某市三甲医院398例输血不良反应回顾性分析

Retrospective Analysis on 398 Cases with Adverse Transfusion Reactions in a Third Class Grade A Hospital of a City

目的通过分析输血不良反应的发生情况,为预防输血不良反应的发生提供理论依据。方法回顾性收集整理2015年1月—2020年3月期间65048份输血治疗病历以及期间上报输血科的398份输血不良反应回报单,按照输血不良反应类型、血液成分、患者类别进行分类统计分析,了解输血不良反应的分布情况,以及探讨输血不良反应的影响因素。结果65048例输血治疗病例中有398例出现输血不良反应,不良反应发生率为0.61%,其中过敏反应(ATR)有278例(占69.85%),非溶血性发热性输血反应(FNHTR)有107例(占26.88%),剩下的13例为不确定反应类型(占3.27%)。各类血液成分的不良反应发生率为血小板(1.48%)、血浆(0.91%)、冷沉淀(0.48%)、红细胞(0.32%),差异有统计学意义(χ^(2)=194.298,P<0.05),血小板的不良反应发生率最高。悬浮红细胞的FNHTR发生率(0.39%)高于去白悬浮红细胞(0.18%),差异有统计学意义(χ^(2)=5.554,P<0.05)。单采去白血小板与混合浓缩血小板的不良反应发生率分别为1.46%、1.85%,差异无统计学意义(χ^(2)=0.597,P>0.05)。女性受血者的不良反应发生率(0.70%)高于男性受血者(0.55%),差异有统计学意义(χ^(2)=5.367,P<0.05)。既往有输血史的受血者的不良反应发生率(0.66%)高于既往无输血史的受血者(0.53%),差异有统计学意义(χ^(2)=4.557,P<0.05)。年龄<14岁、14~60岁、>60岁这3个年龄组的不良反应发生率分别为0.55%、0.81%、0.35%,差异有统计学意义(χ^(2)=47.869,P<0.05),14~60岁年龄组的不良反应发生率最高。结论应提升临床对输血不良反应的鉴别诊断能力,重点关注女性、年龄14~60岁、既往有输血史、需反复输注血小板的受血者输血前后生命指征的变化,提倡科学合理用血,积极开展自体输血等新技术。

Objective To provide theoretical basis for the prevention of adverse transfusion reactions by analyzing the occurrence of adverse transfusion reactions.Methods A retrospective collection of 65048 medical records of blood transfusion treatment and 398 return sheets of adverse blood transfusion reactions reported to the Department of Blood Transfusion from January 2015 to March 2020 during the period were collected and sorted out,and classified and analyzed according to the types of adverse transfusion reactions,blood components and patient categories,so as to understand the distribution of adverse reactions of blood transfusion and explore the influencing factors of adverse reactions of blood transfusion.Results Among the 65048 cases treated with blood transfusion,398 cases had adverse reactions(0.61%),of which 278 cases(69.85%)had allergic transfusion reaction(ATR),107 cases(26.88%)had febrile non-haemolytic transfusion reaction(FNHTR),and the remaining 13 cases had uncertain reaction types(3.27%).The incidence of adverse reactions of various blood components were platelet(1.48%),plasma(0.91%),cryoprecipitate(0.48%)and red blood cells(0.32%),and the difference was statistically significant(χ^(2)=194.298,P<0.05).Among them,the incidence of adverse reactions of platelet was the highest.The incidence of FNHTR in suspension red blood cells(0.39%)was higher than that in leukocytes-depleted suspension red blood cells(0.18%),and the difference was statistically significant(χ^(2)=5.554,P<0.05).The incidence of adverse reactions of aphaeresis platelets and mixed platelet concentration were 1.46%and 1.85%respectively,and there was no statistically significant difference(χ^(2)=0.597,P>0.05).The incidence of adverse reactions in female blood recipients(0.70%)was higher than that in male blood recipients(0.55%),and the difference was statistically significant(χ^(2)=5.367,P<0.05).The incidence of adverse reactions in patients with blood transfusion history(0.66%)was higher than that in patients without blood transfusion history(0.53%),and the difference was statistically significant(χ^(2)=4.557,P<0.05).The incidence of adverse reactions in the age groups<14 years old,14-60 years old,>60 years old were 0.55%,0.81%and 0.35%respectively,and the difference was statistically significant(χ^(2)=47.869,P<0.05).The incidence of adverse reactions in the age group of 14-60 years old was the highest.Conclusion It is necessary to improve the ability of differential diagnosis of adverse reactions of blood transfusion,focus on the changes of vital signs before and after blood transfusion of female recipients aged 14-60 years,who have a history of blood transfusion and need repeated platelet transfusion,advocate scientific and rational use of blood,and actively develop new techniques such as autologous blood transfusion.