免疫性输血反应的预防策略与建立临床输血预警体系探讨

发布时间：2018-12-17 13:37

【摘要】：目的探讨免疫性输血反应的预防策略,建立本地区临床输血预警体系,促进临床输血治疗的安全有效。方法 7 227例申请输注红细胞和血小板治疗的患者样本,应用微柱凝胶抗球蛋白法、凝聚胺法和固相凝集法等新技术,进行输血前免疫性抗体检测;选择急性白血病诱导化疗后完全缓解、同时微小残留病(minimal residual disease MRD)阴性的33例患者,根据与患者沟通情况,分为研究组(18例)和对照组(15例)。研究组患者在其化疗间歇期骨髓造血恢复时进行自体血小板的采集,24 h内加入5%二甲基亚砜(DMSO)于-80℃冰冻保存备用;当患者Plt10×10~9/L或有出血症状时,2组患者分别输注解冻后自体血小板和异体新鲜血小板。通过血小板计数、CCI值和TEG凝血指标,评价自体冰冻血小板质量和临床输注效果。结果 7 227份患者样本中,共检出免疫性抗体37例,其中红细胞血型抗体23例,血小板相关抗体14例,阳性率0.51%(37/7227);男14例,女23例,女性患者的阳性率明显高于男性(P0.05);23例红细胞血型抗体以Rh系统为主,占43.48%(10/23);MN系统次之,占17.39%(4/23)。免疫性抗体的临床分布以反复输血的血液肿瘤患者为主,占78.38%(29/37)。纳入统计资料的16例研究组患者,共采集自体血小板24次,采集血小板总量为154.18×10~11个,分装成66个治疗量的血小板进行冰冻保存。每治疗量自体血小板冰冻保存前后血小板含量分别为(2.36±0.23)×10~11个和(1.94±0.17)×10~11个(P0.01);血小板聚集功能分别为(70.38±4.98)mm和(77±5.41)mm(P0.01);研究组输注自体冰冻血小板53例次,对照组输注异体新鲜血小板55例次,输注血小板24 h后CCI值,分别为(11.25±6.45)×10~9/L和(10.49±5.72)×10~9/L,总有效率为81.13%(43/53)和83.63%(46/55),两者比较差异无统计学意义(P0.05)。结论免疫性抗体的检测和自体输血技术可以提高输血疗效,预防免疫性输血反应的发生;建立临床输血预警体系,对输血关键环节监控,可以保障临床输血安全有效。
[Abstract]:Objective to explore the preventive strategy of immune transfusion reaction and to establish a clinical blood transfusion warning system in order to promote the safety and effectiveness of clinical transfusion therapy. Methods A total of 7,227 patients who applied for erythrocyte and platelet transfusion were examined by microcolumn gel anti-globulin method, polyacrylamide method and solid phase agglutination method. Thirty-three patients with complete remission after induction chemotherapy were divided into study group (n = 18) and control group (n = 15) according to their communication with patients. Patients in the study group underwent autologous platelet collection during bone marrow hematopoietic recovery during intermittent chemotherapy, and 5% dimethyl sulfoxide (DMSO) was added to cryopreservation at -80 鈩，

本文编号：2384267