自身免疫性溶血性贫血(AIHA)患者的不同输血方法与效果

目的:探讨不同输血方法治疗自身免疫性溶血性贫血(autoimmune hemolytic anemia,AIHA)的效果。方法:2017年1月-2018年12月选择在本院血液科诊治的64例自身免疫性溶血性贫血患儿,根据输血方法的不同分为观察组与对照组,各32例。观察组给予洗涤红细胞输注治疗,对照组给予非洗涤红细胞(悬浮红细胞)输注治疗,记录两组输血效果。结果:治疗后4 w观察组的总有效率显著高于对照组(100.0%vs.87.5%,P0.05)。两组治疗后4 w的红细胞计数与血红蛋白都显著高于治疗前,且观察组显著高于对照组(P0.05)。观察组的吸氧、机械通气、住院时间都显著少于对照组(P0.05)。观察组治疗过程的过敏反应、发热反应、紫癜等不良反应发生率显著低于对照组(3.1%vs. 21.9%,P0.05)。结论:洗涤红细胞输注治疗自身免疫性溶血性贫血患儿能促进机体红细胞计数与血红蛋白恢复正常,减少不良反应的发生,提高治疗效果与促进患儿康复。     

苯肼致小鼠溶血性贫血模型的建立

目的:应用苯肼致小鼠发生溶血性贫血,建立急性溶血性贫血模型,筛选苯肼致小鼠贫血最佳浓度和红细胞移植的最佳时机。方法:30只C57BL/6小鼠随机分为6组,经腹腔注射不同浓度的苯肼溶液,于注射前和注射后第1、3、5、7、9天采集小鼠外周血进行检测,记录相关指标的变化,比较各组之间的差异,筛选出最佳溶血效果的给药浓度和红细胞移植治疗介入的时机。结果:注射苯肼溶液可使C57BL/6小鼠短期内产生明显的急性溶血性贫血症状,皮肤黏膜颜色苍白;外周血红细胞数量、血红蛋白含量、红细胞压积降低;随着苯肼溶液浓度的增加,小鼠体重显著减轻,存活率下降。结果表明,苯肼注射小鼠致贫血的最佳作用浓度为1.2mg/10g体重,小鼠贫血状态可维持7d。结论:建立了小鼠溶血性贫血模型,此模型可应用于红细胞输注效果的评价。     

Biochemical genetics of a new glucosephosphate isomerase allele (Gpi-1 c) from wild mice

We have found a new allele at the structural locus for glucosephosphate isomerase (called Gpi-1 ^c ) in a population of wild mice. The Gpi-1 ^c allele codes for an enzyme of greater cathodal electrophoretic mobility than either the Gpi-1 ^a or Gpi-1 ^b alleles found in the wild and in the SM/J and C57BL/6J inbred strains. Mice homozygous for Gpi-1 ^c have erythrocyte enzyme activity reduced to 33% of normal levels, altered pH profile, lowered heat stability, and normal K _m 's when compared with SM/J and C57BL/6J mice. The activity of the enzyme in brain, liver, and kidney is not so markedly lowered, although the electrophoretic mobility, pH profile, and heat stability are altered in these tissues. Deficiencies of erythrocyte glucosephosphate isomerase in man, to this level, can cause severe hemolytic anemia. Homozygotes for Gpi-1 ^c show only mild hematological symptoms. The frequency of Gpi-1 ^c in wild populations of mice is discussed and the occurrence of a further rare allele Gpi-1 ^d is reported.This work was supported by M.R.C. grants to Professor R. J. Berry and Dr. H. Kacser, whom we should also like to thank for much help and useful discussion.     

口服苯肼致小鼠慢性贫血模型的建立

目的:应用苯肼建立小鼠急性溶血性贫血的方法已经成熟,但用苯肼建立慢性溶血性贫血模型尚未见报道。本研究试图应用苯肼口服法建立慢性溶血性贫血动物模型并探索最适建模的苯肼浓度。方法:42只C57BL/6小鼠随机分为6组通过口服不同浓度的苯肼溶液,于口服后的第0,1,2,3,4,5,6周目内眦采集小鼠外周血检测,记录相关指标变化比较各组之间的差异,筛选出最佳慢性溶血效果的给药浓度。结果:口服苯肼溶液浓度在250 mg/L以下时C57BL/6小鼠没有出现明显的贫血状态,当浓度调至250mg/L-350mg/L时可使C57BL/6小鼠在5-7周内出现溶血性贫血症状,各组小鼠的皮肤和粘膜颜色苍白,外周血红细胞数量、血红蛋白含量、红细胞压积降低网织红细胞比例增高。但是当浓度达到350 mg/L时小鼠贫血情况过重且达不到慢性贫血的要求。当浓度为300 mg/L时小鼠各项血液指标平稳下降。结论:本实验建立了一种新的小鼠慢性贫血模型,且通过实验发现小鼠口服苯肼致慢性贫血的最佳浓度为300mg/L。据我们所知,这是首次使用苯肼建立慢性贫血的动物模型,此模型对研究人类慢性贫血具有重要价值。     

