特殊情况紧急抢救输血的回顾性分析

Retrospective analysis on blood transfusions under special urgent circumstances

目的观察交叉配血试验不合或/和抗体筛查阳性时紧急抢救输血推荐方案的临床应用及效果分析。方法对输血前交叉配血试验不合或/和抗体筛查阳性且生命危急的患者,启动《推荐方案》中输血方案进行抢救,密切观察患者输血过程中有无输血不良反应发生,比较输血前与输血后1 d、7 d,Hb、Hct、TBIL、DBIL、IBIL的变化,对应用紧急输血方案临床疗效进行评价。结果 10例交叉配血试验不合和抗体筛查阳性患者需抢救输血,男性3例,女性7例,均为Rh(D)阳性患者;其中3名患者输注同型交叉配血阴性供者红细胞;4名患者输注非同型[均为O型Rh(D)阳性]且交叉配血试验阴性的供者红细胞;还有3名患者未筛选出交叉配血试验阴性的血源,为抢救生命应急选择与患者同型且交叉配血试验凝集程度最弱(±或1+)的供者红细胞输注;10名患者中3名非同型输注AB型血浆;10例患者输注后,血红蛋白、红细胞压积明显提高,均无溶血及其它输血不良反应发生。结论交叉配血试验不合或/和抗体筛查阳性患者紧急抢救输血选择与患者ABO血型同型且交叉配血试验阴性的供者红细胞输注、选择O型且交叉配血试验阴性的供者红细胞输注及直接选择AB型血浆输注是安全有效的,应当推广。

Objective To observe the application of emergency rescue in patients recommended blood transfusion or whose antibody screening was positive and to analyze its effect in mismatched cases. Methods The patients who experienced mismatch or were positive for antibody screening under emergency circumstances were resuscitated with blood transfusion.Patients were closely observed for blood transfusion adverse reactions that occurred during blood transfusion. The changes in Hb,HCT,TBIL,DBIL and IBIL before transfusion and after 1 d and 7 d were compared. The clinical curative effect of blood transfusion was evaluated. Results Among ten cases of mismatched cases whose antibody screening was positive in patients that needed emergency blood transfusion,three cases were male,seven cases were females. All were Rh（ D） positive. Among the cases,3 were infused with the same blood type and experienced no crossmatch incompatibility,4 received infusion of blood type O Rh（ D） positive and experienced no mismatch,and 3 were infused with the same blood type,but experienced mismatch（ ± or 1 ＋）. Three patients were infused with different blood type（ AB Rh（ D） positive） plasma.After transfusion,ten patients demonstrated a significant increase in hemoglobin and hematocrit level. No hemolysis and oth-er adverse transfusion reactions were observed. Conclusion Mismatch or positive antibody were characteristic of patients who need emergency transfusion. Infusion of the same type or different type with correct crossmatch and infusion of AB Rh（ D） positive plasma is safe and effective. This application should be further promoted.