成份输血对胃癌术后血清IL-6、IL-10、COX-2、PGE_2含量的影响

目的：观察围手术期成份输血对胃癌患者炎症反应的影响。方法：随机选择胃癌病人分为3组：对照组,压积红细胞组,全血组。分别采用ELISA法和放免法检测患者术前及术后低1、3、7、14天血清中IL-6、IL-10、COX-2及PGE2含量。结果：手术后第一周是感染发生的主要时期,两周后,炎症反应基本消失,输血能升高患者血清中的促炎因子,降低抗炎因子IL-10的表达,但相对于输异体全血,输成份血能降低血清中COX-2、PGE2、IL-6的含量,升高血清IL-10的含量。结论：胃癌患者围手术期输血能促进机体的炎症反应,成份输血致炎效果弱于输异体全血。     

医院输血安全管理现状分析与对策

目的：通过对某省七家三级医院输血科管理现状调查,了解医院在输血管理制度的制定与实施、技术操作的规范性、输血流程的安全性、输血科人员配置等方面存在的问题,明确今后医院输血安全管理工作的重点,并提出相应的管理对策,旨在为医院及政府职能部门制订有关医院输血安全相关策略提供科学的佐证。方法：1、文献法：对CNKI、维普数据库近五年相关文献进行系统回顾;2、现场调查：对某省7家三级医院输血安全管理现况调查。结果：所调查的7家医院输血安全管理制度知晓率较低,储血冰箱未按照正确的时间进行监测,医务人员对病人输血反应观察不到位,输血前医患沟通较好,输血差错自愿报告系统超过60%的医院尚未建立,输血不良事件发生后,只有14%的医护人员愿意主动上报,输血科医务人员30岁以上的不到30%,专科以下学历占66%,专业背景37%为检验专业,无学历的占8%。结论：医院输血安全管理存在许多问题：管理制度知晓率低、执行不到位,储血过程未按相关要求进行监测,输血科医务人员过于年轻化,学历层次较低,专业背景单一。建议医院应根据存在的问题,采取应对策略。     

基层医院输血科工作现状及改进

输血是现代医学中重要的抢救、治疗手段,临床输血是一门极其复杂的学科。血液及其制品的管理是一项科学的系统工程,是保证血液质量、提高医疗用血效率、促进输血事业和科研技术水平不断发展的关键。输血科是医院的重要部门,具体负责临床用血的技术指导和技术实施,确保贮血、配发血和其他科学、合理用血措施的执行,其基本目的是将血液及成分安全、有效、合理而便宜的输注给需要的病人并取得疗效。输血科如何履行好职能,保证临床输血安全、科学、合理、有效,已成为当前基层医院首先需要解决的问题。本文就基层医院输血科的工作状况进行了分析,并提出完善规章制度,严格执行操作,更新输血观念,科学合理用血,开展业务新技术,保证输血有效性等相应整改措施,在实际运行中取得可喜的成绩。     

洗涤红细胞输注在早产儿贫血中的应用价值分析

目的:分析洗涤红细胞输注在早产儿贫血中的应用价值。方法:选取2015年10月~2017年11月我院需要输血治疗的贫血早产儿107例,均具有《早产儿管理指南》中的输血指征。采用随机数字表法将患儿分为两组,对照组53例输注红细胞悬浮液,观察组54例输注洗涤红细胞。比较两组患儿输血情况、治疗前后血液流变学相关指标、亚硝基硫醇(RSNO)、超氧化物歧化酶(SOD)和苯二醛(MDA)水平的变化及并发症的发生情况。结果:两组患儿输血量、输血次数、输血后血细胞压积和输血后血红蛋白水平比较均无统计学差异(P>0.05)。输血前,两组患儿全血高切黏度、全血低切黏度、血浆黏度、RSNO、SOD和MDA水平比较无统计学差异(P>0.05);输血后,两组全血高切黏度、全血低切黏度及血浆黏度均较输血前显著下降,且观察组以上指标均显著低于对照组(P<0.05);对照组患儿RSNO、SOD水平显著下降,MDA水平显著升高(P<0.05),观察组患儿以上指标均无显著变化(P>0.05)。观察组患儿呼吸暂停和院内感染的发生率显著低于对照组(P<0.05),两组脑白质损伤及颅内出血的发生率比较均无统计学差异(P>0.05)。结论:洗涤红细胞输注可显著改善贫血早产儿的血液流变学,降低应激反应及呼吸暂停和院内感染的发生率,且输血量、输血次数、输血后血细胞压积和输血后血红蛋白水平与输注红细胞悬浮液相当。     

