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Plt〈10×10^9/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（P〈0.05）;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（P〈0.01）;血小板聚集功能分别为（70.38±4.98）mm和（77±5.41）mm（P〈0.01）;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（P〉0.05）。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。
Objective To investigate on the strategies to prevent transfusion reactions, to establish a hemovigilance sys- tem of clinical transfusion in Weihai and to promote safe and effective clinical transfusion therapy. Methods Microcolumn gel method, polybrene and solid agglutination were used for screening in 7 227 cases of patients in order to test autoimmune antibody before transfusion. Among these cases, 33 cases of patients with complete remission after chemotherapy were divided into a study group （ 18 cases） and a control group （ 15 cases）. Autologous platelets were collected from the patients of the study group who received an intermittent chemotherapy. Their platelets were added 5% DMSO and were stored at -80℃. When platelet count dropped below 10 × 10^9/L or when symptoms of bleeding occurred, patients were tran. sfused with the autologous platelets. While in the control group, they were transfused with allogeneic fresh platelets. The quality of autologous cryopreserved platelets were analyzed through platelet count, corrected count increment （CCI） and Thrombelastography （TEG） coagulation. Results We detected 37 cases of autoimmune antibodies in 7 227 cases of patient samples, including 23 cases of RBC blood group antibodies and 14 cases of platelet antibodies, at a positive rate of 0. 51%. Among the 37 cases, 14 were males, 23 were females. The positive rate of female patients was significantly higher than men （P 〈 0. 05）. 23 cases of RBC blood group antibodies were mainly Rh system based, accounting for 43.48%, followed by MN system, accounting for 17.39%. The clinical distribution of autoimmune antibodies in the blood of cancer patients were patients who have received repeated blood transfusions in the past, accounting for 78. 38%. In 16 cases of hematological patients, autolo- gons platelets were collected 24 times, whose count were 154. 18 × 10^11 and packed into 66 therapeutic doses of cryopreserved platelets. The number of autologous cryopreserved platelets were （2. 36 ±0. 23） × 10^11 and （ 1.94 ±0. 17） × 10^11 before and after thawing （ P 〈 0. 01 ）. The platelet aggregation studies were （70. 38 ± 4. 98） mm and （77 ± 5.41 ） mm （ P 〈 0. 01 ）, respectively. There was no significant difference in the 24 h CCI and the total effective rates among the 53 cases of autologous cryopreserved platelets and 55 cases of allogeneic fresh platelets. The 24 h CCI of the two group were （ 11.25 ± 6.45） × 10^9/L and （ 10. 49 ± 5. 72） × 10^9/L. The total effective rate were 81.13 % and 83.63 %, respectively （P 〉 0. 05 ）. Conclusion The detection of autoimmune antibodies and autotransfusion technology can improve the efficacy of blood transfusion and prevent possible transfusion reactions. The establishment of a hemovigilance system of clinical transfusion will guarantee the safety and efficacy of clinical transfusion.
作者
宋雪珍
宋雪梅
任小宁
王毅力
辛晓文
王明静
王国礼
SONG Xuezhen SONG Xuemei REN Xiaoning WANG Yili XIN Xiaowen WANG Mingjing WANG Guoli(Weihai Municipal Hospital of Dalian Medical University, Weihai 264200, China Weihai Blood Center.)
出处
《中国输血杂志》
CAS
北大核心
2016年第8期816-819,共4页
Chinese Journal of Blood Transfusion
基金
威海市科学技术发展计划项目(2015GNS049)
关键词
免疫性抗体
输血反应
冰冻血小板
自体输血
输血预警
autoimmune antibodies
transfusion reaction
cryopreserved platelets
autologous blood transfusion
hemovigilance system
