全自动血型仪的应用评价

目的了解全自动血型鉴定系统用于检测ABO血型和Rh(D)血型的效果。方法采用深圳爱康AK03A型数字血型仪对北海市中心血站2010年5月—2011年12月无偿献血者20702份样本进行ABO血型和Rh(D)血型鉴定,并与手工试管法进行对比验证。结果发现正反定型不一致的有75例,ABO初筛血型错误的36例,Rh(D)阴性的53例。结论全自动血型鉴定系统检测血型快捷、方便、高效,能降低检测人员的工作强度,但判读结果时需要与手工试管法结合进行验证,才能得出正确的结果。     

自身抗体引起的ABO血型正反定型结果不一致

目的:对因自身抗体引起ABO血型正反定型结果不一致的疑难血标本进行血型鉴定和分析,探讨其原因和解决办法。方法:先用直接抗人球蛋白试验(DAT)和间接抗人球蛋白试验(IAT)确定ABO血型正反定型结果不一致的原因是由于自身抗体的存在,然后做吸收放散试验、抗体筛选试验等排除自身抗体的干扰以便血型的正确判定。结果:ABO血型正反定型结果不一致因自身抗体引起的有10例,其中温抗体7例,冷抗体3例,温抗体同时同种抗体阳性2例,冷抗体同时同种抗体阳性2例。结论:自身抗体会影响ABO血型的正确判定,选用合适的试验进行分析判断以提高血型鉴定的准确性。     

ABO血型实验结果矛盾解析

通过观察近千例学生操作步骤、亲自操作以及查阅文献,解析学生实验“ABO血型测定”结果不一致的原因。发现ABO血型测定结果矛盾的原因是：正向定型玻片法灵敏度低;学生操作技术不规范或者抗原、抗体反应条件不当;低质量的血清试剂：献血车上测定结果可能错误以及其他小概率事件等。因此在教学实验过程中要求：规范学生操作．培养基本技能;尽量选用质量稳定、可靠的试剂,培养科学的态度;要重视学生实验中发现的意外结果,培养学生的创新思维。     

卡式微柱凝胶法在ABO、RhD血型鉴定中的应用价值

目的:探讨微柱法在ABO、RhD血型鉴定中的应用价值。方法:抽取2012年3月至2013年3月我站检验科血液筛查标本共1081份作为研究对象,在metis全自动血型仪进行初筛的基础上,同时进行卡式微柱凝胶法ABO、RhD血型鉴定,据定型结果配血,统计输血结局并作为评价依据。结果:筛查RhD阴性者6份占0.56%,阳性者1075份占99.44%;所有血液输用后均未产生输血反应。结论:ABO、RhD血型鉴定是保障输血安全、抑制溶血性疾病的必要措施,而微柱法具有操作简便、价格低廉、科学准确的优点,适合血站的血型鉴定和临床的推广。     

优质护理服务在血站工作中的应用

目的探讨优质护理服务在血站无偿献血工作中的应用,从而有效减少献血不良反应,进一步拓展和稳定无偿献血者队伍。方法对2009~2011年我站开展优质护理服务前、后自愿无偿献血人员的资料进行分析比较献血不良反应发生率。结果开展优质护理服务后,无偿献血总人数呈上升趋势,而献血不良反应发生率呈下降趋势。结论开展优质护理服务,能有效降低献血不良反应的发生率,提升无偿献血者满意度;有利于扩大和稳定无偿献血者队伍,有利于建立无偿献血长效机制。     

无偿献血者ALT异常与戊型肝炎病毒感染的关系

目的 了解无偿献血者ALT异常（按血站标准,以大于25赖氏单位为异常）与戊型肝炎病毒感染的关系。方法 对萧山地区2004年8～11月无偿献血者中,ALT异常的102例血清标本,进行抗-HEV IgM抗体检测;同时对照检测450份ALT正常的无偿献血者血清标本。结果 在102例ALT异常血清中,抗-HEV IgM抗体阳性为6例,阳性率为5.88%,在450份ALT正常血清中,抗-HEV IgM抗体阳性为5例,阳性率为1.11%。结论 在无偿献血者ALT异常血清中,抗-HEV IgM抗体检出比例较高。     

GoldenEye 16BT体系在ABO基因及亲子鉴定中的应用评估

目的:调查湖南地区汉族ABO血型及其基因型,评估GoldenEye 16BT体系在血型与亲子鉴定中的检验能力.方法:以533例亲子鉴定案例为基础,用抗A(B)血清检测1248个个体的血清学血型,观察和分析GoldenEye 16BT体系在ABO基因型检测和15个STR基因座的遗传学数据资料.结果:(1)1248个个体中,1245(97.76%)个个体的血清学血型与基因型检测结果相符,有3例O型血经基因检测发现1例含A基因、2例含B基因 .688名无关个体血清学血型A＞O＞B＞AB,等位基因频率O＞A＞B.(2)GoldenEye 16BT体系累计个体识别能力为0.9999999999999999971,累积非父排除率为0.999999999999971.533例亲子鉴定中有380例肯定亲权关系,153例排除亲权关系;11例中有1个STR基因座发生突变.结论:GoldenEye 16BT体系用于ABO基因型检测与亲权鉴定是高效、可靠的.     