Methods for Quantitative Detection of Antibody-induced Complement Activation on Red Blood Cells

Antibodies against red blood cells (RBCs) can lead to complement activation resulting in an accelerated clearance via complement receptors in the liver (extravascular hemolysis) or leading to intravascular lysis of RBCs. Alloantibodies (e.g. ABO) or autoantibodies to RBC antigens (as seen in autoimmune hemolytic anemia, AIHA) leading to complement activation are potentially harmful and can be - especially when leading to intravascular lysis - fatal¹. Currently, complement activation due to (auto)-antibodies on RBCs is assessed in vitro by using the Coombs test reflecting complement deposition on RBC or by a nonquantitative hemolytic assay reflecting RBC lysis^1-4. However, to assess the efficacy of complement inhibitors, it is mandatory to have quantitative techniques. Here we describe two such techniques. First, an assay to detect C3 and C4 deposition on red blood cells that is induced by antibodies in patient serum is presented. For this, FACS analysis is used with fluorescently labeled anti-C3 or anti-C4 antibodies. Next, a quantitative hemolytic assay is described. In this assay, complement-mediated hemolysis induced by patient serum is measured making use of spectrophotometric detection of the released hemoglobin. Both of these assays are very reproducible and quantitative, facilitating studies of antibody-induced complement activation.     

温抗体型自身免疫性溶血性贫血的诊治进展

自身免疫性溶血性贫血(AIHI)按照自身抗体作用于红细胞时所需的温度分为温抗体型AIHI(WAIHI)和冷抗体型AIHI(CAIHI),以WAIHI居多,并且多为继发性。WAIHI的发病与温度没有显著的相关关系,其发病是由各种原因引起的免疫机制变异,主要包括基因遗传因素、自身免疫调节异常及免疫因素等,导致针对自身红细胞的抗体产生,再与红细胞膜表面抗原结合,它是一种会使自身红细胞破坏或者缩短寿命的比较难以治疗的贫血,目前治疗AIHI首选疗法为肾上腺皮质激素(激素),有效率可达80%,大剂量静脉注射丙种球蛋白(IVIG)、输血、切除脾等方法的使用也在实践中逐渐增多,并且疗效可观。近年来对温抗体型自身免疫性溶血性贫血的诊治进展的研究越来越多。     

异基因造血干细胞移植后并发自身免疫性溶血性贫血的治疗进展

异基因造血干细胞移植（HSCT）后自身免疫性溶血性贫血（AIHA）是HSCT后并不少见的并发症,其发病率约1﹪~ 6﹪,不同于一般的AIHA,HSCT后AIHA发病机制尚未完全明确,可能与HSCT后受者体内免疫失调相关。危险因素与移植患者年龄小、非恶性疾病、使用无关供者、半相合供者移植、脐血移植、去T细胞移植及移植后并发慢性移植物抗宿主病（GVHD）等有关。皮质激素作为一线治疗,疗效有限,难以持续缓解,需联合使用利妥昔单抗（RTX）、大剂量丙种球蛋白等,甚至需要联合霉酚酸酯、环磷酰胺、西罗莫司、阿伦单抗、依库丽单抗或蛋白酶体抑制剂硼替佐米等免疫抑制剂治疗,部分患者需行血浆置换,偶有行脾切除术者。移植后AIHA总死亡率常高达50﹪,总体预后差于单纯AIHA。该综述旨在总结HSCT后并发AIHA的最新治疗进展,供临床医师参考。     

