二次血型制配合输血管理系统阻止不相容血液发放的研究

Research on two specimens policy with blood transfusion management system in prevention incompatible blood

目的 探讨2次血型制配合输血管理系统阻止不相容血液发放的作用及意义.方法 选取2011年3月至2014年6月于遂宁市中心医院门诊与住院的全部患者血液样本120 962份,以及待发放的悬浮红细胞血袋24 963袋作为研究对象.本研究纳入标准：无破损、漏液,肉眼观察无异常;排除标准：污染.本研究遵循的程序符合遂宁市中心医院人体试验委员会所制定的伦理学标准,得到该委员会批准.对申请输血及手术备血的患者血液样本的血型鉴定采用2次血型制,分别为初次血型鉴定与再次血型鉴定.同时,对血袋进行血型鉴定及不规则抗体筛查;全部数据输入输血管理系统存档,输血管理系统自动对录入的患者血液样本2次血型信息进行比对;并对血袋血型鉴定结果与血袋血型标签进行比对.患者血液样本2次血型鉴定结果一致,且不规则抗体筛查结果呈阴性,同时血袋血型对比结果一致,方可发放血液;否则输血管理系统会阻止血液发放,并发出警告.对患者血液样本血型鉴定错误率与血袋血型鉴定错误率进行统计与校正.患者血液样本2次血型鉴定不一致者再次采集样本检测,区分初次样本错误与再次样本错误.并统计输血安全风险.对血袋血型鉴定不一致者,进行溯源并更正.结果 ①本研究纳入患者血液样本中,初次血型鉴定样本数为93 647份,再次血型鉴定样本数为27 315份.根据初次血型鉴定结果,计算血型鉴定错误率的校正因子为1.39.再次血型鉴定样本与初次血型鉴定结果不一致者为19份,血型鉴定错误率为0.070％,校正后错误率为0.097％.同时,鉴定血袋血型24 963袋,与血袋血型标签不一致者为2袋,血袋血型鉴定错误率为0.008％.②患者血液样本中,再次血型鉴定样本与初次血型鉴定结果不一致的19份血液样本中,初次血样错误为12份,再次血样错误为7份.在12份初次血型鉴定错误的血样中,如果根据这些血液样本的血型鉴定结果发放血液,其中3份可导致急性溶血性输血反应,存在输血安全风险（25％,3/12）.采用2次血型制,每年可避免约1次血型不相容输血.血袋因采、供血机构已进行多次血型检测、复核,其安全风险无法用具体数据评估.结论 2次血型检测制配合输血管理系统能防止不相容血液的发放,大幅减低输血安全风险.

Objective To investigate the role and significance of two specimens policy cooperated with blood transfusion management system in the prevention of incompatible blood.Methods From March 2011 to June 2014,a total of 120 962 blood samples from outpatients and inpatients in Suining Central Hospital and 24 963 blood bags （suspended red blood cells） were collected into this study,as research objects.Inclusion criteria：no damage and leakage,no exception to the naked eye;Exclusion criteria：pollution.The study protocol was approved by the Ethical Review Board of Investigation in Human at Suining Central Hospital.Patients＇ blood samples were carried out twice independent blood group appraisals,respectively,as the initial blood grouping and second blood grouping.At the same time,the blood group appraisal and the irregular antibody screening of the blood bags were carried out.All data input into the blood transfusion management system,and the blood transfusion management system automatically compared these entry data.If twice blood group appraisal results were consistent,and irregular antibody screening results were negative,the blood can be extended.Otherwise,blood transfusion management system could prevent to extend blood,and issue a warning.Twice blood grouping error rates were computed and corrected.Blood samples of which twice blood group appraisals cannot match were tested again,to distinguish between initial sample error and second sample error.Blood transfusion safety risks were computed.Blood bags of which blood group appraisals weren＇t consistent with their labels must be corrected.Results ① Among the patients＇ blood samples,the initial blood grouping samples were 93 647 cases,and second blood grouping samples were 27 315 cases.According to the results of the initial blood grouping,the twice blood grouping error correction factor was 1.39.And 19 cases of second blood grouping were not consistent with the result of initial ones.Twice blood grouping error rate was 0.070%,and the error rate after correction was 0.097%.At the same time,24 963 cases of blood bags＇ grouping were carried out.Blood grouping results showed that 2 cases were not consistent with blood bags group label,and the blood grouping error rate of blood bags was 0.008%.（） Among 19 cases of blood samples of which the result of second blood grouping were not consistent with the initial blood grouping,initial blood sample errors were 12 cases,and second blood sample errors were 7 cases.Among the 12 cases of initial blood grouping error samples,if the blood were extended according to the results of initial blood typing results,3 cases could lead to acute hemolytic transfusion reaction.There was a blood transfusion safety risk （25%,3/12）.Adapting two specimens policy could avoid about 1 case of incompatible blood transfusion every year.As blood bags tested and checked for blood group by blood supply institutions many times,its transfusion safety risk couldn＇t be represented by data.Conclusion A separate two specimens policy cooperated with blood transfusion management system can prevent incompatible blood transfusion and reduce the safety risk of blood transfusion.