张家口地区献血者隐匿性乙肝病毒感染研究

目的:对张家口地区无偿献血者中隐匿性乙肝病毒感染情况进行流行病学调查,为当地血液安全筛查提供指导意义.方法:应用HBsAg ELISA检测试剂盒对回库无偿献血者标本进行检测;对血浆标本采用nested-PCR技术进行HBV核酸检测;对阳性标本进行HBVDNA序列分析.结果:在总计5498例次标本的检测中,共有5417例为HBsAg阴性;HBsAg阴性标本中nested-PCR方法检出13例HBV DNA阳性(0.24％,13/5417);测序结果显示隐匿性HBV感染者中C基因型所占的比例为61.5％(10/16),明显高于HBsAg阳性的HBV感染者(28.2％,11/39,P＜0.01).结论:张家口地区无偿献血者中存在较高比例的隐匿性乙肝病毒感染.     

快速血型定型及交叉配血对创伤出血性休克患者抢救重要性的探讨

摘要 目的：通过对创伤出血性休克患者快速血型定型及交叉配血结果的分析,探讨其对创伤出血性休克患者抢救的重要性。方法：选择2018年2月至2020年2月于我院接受治疗的156例腹部创伤出血性休克患者为研究对象,对入组患者均实施快速血型鉴定及交叉配血,记录血型定型结果与交叉配血结果,对血型定型正反不一致,交叉配血结果不相合的数据进行分析。结果：156例入组患者实施快速血型定型显示有40例存在正反定型不一致,占比为25.64 %（40/156）,其中男性21例,占比52.50 %（21/40）,女性19例,占比47.50 %（19/40）,年龄分布10岁以下占比15.00 %,10~30岁占比37.50 %,31~60岁占比35.00 %,61岁及以上占比12.50 %,不同性别和年龄患者分布不具有统计学意义（P>0.05）;不规则抗体筛查阳性8例,检出率为5.13 %,其中男性2例占比25.00 %,女性6例占比75.00 %,有输血史7例占比87.50 %,无输血史1例占比12.50 %,比较显示女性明显高于男性,有输血史高于无输血史（P<0.05）;进行卡式交叉配血87例,其中有主侧相合而次侧不合2例,主侧不合次侧相合2例,在抢救用血过程中均采用配合性输血原则。156例患者经过快速血型定型及交叉配血,救治成功的有137例,成功率为87.82 %。结论：及时准确的血型定型及交叉配血对创伤出血性休克患者的救治具有重要意义,为创伤患者的输血救治提供有力保障,在临床上值得推广。     

新生溶血病患儿红细胞上致敏抗体对Rh 血型检测的影响

目的:探讨新生溶血病患儿红细胞致敏抗体对其Rh血型鉴定的影响。方法:采用抗球蛋白法、盐水法、微柱凝胶法(Rh血型测定型)、凝聚胺法和抗血清微柱凝胶法(Ig G型)五种方法对近三年来我院收集的163例新生溶血病患儿红细胞进行Rh血型检测,对五种检测结果不一致的患儿红细胞进行0.2 M 2-巯基乙醇抗体放散,比较放散后五种方法检测结果并验证其准确性。结果:29例直接抗体试验阳性患儿的五种Rh血型检测结果不一致,经0.2 M 2-巯基乙醇抗体放散后检测结果均一致。Rh血型准确性验证表明,红细胞放散测定的Rh血型完全符合临床现象。结论:患儿红细胞的致敏抗体达一定数量后,会影响抗球蛋白法、盐水法、微柱凝胶法(Rh血型测定型)、凝聚胺法和抗血清微柱凝胶法(Ig G型)对Rh血型鉴定,0.2M 2-巯基乙醇抗体放散法是一种正确鉴定新生儿Rh血型的简单可行的方法。     

Presence of lower temperature-dependent antibody with low avidity to C100-3 (HCV) antigen in voluntary blood donors.