血小板输注无效的原因与对策的研究进展

血小板的主要生理作用是参与正常的止血,防止损伤后血液丢失。在临床治疗中,血小板的输注频率仅次于红细胞,是现代成分输血的一个重要组成部分,适用于预防和治疗血小板减少和/或血小板功能缺陷患者的出血,并且已成为各种血液病及肿瘤患者放、化疗的有效支持疗法[1],可以降低血液病患者及肿瘤患者放、化疗后因血小板减少而导致出血致死的死亡率。但是随着血小板的大量使用,血小板输血反应日渐增多,特别是血小板输注无效(refractoriness to platelet transfusion,RPT)是临床面临的一大难题。据文献报道,其发生率为30%-70%。产生原因包括免疫性因素和非免疫性因素。处理措施主要是分析血小板输注无效的主要原因,尽量减少输血次数,控制感染和发热,开展血小板组织配型为患者选择适用的血小板,提高输注疗效。     

Blood salvage, proper choice for tumor patients?

Blood transfusion is frequently used in tumor patients, However, allogeneic blood transfusion have been claimed to be associated with an increased risk of negative outcomes, including transfusion reactions, fever, virus transmission, and alloimmunization. Other risks of homologous transfusion specific to the tumor patients are the potential deleterious effects on the recurrence of tumor and indefinite overall survival. On the contrary, autologous blood transfusion offers survival advantages to tumor patients and has been shown to minimize the occurrence of many detrimental allogeneic blood associated effects and complications. It also reduces the volume of banked blood needed and improves the prognosis of patients. However, the quality of salvaged blood is still a matter of debate, because it may contain tumor cells which are associated with potential detrimental effects such as metastasis. So, an advanced technology is needed to remove such contaminants to make autologous blood transfusion safer.     

Quality of the blood sampled from surgical drainage after total hip arthroplasty

Several methods have been found to be successful in reducing the need for allogeneic transfusion among the patients undergoing total hip replacement. The purpose of this prospective study was to analyse the quality and evaluate the effect of postoperative autotransfusion on the need for allogeneic transfusion following total hip replacement. The prospective study was performed in two groups of patients undergoing total hip replacement. Before the operative procedure all patients in both groups predonated two doses of autologous blood. In GROUP 1. the system for postoperative collection and transfusion of shed blood was used. In GROUP 2. the patients underwent total hip replacement without blood salvage system. Standard suction collection sets were used postoperatively. In this group shed blood was not transfused to the patients. The samples of preoperative donated autologus blood, allogeneic blood and postoperative collected autologous blood were analysed for number of red cells, hemoglobin, hematocrit, platelets, white blood cells, values of potassium, sodium, free hemoglobin and acid base status. The postoperatively blood salvage significantly reduced the use of allogeneic transfusion among patients managed with total hip replacement (allogeneic transfusion received 12% patients in Group 1 and 80% patients in Group 2; p<0.001). The values of red blood cells are significantly lower in postoperative collected autotransfusion blood compared with preoperative collected autologous blood and allogeneic blood (p<0.001). The values of potassium and acid base status were in normal range in postoperatively collected autotransfusion blood. These values in preoperatively collected autologous blood and allogeneic blood were out of normal range; (p<0.001). In addition to reducing the risk of complications that are associated with allogeneic transfusion, postoperative blood salvage may offer benefits including reducing the need for allogeneic blood. Our study confirmed that postoperative collection and transfusion of drainaged blood is simple and safe method that significantly reduce the need for allogeneic transfusion in patients underwent total hip replacement. The blood collected and transfused postoperatively has lower values of red blood cells and normal values of potassium and acid base balance. The transfusion of this blood caused no complications in our patients.     

