医院用血液制品HCV污染情况的调查

目的调查医院治疗用血液制品ＨＣＶ污染情况．方法临床治疗所用的血液制品，在输完后留容器之残液备检．采用酶标免疫法（ＥＬＩＳＡ）检测．对ＥＬＩＳＡ检测之阳性标本及在阴性标本中随机抽取９份，采用逆转录双ＰＣＲ方法检测ＨＣＶ＿ＲＮＡ．结果血浆白蛋白抗＿ＨＣＶ阳性率４５８％，新鲜血浆阳性率２６％．两种方法检测同一标本，ＥＬＩＳＡ检测阳性的血液制品中，用ＰＣＲ证实，并非都有病毒复制；而在ＥＬＩＳＡ检测的阴性标本中，仍旧有较高的ＰＣＲ阳性检出．结论血液制品存在着ＨＣＶ污染，抗＿ＨＣＶ对于ＨＣＶ感染的诊断价值很高．检测血液制品中的抗＿ＨＣＶ，合理使用血液成份，可防止ＨＣＶ在医院内传播．     

Rh phenotype prediction by DNA typing and its application to practice

The complexity of the RHD and RHCE genes, which is the greatest of all blood group systems, confounds analysis at the molecular level. RH DNA typing was introduced in 1993 and has been applied to prenatal testing. PCR-SSP analysis covering multiple polymorphisms was recently introduced for the screening and initial characterization of partial D. Our objective is to summarize the accrued knowledge relevant to the approaches to Rh phenotype prediction by DNA typing, their possible applications beyond research laboratories and their limitations. The procedures, results and problems encountered are highly detailed. It is recommended that DNA typing comprises an analysis of more than one polymorphism. We discuss future directions and propose a piecemeal approach to improve reliability and cost-efficiency of blood group genotyping that may eventually replace the prevalent serology-based techniques even for many routine tasks. Transfusion medicine is in the unique position of being able to utilize the most extensive phenotype databases available to check and develop genotyping strategies.     

丙型肝炎六例报告及随访观察

本文首次报告新疆6例丙型肝炎。对20例病毒性肝炎病人血清进行抗HCV检测,结果6例阳性。结合临床及化验检查,可诊断为丙型肝炎。对此6例进行分析,结果表明:本病多发生在输血后,临床表现不重,肝功能检查主要是ALT反复波动不降,易致慢性。     

体外丹参、藻酸双酯钠对脑血栓形成患者红细胞与内皮细胞粘附的影响

丹参、藻酸双酯钠是临床治疗脑血管病的常用药。本研究发现，在体外流场中用丹参、藻酸双酯钠分别处理脑血栓形成病人的红细胞后，此红细胞与培养的人脉静脉内皮细胞的粘附数目明显减少、粘附强度明显减弱；而且，在临床常用剂量下藻酸双酯钠的这种抗粘附作用优于丹参。认为丹参、藻酸双酯钠的这种抗粘附作用可能是临床用以治疗脑血栓形成的一个重要机理。     

致敏供者淋巴细胞输注对受者免疫功能重建及移植物抗宿主病发生率的影响

目的探讨非清髓异基因外周血造血干细胞移植后致敏供者淋巴细胞输注(DLI)对受者免疫重建及移植物抗宿主病(GVHD)发生率的影响。方法以C57BL/6小鼠(H-2b)为受鼠, BALB/c小鼠(H-2d)为供鼠,建立异基因外周血造血干细胞移植模型(实验组),移植当天受者接受60Coγ射线全身照射,移植后第2天腹腔注射环磷酰胺200 mg/kg。以不行造血干细胞移植,仅行γ射线全身照射和环磷酰胺腹腔注射的正常C57BL/6小鼠为对照。实验组存活小鼠在移植后第28天分别接受致敏供鼠淋巴细胞输注(n=8)、未致敏供鼠淋巴细胞输注(n=8),另有6只不输注供鼠淋巴细胞。移植后检测受者异基因嵌合率,观察GVHD的发生情况以及T淋巴细胞亚群变化,并行供受者间以及供受者与第三方小鼠(昆明鼠)间的单向混合淋巴细胞反应。结果实验组受鼠SRY基因均为阳性,嵌合率为(30.881±3.962)%。DLI后,接受未致敏DLI者均出现不同程度的GVHD,死亡3只(7.5%,3/8),而接受致敏DLI者无明显GVHD及死亡者。移植后45 d,接受致敏DLI者的CD8 T淋巴细胞明显高于正常C57BL/6小鼠(P<0.05),而接受未致敏DLI者的CD8 T淋巴细胞与正常对照的差异无统计学意义(P>0.05),至移植后60 d,接受DLI者的T淋巴细胞亚群接近正常(P>0.05);对照组T淋巴细胞亚群持续低于正常对照(P<0.05)。实验组小鼠淋巴细胞对供者淋巴细胞刺激的反应性均下降(P<0.01),以接受致敏DLI者最明显,而对昆明鼠淋巴细胞刺激的反应性维持正常水平。结论造血干细胞移植后输注致敏供者的淋巴细胞能促进受者的免疫功能重建,并可减少GVHD的发生。     

