全血及成分血制备与发血融浆时血袋破损情况及原因分析

Analysis of blood bag damage and its causes during blood component preparation and freezing-thawing

目的了解成分血制备与发血融浆时血袋破损情况及其原因。方法收集2011年6月-2018年5月解放军桂林血站采集的34 581袋全血的信息资料,使用Excel 2003和SPSS13.0软件分析比较成分血制备与发血融浆时发生的血袋破损情况及原因;采取热合改良法与热合机性能监测等细节管理予以改进。结果本组血袋破损率为0.14%(108/78 789),排在前3位的破袋原因:离心后热合口渗漏、离心后血袋底部渗漏与冰冻成分血融解后血袋渗漏,破损比例分别为36.11%(39/108)、18.52%(20/108)与32.41%(35/108);制备冰冻血浆产生的血袋破损占73.15%(79/108),其中离心时热合口裂占46.84%(37/79),融浆后折叠处裂占15.19%(12/79),融浆后血袋破裂占20.25%(16/79),冰冻血浆搬运过程破损占17.72%(14/79)。制备及融化冷沉淀产生的血袋破损占7.4%(8/108),其中融化产生的血袋破损占87.5%(7/8)。除了运输破损为人为突发情况外,2016年以后冰冻成分血融解后破袋率与离心后热合口渗漏明显改善(P<0.05)。结论成分血制备过程中,保障设备能力、规范作业、方法得当与妥善管理可有效降低成分血制备与发血融浆时血袋破损。

Objective To understand the blood bag damage and its causes during blood component preparation and freezing-thawing.Methods The data of 34 581 bags of whole blood collected from the Guilin Blood Station of the People’s Liberation Army from June 2011 to May 2018 were collected. The statistical analysis of the blood bag damage during blood preparation and freezing-thawing was compared using Excel 2003 and SPSS 13.0 software. Damage situation and cause;improve the details management such as heat sealing improvement method and heat sealing machine performance monitoring.Some methods such as heat sealing improvement and performance monitoring of heat sealing machine were adopted to improve the management.Results The blood bag breakage rate in this group was 0.14%(108/78 789). The top three causes of bag breakage was the leakage of heat sealing after centrifugation[36.11%(39/108)], the leakage at the bottom of blood bag after centrifugation[18.52%(20/108)] and the blood bag leakage after freezing-thawing[32.41%(35/108)]. The blood bag damage during the preparation of frozen plasma accounted for 73.15%(79/108), including the heat sealing cracked during centrifugation[46.84%(37/79)], folds cracked after thawing[15.19%,12/79],blood bag ruptured afte thawing[20.25%,16/79],damage of frozen plasma bag during shipping[17.72%(14/79)].The blood bag damage during preparation and freezing-thawing of cryoprecipitate accounted for 7.4%(8/108), most of which occured during thawing[ 87.5%(7/8)].In addition to the 14 bags of plasma damaged during shipping, the breakage rate of frozen components occurred after thawing and centrifugation significantly decreased since 2016(P<0.05).Conclusion Optimized capacity of equipments, standardized operation and proper management can significantly reduce blood bag breakage during the preparation and freezing-thawing of blood components.