Plasma fibronectin (Fn) study in homozygous beta-thalassemia: relation to splenectomy and transfusion

The concentration of plasma Fn was determined in non-splenectomized and splenectomized patients with homozygous beta-thalassemia, before and 7-10 days after blood transfusion. The mean Fn concentration of non-splenectomized patients before transfusion did not differ from that of matched normal controls but appeared significantly decreased following blood transfusion. On the other hand, in splenectomized thalassemics, Fn levels were increased but were unrelated to transfusion. It is concluded that Fn plays some homeostatic function when RES activity of thalassemic patients is altered either as a result of splenectomy or blood transfusion.     

Blood transfusion induced changes in cell-mediated lympholysis: to immunize or not to immunize

We have recently observed that the HLA-DR match between recipients and transfusion donors influences the beneficial effect of blood transfusions on allograft survival. To examine the immunologic effects of one-HLA-DR-Ag-matched and completely DR-mismatched transfusions, transfusion-induced changes in cell-mediated lympholysis (CML) were investigated. Blood donor directed CTL activity was measured in vitro before and after blood transfusion in 56 candidates for organ transplantation who received planned HLA-typed blood. We report that blood donor-directed CTL activity increased substantially after a single transfusion mismatched with the recipient for two HLA-DR Ag (p less than 0.0001). A transfusion matched for one HLA-DR Ag did not enhance CTL activity. No correlation was found between CTL reactivity and sharing of HLA class I Ag. The present study supports our previous observation that matching for at least one HLA class II Ag (HLA-DR) between transfusion recipient and blood donor is required if immunization by blood transfusion is to be avoided. These data show that the presence or absence of "autologous" HLA-DR Ag on the leucocytes of the transfusion donor plays a decisive rol whether immunization or immune suppression will ensue.     

输血内涵质量评价机制的建立与应用

目的 建立输血内涵质量评价机制,提高临床科学合理用血水平。方法 制定系统的评价方案,确定专项的评价标准,成立评审专家团队,依托数字化病案管理系统平台,分季度有重点地开展输血内涵质量评价。结果 输血评价平均成绩2014年143分,2013年139分,t小于0.01,差异有统计学意义;输血评价缺陷数,手术、非手术科室2014年比2013年分别下降了37.8%和14%;2012—2014年输血比例和人均用血量逐年下降;2013-2014年24小时大量用血人数和用血量分别下降40.9%、37.3%;二次手术用血人数持平,用血量下降14.1%。结论 建立输血内涵质量评价机制,实现全过程输血质量监控,提高了临床合理用血水平,保护稀缺血源,保障临床用血安全。

     

Cost of allogeneic and autologous blood transfusion in Canada. Canadian Cost of Transfusion Study Group.

OBJECTIVE: To determine the cost, from a societal perspective, of blood transfusion in Canada. STUDY DESIGN: Cost-structure analysis. SETTING: Data were collected from eight hospitals and from six blood centres operated by the Canadian Red Cross Society in four provinces. OUTCOME MEASURES: Costs associated with four stages of transfusion-- collection, production, distribution and delivery--in 1933 were assessed. Costs were divided into the following categories; personnel, purchases, external services, overhead, donors'' time, patients'' time (for autologous transfusion), wastage and infection. RESULTS: The mean overall cost of a transfusion performed on an inpatient basis was $210 per unit of red blood cells for an allogeneic transfusion and $338 per unit of blood for an autologous transfusion. The mean cost of an allogeneic transfusion performed on an outpatient basis was $280 per unit of red blood cells. CONCLUSION: The costs determined in this study can be used in future studies comparing the cost-effectiveness of allogeneic transfusion with that of alternative methods.     