神经外科手术中大量输血患者红细胞压积及凝血状态研究

摘要 目的：探讨神经外科手术中大量输血患者采用不同输血方法对红细胞压积及凝血状态的影响。方法：选择2017年2月至2019年12月在本院进行手术的神经外科患者104例,根据随机数字表法把患者分为观察组与对照组各52例。观察组给予自体输血治疗,对照组给予异体输血治疗,记录和比较患者红细胞压积及凝血状态变化情况。结果：所有患者都完成手术,两组的手术时间、术中输血量与补液量对比差异无统计学意义(P>0.05)。两组术后1 d的红细胞压积低于术前1 d(P<0.05),组间手术前后对比差异都无统计学意义(P>0.05)。两组术后1 d的凝血酶原时间(prothombin time,PT)与活化部分凝血活酶时间(activited partial thomboplastin time,APTT)值高于术前1 d(P<0.05),组间手术前后对比差异都无统计学意义(P>0.05)。观察组输血后7 d的感染发生率为1.9 %,显著低于对照组的15.4 %(P<0.05)。结论：神经外科手术中大量输血中采用自体输血并不会影响患者的红细胞压积与凝血状态,不会增加输血难度与输血量,但能有效减少感染等不良反应。     

不规则抗体筛查对临床安全输血的意义

目的:不规则抗体是血浆中除了抗A、抗B以外的其他血型抗体,会引起血型鉴定困难、疑难配血、溶血性输血反应及新生儿溶血症。本文探讨不规则抗体在住院患者中的发生情况,为需要输血的患者选择匹配的血液供应,确保临床输血安全、合理、有效。方法:利用Ⅰ~Ⅲ类谱细胞用微柱凝胶抗人球蛋白检测卡对住院患者血标本进行不规则抗体筛查,再对阳性标本利用Ⅰ~Ⅻ类谱细胞进行特异性鉴定。结果:13889例受检血标本中,检出不规则抗体25例,阳性率为0.18%。检出的不规则抗体涉及Rh、MNSs、Lewis、Kidd四个血型系统,所占比例分别为80%、8%、8%、4%。且不规则抗体在女性患者中的检出率高于男性患者。结论:输血前对患者进行不规则抗体筛查及特异性鉴定,可有效减少和避免溶血性输血反应的发生,对于安全输血是十分必要的。     

我院临床输血安全管理的做法

输血作为一种特殊的治疗手段,是现代医学不可替代的。在拯救患者生命的同时也可能会给受血者带来不良反应,有些是终生的甚至是致命的。把输血安全问题放在工作的首位,应充分认识输血治疗的危险因素,加强临床输血管理,完善临床输血规程,确保临床用血安全。     

不同比例新鲜冰冻血浆对大量输血患者凝血功能的影响

目的:探讨不同比例输注新鲜冰冻血浆对大量输血患者凝血功能的影响。方法:回顾性分析本院2018年1月至2018年12月收治的123例大量输血患者的临床资料,依据所输注新鲜冰冻血浆与红细胞比例不同,将其分为低比例组(1:3)、中比例组(1:2)、高比例组(1:1),比较三组患者输血前后凝血功能、血小板计数及电解质变化。结果:输血后,三组患者FIB较输血前明显降低,而PT、APTT较输血前显著升高(P0.05),高比例组PT和APTT明显低于中比例组和低比例组,FIB、血小板均高于中比例组和低比例组(P0.05),电解质水平优于低比例组和中比例组(P0.05)。结论:在大量输血时,提高血浆与红细胞比例有利于改善大量输血患者凝血功能障碍,减少电解质紊乱。     

Magnesium and iron contents of leukemic lymphocytes in acute leukemias and hemolytic anemia

In this study, magnesium and iron concentrations were measured in lymphocytes from patients with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and hemolytic anemia (HA) before and after chemotherapy treatment. The results were compared with those of control subjects. Magnesium concentrations were significantly lower in the patient groups, compared with control values. However, no significant differences, except in the HA group, were found among magnesium concentrations of the patient groups them-selves. Iron level values were at physiological range in all groups. Similarly, no statistically significant differences were found between lymphocyte magnesium concentrations before and after chemotherapy treatment in the patient groups. Fe⁺³ values were higher in the ALL and HA groups with respect to the group before chemotherapy.     

In vitro hemolytic activity ofPlasmodium berghei on red blood cells

A suspension ofPlasmodium berghei obtained by lysis with saponin of red blood cells from an infected rat showed high hemolytic activity, when incubatedin vitro with normal rat red blood cells. The hemolysis was a temperature-dependent process and was dependent on the concentration of the parasite. Plasma ofPlasmodium berghei infected albino rats also possessed lytic activity.