以智慧化献血服务改善献血者体验

献血服务全过程从数据化向智慧化发展是大势所趋。献血服务始终围绕献血者展开，以献血者为中心的特点，决定了科学技术手段应用的终极目标为人的体验和感受。借助智慧管理精准识别献血者需求，是提升献血服务水平的首要任务。以武汉血液中心智慧化献血服务为例，阐述了智慧化为献血者带来的全新体验。     

Effect of pre-donation fluid intake on fluid shift from interstitial to intravascular compartment in blood donors

Background

Fluid shifts from interstitial to intravascular space during blood donation helps in compensating the lost blood volume. We aimed to determine the volume of fluid shift following donation in donors with and without pre-donation fluid intake.

Successful Transplantation of Kidneys From Elderly Circulatory Death Donors by Using Microscopic and Macroscopic Characteristics to Guide Single or Dual Implantation

Most kidneys from potential elderly circulatory death (DCD) donors are declined. We report single center outcomes for kidneys transplanted from DCD donors over 70 years old, using preimplantation biopsy Remuzzi grading to inform implantation as single or dual transplants. Between 2009 and 2012, 43 single transplants and 12 dual transplants were performed from elderly DCD donors. Remuzzi scores were higher for dual than single implants (4.4 vs. 3.4, p < 0.001), indicating more severe baseline injury. Donor and recipient characteristics for both groups were otherwise similar. Early graft loss from renal vein thrombosis occurred in two singly implanted kidneys, and in one dual‐implanted kidney; its pair continued to function satisfactorily. Death‐censored graft survival at 3 years was comparable for the two groups (single 94%; dual 100%), as was 1 year eGFR. Delayed graft function occurred less frequently in the dual‐implant group (25% vs. 65%, p = 0.010). Using this approach, we performed proportionally more kidney transplants from elderly DCD donors (23.4%) than the rest of the United Kingdom (7.3%, p < 0.001), with graft outcomes comparable to those achieved nationally for all deceased‐donor kidney transplants. Preimplantation biopsy analysis is associated with acceptable transplant outcomes for elderly DCD kidneys and may increase transplant numbers from an underutilized donor pool.     

Benchmarking: applications to transfusion medicine

Benchmarking is ‘a structured, continuous, collaborative process in which comparisons for selected indicators are used to identify factors which when implemented will improve transfusion practices’. In the Transfusion Medicine literature, there are only a few published articles that meet the criteria for benchmarking: (1) using comparisons between institutions to identify practice variation; (2) using a communication and/or evaluation process to identify factors associated with best practices; (3) introduce best practice factors into one's own setting; and (4) re-evaluate performance. Three models for benchmarking have been proposed: (1) a regional benchmarking programme that collects and links relevant data from existing electronic sources; (2) a sentinel site model where data from a limited number of sites are collected; and (3) an institutional-initiated model where a site identifies indicators of interest and approach other institutions as comparators. Finland has the most well-developed benchmarking model where hospital data are collected electronically from multiple sources and analysed centrally with web-based reports available for participants. Areas of practice variation are explored in annual benchmarking workshops, interventions are identified and implemented, and the impact of the interventions are evaluated at a later date. A provincial model used in Canada will also be described showing the impact on red cell outdating when hospitals were challenged to meet evidence based targets. Limitations of benchmarking and future research will be discussed.     

运用高龄供肝移植的研究现状及其可行性

肝移植作为治疗终末期肝病的唯一有效方法已得到广泛的认同。但目前肝源的匮乏,已远不能满足等待肝移植患者的需要。运用高龄（≥60岁）供肝移植能够部分缓解供肝短缺,但仍存在争议。笔者从高龄肝脏的变化特点、运用高龄供肝移植的研究现状和高龄供肝移植的可行性3个方面作相关综述。     

Deciphering the reasons for milky-white blood donor plasma

Donors who eat a fatty meal before donating blood are known to have an increased level of plasma triglyceride concentrations for several hours. This may contribute to “milky-white” appearance of their plasma samples. We herein report the case of a blood donor who gave a history of the intake of a fatty meal, on the night prior to donation. This was affirmed by his serum lipid concentration done on the following day and on repeating the same subsequently after two weeks of donation respectively.     

