过滤有凝块献血者血液的质量探讨

Discussion on the quality of filtering blood from blood donors with clots

目的探讨过滤前、后有凝块献血者血液的质量变化。方法选取采血不畅血液,经白细胞过滤血袋过滤后,通过透明塑料直尺测量凝块大小并计算比例;检测并分析过滤前、后悬浮红细胞和冰冻血浆常规检测指标变化。结果2019年3-12月共采集血液39831袋,发现采血不畅230袋,发生率为0.58%,过滤后肉眼可见血液凝块与纤维蛋白析出共30袋,占13.04%;过滤前和过滤后悬浮红细胞容量无明显变化。过滤后发现血液凝块<20 mm的悬浮红细胞质量检测数据均符合要求,血液凝块≥20 mm的悬浮红细胞血细胞比容(Hct)不符合质量标准。过滤前血液凝块<20 mm与≥20 mm的悬浮红细胞Hct比较,过滤后血液凝块<20 mm与≥20 mm的悬浮红细胞Hct比较,过滤前血液凝块<20 mm与≥20 mm的悬浮红细胞Hb比较,过滤后血液凝块<20 mm与≥20 mm的悬浮红细胞Hb比较,差异均有统计学意义(t=8.384、7.410、6.573、5.987,P<0.05)。过滤后血液凝块≥20 mm的悬浮红细胞经检测质量合格率为43.3%;血液凝块<20 mm悬浮红细胞贮存0~28 d过滤前和过滤后溶血率比较,差异无统计学意义(P>0.05);贮存35 d悬浮红细胞过滤前和过滤后溶血率比较,差异有统计学意义(P<0.05),但均在国家标准规定的范围内。检测30袋发现血液凝块和纤维蛋白析出后的冰冻血浆,其中25袋检测合格,另外5袋为纤维蛋白析出血浆,血浆总蛋白为(46.62±2.93)g/L,均不合格,血浆纤维蛋白原为(181.00±21.63)mg/dL,与正常血浆结果比较略低。使用显微镜镜检发现过滤前个别悬浮红细胞标本出现明显红细胞聚集,过滤后没有发现明显红细胞聚集,且过滤后悬浮红细胞细菌培养结果均无细菌生长。结论血液凝块≥20 mm的悬浮红细胞质量不合格,可以直接报废,血液凝块<20 mm的悬浮红细胞质量合格,纤维蛋白析出的冰冻血浆质量不合格,可以直接报废。血液采集时,应避免血管异常献血者献血,减少血液凝块产生。

Objective To explore the change of blood quality of blood with clots before and after filtering.Methods After filtering by white blood cell filter bag,the clot size was measured by transparent plastic ruler and the proportion was calculated,the routine test indexes of suspended red blood cells and ordinary frozen plasma before and after filtrating were detected and analyzed.Results From March to December 2019,a total of 39831 bags of blood were collected,230 bags of blood were found to be poor which had clots and fibrin,with an incidence of 0.58%.After filtrating,30 bags blood with clots and fibrin could be seen with naked eyes,accounting for 13.04%.There was no significant change on the capacity of suspended red blood cells before and after filtrating.After filtrating,it was found that the quality test data of suspension red blood cells with clot<20 mm met the requirements,and the Hct of suspension red blood cells with clot≥20 mm did not meet the quality standard.There were significant differences on Hct of suspension red blood cells before filtration between clot<20 mm and clot≥20 mm,the Hct of suspension red blood cells after filtration between clot<20 mm and clot≥20 mm,the Hb before filtrating between clot<20 mm and clot≥20 mm,the Hb after filtrating between clot<20 mm and clot≥20 mm(t=8.384,7.410,6.573,5.987,P<0.05).The qualified rate of the filtered suspension red blood cells was 43.3%.There was no significant difference on the hemolysis rate of the suspension red blood cells which clot was<20 mm for storage 0-28 days(P>0.05),but there was significant difference on the hemolysis rate of storage 35 days(P<0.05),but all of these were within the range of the national standard.A total of 30 bags of frozen plasma after filtrating were found clot and fibrin separation,25 bags of frozen plasma were all qualified,the other 5 bags with fibrin separation,which total plasma protein[(46.62±2.93)g/L]were unqualified,the plasma fibrinogen[(181.00±21.63)mg/dL]were slightly lower than that of normal plasma.It was found that there was obvious aggregation of red blood cells before filtrating,but no obvious aggregation after filtrating,and there was no bacterial growth after filtrating.Conclusion If the suspended red clot is≥20 mm,it could be scrapped directly.If the suspended red clot is<20 mm,it could be qualified.The quality of ordinary frozen plasma separated from fibrin is unqualified and could be directly discarded.During blood collection,blood donation from donors with abnormal vascular conditions should be avoided to reducing the production of blood clots.