Serum samples with lower temperature-dependent antibody with low avidity to C100-3 (HCV) antigen were found in 0.19% of 23,197 voluntary blood donors at this blood center. They showed positive C100-3 antibody activity at 24 C but not at 37 C. The antibody activity bound to C100-3 antigen at lower temperature disappeared after incubation for 60 min at 37 C or treatment with 8 M urea. Other markers of hepatitis C virus infection, especially the presence of HCV-RNA were demonstrated in some of these serum samples and the importance of this phenomenon is discussed with regard to virus screening of blood donors for hepatitis C.     

Risk factors for Trypanosoma cruzi infection among blood donors in central Brazil.

Characteristics and possible risk factors associated with Trypanosoma cruzi infection among blood donors were assessed within a routine screening programme in blood banks in an endemic area of Chagas disease. 6,172 voluntary blood donors were interviewed and tested for anti-T. cruzi antibodies by Haemagglutination and Complement Fixation tests in six blood banks in Goiania-Central Brazil from October 1988 to April 1989. An overall prevalence of 2.3% for T. cruzi infection was obtained, being 3.3% for first-time blood donors and 1.9% for regular ones (p < 0.01). Considering this seropositivity among regular blood donors, selection of candidates relying only on the history of previous donation was found to be inadequate. The risk of infection increased inversely with the degrees of education and monthly income. There was a 9.2 risk of infection (95% CI 3.8-22.6) for those who had lived more than 21 years in an endemic area compared to subjects who had never lived in rural settings, after multivariate analysis. These informations may help to review the criteria of selection of donors in order to improve quality of blood products in endemic areas.     

Fostering repeat donations in Ghana

IntroductionMost African countries are challenged in recruiting and retaining voluntary blood donors by cost and other complexities and in establishing and implementing national blood policies. The availability of replacement donors who are a cheaper source of blood has not enhanced repeat voluntary donor initiatives.MethodsAn overview of activities for recruiting and retaining voluntary blood donors was carried out. Donor records from mobile sessions were reviewed from 2002 to 2008.Results and discussionA total of 71,701 blood donations; 45,515 (63.5%) being voluntary donations with 11,680 (25%) repeat donations were collected during the study period. Donations from schools and colleges contributed a steady 60% of total voluntary whilst radio station blood drives increased contribution from 10 to 27%. Though Muslim population is less than 20%, blood collection was above the 30-donation cost-effectiveness threshold with a repeat donation trend reaching 60%. In contrast Christian worshippers provided <25 unit/session and 30% repeat donations. Repeat donation trends amongst school donors and radio blood drives were 20% and 70% respectively.ConclusionRepeat donations rates have been variable amongst different blood donor groups in Kumasi, Ghana. The impact of community leaders in propagating altruism cannot be overemphasized. Programs aiming at motivating replacement donors to be repeat donors should be developed and assessed.     

Should we neglect or nurture replacement blood donors in sub-Saharan Africa?

Lack of blood is common in SSA but quantification of the overall shortfall is hampered by a lack of evidence-based targets for blood collection. Despite recommendations that all blood donors should be voluntary and non-remunerated, replacement donors are common throughout sub-Saharan Africa (SSA). Voluntary donors are generally recruited through centralised systems whereas replacement donors are recruited by families and donate through hospitals. Blood from a centralised service is more expensive than from a hospital-based service due to the higher costs of donor recruitment, quality assurance processes and the maintenance of distribution networks.Information about the contribution of replacement donors to the blood supply is scanty and inconsistent but it is likely that they currently provide over half of the blood in SSA. WHO's guidelines for transfusion services deal exclusively with voluntary donors and neglect the substantial contribution made by replacement donors. Examples of how the supply and quality of blood from the replacement donors can be improved have been published but need to be evaluated and disseminated. Political will and open-mindedness to innovative ways to improve supply and safety of blood from all types of donors are essential to promote more evidence-based approaches to blood transfusion practice in low-income countries.     

Occurrence of non-A, non-B post-transfusion hepatitis in heart surgery. Prospective study on the value of the determination of serum alanine aminotransferase and detection of anti-HBc antibodies in blood donors

We studied a group of 64 patients undergoing cardiac surgery for the occurrence of post-transfusion hepatitis during a follow-up period of 5 months. They received blood units (packed red cells in saline-adenine-glucose medium and/or fresh frozen plasma exclusively) from 447 volunteer donors. Post-transfusion hepatitis was identified in 5 patients: 1 patient had cytomegalovirus hepatitis and the remaining 4 cases were defined, by exclusion, as non-A, non-B hepatitis (with prevalence and incidence rates of 80% and 6.25% respectively). We found no statistically significant differences between the numbers of transfused blood product units in patients who developed non-A, non-B hepatitis as compared to those who did not. Our analysis of the predictive effectiveness of alanine aminotransferase and anti-HBc antibodies screening in blood donors to prevent non-A, non-B post-transfusion hepatitis led to the following conclusions: we failed to confirm the association between anti-HBc in blood donors and enhanced risk of non-A, non-B hepatitis in recipients since no case developed among patients receiving blood products from anti-HBc positive donors. So, 20 donors (4.5%) would have been discarded without any reduction of the incidence of non-A, non-B hepatitis. we could not confirm nor exclude the possibility that screening donor blood for elevated alanine aminotransferase levels would have reduced the number of non-A, non-B hepatitis in recipients.     