Density distribution of erythrocytes in class A2 (insulin requiring) gestational diabetes

We evaluated the age distribution of erythrocytes in pregnancy complicated by gestational diabetes class A2 by the density distribution of cells (DDC) method. The values for normal pregnancy and nonpregnant women were obtained from recently published studies. The cumulative density distribution of cells (DDC) of women with gestational diabetes resembled that of normal pregnancy.     

In-vivo evaluation of random donor platelet concentrates from pooled buffy coats

 Random-donor platelet concentrates (PC) prepared from pooled buffy coats have recently been described as an alternative method for platelet preparation. We evaluated such PCs in the clinical setting compared with a standard PC from platelet apheresis. PCs were prepared either from pools of buffy coats (BC-PC) or from single donors (SD-PC) with the cell separator CS-3000 plus. PCs were stored for up to 5 days before transfusion. We compared fresh PC (day 1) with stored (day 2–3) and long-stored PC (day 4–5). For analysis, platelet increment in the recipient was determined immediately and 16–22 h (mean 20 h) after transfusion, corrected for total body area and transfused platelets (CCI). A total of 316 PCs were administered to 36 thrombocytopenic patients suffering from various hematological disorders. Patients with detectable HLA or platelet-specific antibodies or splenomegaly were excluded from the study. Mean platelet content of the PC was 262×10⁹ for BC-PC and 251×10⁹ for SD-PC. The 20-h CCI after transfusion of fresh PC was slightly higher with BC-PC than with SD-PC (14.5 versus 11.9;p=0.19), but values did not differ significantly between the two types of PC on any day of storage. For BC-PC, 20-h CCI decreased with further storage by 30% (10.2;p=0.02). For SD-PC a decrease by 9% was not significant. In conclusion, platelet concentrates prepared from pools of buffy coats showed excellent transfusion results when administered fresh, but storage decreased the CCI by 30%. No significant difference from PCs from plateletpheresis was observed on any day of storage. Both types of platelet concentrates were capable of sufficient platelet increment even when stored for up to 5 days. Received: 28 December 1995 / Accepted: 14 May 1996     

Treatment of massively bleeding patients: introducing real‐time monitoring,transfusion packages and thrombelastography (TEG®)

Background Continued haemorrhage remains a major cause of mortality in massively transfused patients, many of whom develop coagulopathy. When reviewing transfusion practice for these patients at our hospital, more than 10% received a suboptimal transfusion therapy and survivors had a higher platelet count than non‐survivors. We therefore speculated whether the blood bank could improve its service and hence improve the outcome. Methods The blood bank introduced monitoring the delivery of blood products and contacted the clinician provided there was an imbalance in the transfusion practice. For massively bleeding patients, transfusion packages, encompassing 5 red blood cells, 5 fresh frozen plasma and 2 platelet concentrates was introduced to improve haemostatic competence. The thrombelastograph (TEG) was implemented, aiding in the diagnosis and treatment of coagulopathy. Results The fraction of suboptimally transfused patients declined from > 10% to < 3%. The transfusion package administered intraoperatively to patients operated for a ruptured abdominal aortic aneurysm resulted in decreased postoperative transfusion requirements and improved 30‐day survival (66% vs. 44%) compared to controls. Only performing TEG in patients with a significant bleeding as judged by the anaesthetist reduces the number of analyses by ~85%, whereas those patients with coagulopathy remain identified. The TEG showed 97% predictability in identifying a surgical cause of bleeding in postoperative patients. Ten percent of the massively bleeding trauma patients had hyperfibrinolysis as the major cause of bleeding, whereas 45% were hypercoagulable. Conclusion The initiatives from the blood bank has improved the transfusion practice and, hence, survival in massively transfused patients at our hospital.     

Red cell transfusion in medicine: Future challenges

Many side-effects of red blood cell transfusion have been described. They include iron-overload, as well as allo- and autoantibody formation against red cells. During storage, erythrocytes undergo complex structural and biochemical changes. It has been suggested that accelerated and/or aberrant forms of the physiological erythrocyte aging process underlie the red cell storage lesion. This storage lesion may contribute to side-effects of transfusion as endothelial damage by release of internal erythrocyte constituents, (pro)inflammatory consequences, hampered microcirculation and oxygen delivery. Understanding the process that determines the fate of red blood cells after transfusion may contribute to the prevention of side-effects after red blood cell transfusion. This should be the focus of research on red blood cell transfusion in clinical transfusion medicine.