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。     

Whole blood transfusion in common marmosets: a clinical evaluation

In veterinary medicine, blood transfusion is commonly performed on companion animals. The common marmoset is a small nonhuman primate with increasing popularity as an animal model in biomedical research. Because of its small whole blood volume, the marmoset is at high risk of exsanguination, and blood transfusion is required to care for life-threatening bleeding. However, few clinical evaluations exist on transfusions for marmosets. This study performed whole blood transfusion with cross-matching on nine marmosets and surveyed the therapeutic effects. Recipients included clinical cases with persistent bleeding, anemia, and coma, as well as animals subjected to postoperative bleeding prophylaxis. Donors were selected from healthy marmosets, including littermates. Cross-match assay before transfusion were all negative, and recipients showed no visible signs of transfusion-related adverse reactions. Whole blood transfusions caused hemostasis and successful recovery in bleeding marmosets, including long-term improvement of anemia cases. Our results indicated that blood transfusion is effective for marmosets with severe anemia and persistent hemorrhage from both non-experimental and surgical causes. Furthermore, DNA sequencing for blood-group classification revealed that all subject marmosets were type A, suggesting that the risk of blood type mismatch may be low in this species.     

Risk of acquiring Creutzfeldt-Jakob disease from blood transfusions: systematic review of case-control studies

ObjectiveTo determine the strength of association between history of blood transfusion and development of Creutzfeldt-Jakob disease.ConclusionsCase-control studies do not suggest a risk of developing Creutzfeldt-Jakob disease from blood transfusion. Rather, a trend seems to exist towards a lower frequency of previous blood transfusion in patients with Creutzfeldt-Jakob disease than in controls. However, it is important to be aware of these studies'' methodological limitations—primarily the choice of control population and reliability of recall of transfusion status.     

血栓弹力图指导食管癌患者临床输血的价值及其与常规凝血实验检测指标的相关性分析

目的:探讨血栓弹力图(TEG)指导食管癌患者临床输血的价值及其与常规凝血实验检测指标的相关性。方法:选取2017年1月-2019年3月在我院收治的食管癌手术治疗需输血的99例患者作为研究对象,将99例患者随机分为常规凝血功能检测组和TEG组,常规凝血功能检测组采用常规凝血实验检查结果指导输血,TEG组采用TEG检查结果指导输血,对比两组输血前后的常规凝血实验检测指标以及临床用血量,对比TEG组输血前后的TEG指标,分析TEG指标与常规凝血实验检测指标的相关性。结果:两组患者输血前凝血四项和血小板计数(PLT)差异无统计学意义(P>0.05),输血后两组活化凝血酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)均有不同程度的改善(P<0.05),TEG组PT、TT较常规凝血功能检测组低(P<0.05);输血后,TEG组患者凝血反应时间(R值)、血凝块形成时间(K值)较输血前降低,最大血凝块强度(MA值)、凝血综合指数(CI值)升高,凝血形成速率(Angle角)增大,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,R值与APTT呈正相关(P<0.05),K值与PLT呈负相关,与FIB呈正相关(P<0.05),Angle角、MA值、CI值与FIB、PLT呈正相关(P<0.05);TEG组新鲜冰冻血浆、冷沉淀输注量少于常规凝血功能检测组,差异有统计学意义(P<0.05)。结论:TEG能更好地指导食管癌手术患者各种血液成分的合理输注,有效改善凝血异常情况,减少输血用量,TEG指标与常规凝血实验检测指标存在一定的相关性。     

All clinically-relevant blood components transmit prion disease following a single blood transfusion: a sheep model of vCJD

Variant CJD (vCJD) is an incurable, infectious human disease, likely arising from the consumption of BSE-contaminated meat products. Whilst the epidemic appears to be waning, there is much concern that vCJD infection may be perpetuated in humans by the transfusion of contaminated blood products. Since 2004, several cases of transfusion-associated vCJD transmission have been reported and linked to blood collected from pre-clinically affected donors. Using an animal model in which the disease manifested resembles that of humans affected with vCJD, we examined which blood components used in human medicine are likely to pose the greatest risk of transmitting vCJD via transfusion. We collected two full units of blood from BSE-infected donor animals during the pre-clinical phase of infection. Using methods employed by transfusion services we prepared red cell concentrates, plasma and platelets units (including leucoreduced equivalents). Following transfusion, we showed that all components contain sufficient levels of infectivity to cause disease following only a single transfusion and also that leucoreduction did not prevent disease transmission. These data suggest that all blood components are vectors for prion disease transmission, and highlight the importance of multiple control measures to minimise the risk of human to human transmission of vCJD by blood transfusion.     