Fetal Tissue Banking for Transplantation: Characteristics of the Donor Population and Considerations for Donor and Tissue Screening

We initiated this study to evaluate the suitability for therapeutic use in transplantation of tissues obtained from human abortuses. We have developed protocols for the collection, handling and preservation of hepatic stem cells from electively aborted embryos and have developed methods for assessment of the cells so derived and processed. In this paper we present our findings regarding screening of potential donors, acquisition of fetal tissues, and assessment of the tissues for potentially infectious contaminants. We assess the suitability of the tissue donors according to current standards used for donors of commonly transplanted tissues (e.g., bone grafts, skin grafts and heart valves) and present data regarding the real availability of tissues from elective abortion procedures that would meet those standard tissue banking criteria.We specifically evaluated the donor's willingness to provide a blood sample for testing, conducted a detailed interview similar to those used for typical organ and tissue donors, and assessed the type and incidence of contamination in collected tissues. We find that although many women are willing to consent to use of the tissues for transplantation, attrition from the study for various reasons results in few fetal organs ultimately realistically available for transplantation. Typical reasons for attrition include: unwillingness to have a blood sample drawn or tested, positive serology results, social/medical high risk factors for acquisition of transmissible disease, no identifiable organs available, and unacceptable microbial contamination. Thus, although it might seem that due to the numbers of abortions performed annually, that there would be substantial numbers of suitable tissues available, only a small proportion are truly suitable for transplantation.     

Retroviral infections transmitted by blood transfusion

Modifications in donor screening and the introduction of laboratory testing of donated blood for anti-HIV-1 and anti-HTLV-I have resulted in a significant reduction in the risks of retroviral infections from blood transfusion. Presently, the American Red Cross detects an average of eight carriers of human immunodeficiency virus, type 1 (HIV-1) per 100,000 otherwise acceptable blood donors (0.008 percent), compared with an average of 35 per 100,000 (0.035 percent) when testing for HIV-1 antibodies began in 1985. Surveillance studies in the United States indicate a small likelihood that HIV-2 carriers will pass current screening procedures and be accepted as blood donors. Even if an HIV-2-infected person were to be accepted as a blood donor, there is a 42-92 percent likelihood that this person's blood would be detected as infective for HIV-2 and excluded because of serological cross-reactions that occur in the EIA for HIV-1 antibodies. During 1989, which was the first year that donated blood was routinely tested for antibodies to human T-lymphotropic virus, type I (HTLV-I) in the United States, approximately nine in 100,000 donors (0.009 percent) were confirmed positive for antibodies to HTLV-I, and their donated blood was excluded. Subsequent testing has revealed that a significant number of these persons whose sera was reactive by the HTLV-I EIA were, in fact, infected by HTLV-II. Epidemiological studies of human retroviral infections (HIV-1, HIV-2, HTLV-I, and HTLV-II) continue to provide important data and direction for improving criteria for qualifying blood donors.     

Transfusion medicine and safety

Advances in safety of blood transfusion in clinical practice principally relate to preventing transfusion-transmitted infections (TTI). Epidemiological studies of TTI have resulted in the development, standardization, and implementation of an expanding array of immunoassays employed worldwide in routine screening of blood donated by voluntary blood donors. Exclusion of infected blood and their donors has remarkably reduced the risk of transmitting HBV, HCV, HIV-1/2, and HTLV-I/II infections. Nucleic acid tests (NAT) using enzymatic amplification of viral gene sequences have augmented the risk reduction in “window period” infections that are undetectable by the serological tests. Improved viral safety of transfusion therapy has led us to recognize the risk of bacterial contamination, especially in platelet concentrates stored optimally at room temperature. Besides the current effort devoted to microbial risk reduction, pathogen inactivation technologies promise reduction of the residual risk of known and emerging infectious agents. The clinical effectiveness of the foregoing measures, international harmonization/standardization of practices and procedures, and continued hemovigilance portend safest possible safety in the clinical practice of blood transfusion.