血液白细胞滤除方法及其临床应用效果比较

Comparative Study of the Methods and Clinical Effects of Preparation of Blood with the Removal of Leukocytes

【目的】探讨去白细胞血液制备最佳工艺方法和临床应用效果。【方法】应用五种全血过滤方法，即无菌导管连接法（A法）；贮存后过滤法（B法）；采用血袋和滤器一体四联袋采血后6h直接过滤法（C法）；采用血袋和滤器一体四联袋采血后24～72h直接过滤法（D法）；采用血袋和滤器一体四联袋采血后96h直接过滤法（E法）。对过滤前后的血液进行血细胞计数、游离血红蛋白含量、红细胞膜脆性实验、白细胞介素2（IL-2）等质量检测，同时计算去白细胞血液红细胞回收率、白细胞去除率。比较不同方法制备的去白细胞血液经临床输注后红细胞输注效果及非溶血性发热性输血反应（febrilenonhemolytictransfusionreactions，FNHTR）。【结果】采用不同的过滤方法制备的血液产品质量不同，B法与C法制备血液临床输注后FNHTR和红细胞输注效果都有统计学意义（P〈0．05）。B法和E法两种方法与A法、C法、D法三种方法比较去白细胞血液红细胞脆性和游离血红蛋白FHb有统计学意义（P〈0．05），同时前两种方法制备血液保存期末IL-2与其它方法也有差异（P〈0．01）。C法制备的去白细胞血液质量及制备工艺整体优于其它方法，而且能够减少临床FNHTR和红细胞输注无效。【结论】采用联袋采集血液后6h内进行血液白细胞过滤，能够提高临床输血整体疗效，减少红细胞输注无效及FNHTR。

[Objective]To explore the best method and clinical effect of preparation of blood with the removal of leukocytes. [Methods] The whole blood was filtrated respectively by five methods including the connection of sterile catheter （Method A）, the filtration after storage （Method B）, direct filtration using connected bag in 6h （Method C）, direct filtration using connected bag in 6h and 24~72 h （Method D） and direct filtration using connected bag in 96h （Method E）. After filtration, the parameters such as complete blood count, content of free hemoglobin, osmotic fragility of erythrocyte membrane and interleukin-2 （IL-2） were detected. At the same time, the recovery rate of erythrocyte and removal rate of leukocyte were calculated. In addition, the febrile nonhemolytic transfusion reactions （FNHTR） and the effect of erythrocyte transfusion after blood infusion were compared among different methods of the removal of leukocytes. [Results] Different quality of blood products were prepared by different filtrating methods. There was a statistically significant difference in FNHTR and the effect of erythrocyte transfusion between Method B and Method C（ P〈0.05）. There was statistical significance in fragility of erythrocyte and free hemoglobin between Method B, E and Method A, C, D. As the end of preservation, IL-2 also had statistical difference between Method B, E and the others（ P〈 0.01）. The quality of leukocyte depleted blood prepared by Method C was better than other methods. And Method C could decrease the incidence of clinical FNHTR and ineffective erythrocyte transfusion. [Conclusion]Whole blood leukocyte directly filtrated by using connected bag in 6h can improve the clinical effect of blood infusion and decrease the incidence of FNHTR and ineffective erythrocyte transfusion.