Prevalence and Quantity of Parvovirus B19 DNA Among Blood Donors from a Regional Blood Center in Turkey

ObjectiveParvovirus B19 causes a range of diseases and morbidity in humans and is transmissible by transfusion of blood, blood components and plasma derivatives. The objective of the study was to investigate the prevalence and quantity of B19 DNA among blood donors. Method: Totally 1053 samples were collected from March to July 2016 at a blood bank for detection of Parvovirus B19 DNA and serological status of blood donors. Testing of the presence of viral DNA was performed by a quantitative real-time PCR with a 101 copies/ml detection limit. All DNA positive and randomly selected 267 samples were tested for the presence of anti-B19 IgM and IgG by ELISA.ResultsAge distribution of donors was between 18-64; mean age was 27 and median was 23. Among the 1053 samples, 5 (0.47%) had PB19 DNA. All PB19 DNA positive donations had both B19 IgM and IgG antibodies. The DNA level for positive donations were between 0.9 × 102 to 3.1 × 104 copies/ml. IgG and IgM were present in 59.9% (160/267) and 0,74% (2/267) respectively among the healthy donors without PB19 DNA.ConclusionDetected DNA concentration was less than 105 copies/ml. The presence of IgM in low level PB19 DNA positive donors may indicate that there might be a risk in transmission of PB19 to particularly immunosuppressed recipients. The clinical follow-up of blood donation with low level of PB19DNA should be considered to answer the questions about blood safety.     

G-CSF对供者外周血CD34+细胞黏附分子表达的影响

目的通过观察健康供者外周血CD34+细胞黏附分子表达的变化,探讨粒细胞集落刺激因子(G-CSF)动员的机制及其对供者的影响。方法应用流式细胞仪分析15名健康供者在接受G-CSF10μg.kg-1.d-1动员前(Pre-G)、动员d4和停止动员后7d(Pro-G)外周血CD34+细胞比例及其表面黏附分子非常延迟抗原-5(VLA-5,CD49e)和L-选择素(CD62L)的表达情况。结果G-CSF动员后供者外周血CD34+细胞比例较动员前增高5-10倍,停止动员后恢复至动员前水平。G-CSF动员后CD34+CD49e+细胞比例(97.74%)明显高于动员前(79.95%),停止动员后7d CD34+CD49e+细胞比例基本恢复至动员前水平;CD34+CD62L+细胞比例在G-CSF动员过程中无明显改变;CD34+细胞表面CD49e与CD62L的平均荧光强度于动员后呈减弱趋势,但无显著统计学意义。结论G-CSF动员后d4可显著增加供者外周血CD34+细胞比例,可致CD34+CD49e+细胞比例一过性增加,但不影响CD34+CD62L+细胞群的比例。     

构建中国人体器官捐献社会宣教系统的策略

背景:分析中国目前人体器官移植所面临的困境及导致器官移植供体短缺的社会影响因素,发现民众对器官移植及捐献流程相关知识普遍缺乏。目的:从器官捐献宣教系统构建的重大意义、现状总结、应遵循的伦理原则以及建议对策等4个方面进行了尝试性探索,为科学地进行器官捐献的宣传教育提供建议与参考。方法:在CNKI和Pub Med通过关键词"器官捐献、器官移植、伦理学原则、宣传教育"查阅相关文献,对来源于核心期刊的文章进行综合分析。以"器官捐献,器官移植,伦理原则,供体短缺,遗体捐献,宣传教育"为中文捡索词,以"organ donation,organ transplantation,shortage of donor,body donation,education system"为英文检索词,检索维普和中国知网(CNKI)期刊全文数据库万方、Pubmed,Medline,2005年1月至2014年11月有关器官捐献报告中主要涉及器官捐献宣传教育及协调员的相关报道。通过对文献归纳,总结分析目前中国器官捐献宣教的现况,提出构建器官捐献宣教系统的对策。结果与结论:详细阐述了器官捐献宣教系统的必要性,系统分析了国内目前器官捐献宣传教育存在的问题及应该遵循的伦理原则,探索了国内器官捐献宣教系统建设应采取的路径和方法。缓解器官移植供体紧张,扩大供体来源,必须要赢得公民的广泛支持与理解,才能保证器官捐献工作的可持续发展。因此构建人体器官捐献社会宣教体系具有重要意义。