THE ONGOING CHARITY OF ORGAN DONATION. CONTEMPORARY ENGLISH SUNNI FATWAS ON ORGAN DONATION AND BLOOD TRANSFUSION

Background: Empirical studies in Muslim communities on organ donation and blood transfusion show that Muslim counsellors play an important role in the decision process. Despite the emerging importance of online English Sunni fatwas, these fatwas on organ donation and blood transfusion have hardly been studied, thus creating a gap in our knowledge of contemporary Islamic views on the subject. Method: We analysed 70 English Sunni e‐fatwas and subjected them to an in‐depth text analysis in order to reveal the key concepts in the Islamic ethical framework regarding organ donation and blood transfusion. Results: All 70 fatwas allow for organ donation and blood transfusion. Autotransplantation is no problem at all if done for medical reasons. Allotransplantation, both from a living and a dead donor, appears to be possible though only in quite restricted ways. Xenotransplantation is less often mentioned but can be allowed in case of necessity. Transplantation in general is seen as an ongoing form of charity. Nearly half of the fatwas allowing blood transfusion do so without mentioning any restriction or problem whatsoever. The other half of the fatwas on transfusion contain the same conditional approval as found in the arguments pro organ transplantation. Conclusion: Our findings are very much in line with the international literature on the subject. We found two new elements: debates on the definition of the moment of death are hardly mentioned in the English Sunni fatwas and organ donation and blood transfusion are presented as an ongoing form of charity.     

Iron overload following red blood cell transfusion and its impact on disease severity

Transfusion of red blood cells can be a life-saving therapy both for patients with chronic anemias and for those who are critically ill with acute blood loss. However, transfusion has been associated with significant morbidity. Chronic transfusion results in accumulation of excess iron that surpasses the binding capacity of the major iron transport protein, transferrin. The resulting non-transferrin bound iron (NTBI) can catalyze the production of highly reactive oxygen species (ROS) leading to significant and wide spread injury to the liver, heart, and endocrine organs as well as increases in infection. Acute transfusion of red blood cells in critically ill patients likewise has significant effects including increased mortality, prolonged hospital stays, and elevated risk of nosocomial infection. These effects appear to be more profound with increasing age of stored blood. The progressive release of free iron associated with storage time suggests that morbidity following acute transfusion, like that seen in chronic transfusion, may be due in part to elevated levels of NTBI. It is clear that transfusion is necessary in many instances; however, its risks and benefits must be carefully balanced before proceeding to avoid unnecessary iron toxicity.     

自体CIK细胞联合化疗治疗老年急性白血病的临床疗效评估

目的:探讨自体细胞因子诱导杀伤(CIK)细胞联合化疗方案治疗老年急性白血病的临床疗效。方法:采集6例在我院进行化疗治疗的老年急性白血病患者的静脉血制备自体CIK细胞,成熟后回输入体内,持续注射10天为一个疗程。观察培养前和培养13天后白细胞各亚型细胞所占百分比,并比较CIK细胞回输前后患者白细胞亚群、感染次数及输血量的变化。结果:培养后CD3~+、CD8~+、CD3~+CD8~+、CD3~+CD56~+亚型细胞百分比均显著高于培养前(P0.05),CIK细胞回输后患者体内CD3~+、CD3~+CD8~+、CD3~+CD56~+亚群细胞百分比显著高于回输前(P0.05);CIK细胞回输后,患者感染次数和持续时间均显著少于回输前(P0.05),疾病稳定期输血量显著低于回输前(P0.05),疾病进展期输血量与回输前差异无显著性意义(P0.05)。结论:自体CIK细胞联合化疗治疗老年急性白血病患者有效且安全,可维持病情的稳定、提高机体细胞免疫功能和抗感染能力,值得临床推广。