is made to transfuse. It is important to define the cause of anemia and to institute appropriate corrective therapy. The availability of recombinant human erythropoietin offers an option in selected patients to reduce or eliminate the need for red blood cell transfusion.     

Prospective RBC phenotype matching in a stroke-prevention trial in sickle cell anemia: a multicenter transfusion trial

BACKGROUND: Most sickle cell anemia patients undergo transfusion therapy to prevent complications. The Stroke Prevention Trial in Sickle Cell Anemia showed that transfusion therapy is effective in the primary prevention of stroke. Despite its efficacy, transfusion therapy is limited by alloimmunization. The purpose of this study was to determine if a multicenter trial could implement a transfusion program utilizing phenotypically matched blood to reduce alloimmunization. STUDY DESIGN AND METHODS: One hundred thirty children underwent RBC phenotyping and antibody screening with review of blood bank records. The protocol required use of WBC-reduced RBCs, which were matched for E, C, and Kell. Monthly alloantibody testing and review of transfusion forms were performed to determine compliance and the occurrence of any adverse events. RESULTS: Patient RBCs expressed a low frequency of Kell (2%), E (20%), and C (25%) antigens. Sixty-one patients received 1830 units. Ninety-seven percent of all units were WBC reduced. Only 29 units were inadvertently not matched for E, C, and Kell. Five patients (8%) developed a clinically significant alloantibody. Four developed a single antibody to E or Kell. Three patients (5%) developed a warm autoantibody. There were 11 transfusion reactions and 8 transfusion-associated events. Transfusion reactions included 6 febrile reactions (0.33%/unit), 3 allergic (0.16%/unit), and 2 hemolytic (0.11%/unit). Associated events included 4 episodes of hypertension (0.22%/unit), 3 crises (0.16%/unit), and 1 transient ischemic attack (0.05%/unit). CONCLUSION: This is the first multicenter study to show that extended RBC phenotyping can be implemented nationwide. Compared to studies, the alloimmunization rate dropped from 3 percent to 0.5 percent per unit, and hemolytic transfusion reactions dropped by 90 percent. It is recommended that all transfused sickle cell anemia patients be antigen matched for E, C, and Kell. Patients should be closely monitored during transfusions to avoid preventable risks.     

Allogeneic peripheral blood stem cell transplantation for severe aplastic anemia.

Allogeneic peripheral blood stem cell transplantation (PBSCT) is rarely applied for the treatment of severe aplastic anemia (SAA) because of questionable durability of engraftment and increased risk of graft versus host disease (GVHD). We performed allogeneic PBSCT in 3 SAA patients from their human leukocyte antigen (HLA)-identical siblings. One received bone marrow after conditioning with cyclophoshamide (Cy) plus antithymocyte globulin. He had a second transplant with peripheral blood stem cells from the original donor because of a graft failure (GF). Two other patients received PBSCT as a first option, with Cy as the only conditioning drug. The 3 patients received short-term methotrexate and cyclosporine as a postgrafting immunosupression. In the latter 2 cases, no GF has been observed, and a successful and complete hematological recovery was achieved and maintained for 28 and 25 months, respectively. In conclusion, PBSCT provides a quick and complete hematological recovery in SAA patients.