妊娠晚期3种自体血贮存方法对红细胞凝集状态的影响

Comparison of three different methods for autologous blood storage in late pregnant women

目的通过对红细胞凝集状态作镜下直观比较,探究妊娠晚期3种自体血贮存方案的优劣,为临床更好的开展贮存式自体输血提供依据。方法选择2011年1月至2014年6月有自体输血指征的106例孕妇,按照贮存方案不同,将自体血分成标准抗凝组(30例)、扩大抗凝组(25例)、自体成分组(51例),采用并行留样,于10×50倍镜下观察红细胞聚集状态,观察时间点设为:24h,第7、14、21天。每组每个时间点观察200个红细胞,并计数其中游离红细胞的数目。结果标准抗凝组:保存至第3天红细胞就出现线串样凝集,游离红细胞数目急剧下降;扩大抗凝组:保存至第7天红细胞发生线串样凝集,第14天时游离红细胞数量急剧地下降;自体成分组:24h至第21天,不同时间点几乎所有红细胞均呈游离状态。结论在妊娠晚期行自体贮血,标准比例抗凝方案已经不可取;扩大抗凝方案可以延缓血液凝集,但血液保存超过7d,不推荐临床使用;而对自体血进行成分分离后保存,可以长时间保持红细胞的游离状态,是一种值得推广的新方案。

Objective To compare three different methods for autologous blood storage in late pregnant women. Methods One hundred and six pregnant women with indications of autotransfusion from January 2011 to June 2014 were enrolled. The autologous blood samples were collected and stored using three different methods： standard anticoagulation, extended anticoagulation and autologous components. The aggregation degree of red cells was observed under microscope （10 × 50） after 24h, 7, 14 and 21d of storage. Two hundred red cells of each group were observed and the number of free red cells was counted. Results The red blood cells in standard anticoagulation group began rouleau-like agglutination at d3 and the number of free red cells decreased dramatically; the red blood cells in extended anticoagulation began rouleau-like agglutination at d7 and the number of free red cells decreased dramatically at d3; while in autologous components group, nearly all red cells were free from 24h to 21d after storage. Conclusion The separation of the blood component is the best method for storage of autologous blood in late pregnancy.