适宜于地级市的RhD阴性血液采供模式探讨——以山东聊城为例

Discussion on the collection and supply mode of RhD negative blood suitable for prefecture-level city:a retrospective analysis

目的探索适合本地区(地级市)的RhD阴性血液采集供应模式,提高阴性患者用血需求满足率。方法在不同采集供应模式下(采集模式:2020年不提倡RhD阴性重复献血者随机献血,2021、2022年反之;供应模式:2020年A、B、O和AB型冷藏保存红细胞均不保留库存,采血6 d内制备成冰冻红细胞;2021、2022年分别保存2~6 U库存,剩余部分于采血6 d内制备成冰冻红细胞),分别依据ABO血型、是否预约、是否初次献血、储存温度将RhD阴性血液分组:A、B、O和AB型组,预约献血和随机献血组,初次献血和重复献血组,冷藏保存红细胞、冰冻红细胞和冰冻解冻去甘油红细胞组,统计出各组2020—2022年的采集供应数据并进行比对分析。依据RhD阴性患者的用血需求是否得到满足,把患者分为去外地就医组、输RhD阳性血液组和输RhD阴性血液组,统计用血情况。结果2020—2022年,重复预约献血者捐献的RhD阴性血液占比逐年降低(P<0.05);重复随机献血者捐献的RhD阴性血液占比逐年升高(P<0.05);冰冻解冻去甘油红细胞供应量占当年RhD阴性红细胞供应量的比例逐年升高(P<0.05);按RhD阴性发放的冷藏保存红细胞供应量占当年RhD阴性红细胞供应量的比例逐年下降(P<0.05);按RhD阳性发放的冷藏保存红细胞供应量占当年RhD阴性红细胞供应量的比例逐年下降(P<0.05);冰冻红细胞库存增加量占当年冰冻红细胞库存量的比例逐年降低(P<0.05)。RhD阴性患者用血需求满足率逐年增高(P<0.05),输RhD阳性血液人数逐年减少(P<0.05),去外地就医人数逐年减少(P<0.05)。结论在聊城地区,适当提倡RhD阴性献血者随机献血,A、B、O和AB型冷藏保存红细胞分别保持2~6 U库存,当高于库存量时,6 d内再制备成冰冻红细胞,既可以提高阴性患者用血需求满足率,也不会造成过多的RhD阴性红细胞按阳性发往临床。

Objective To explore a RhD negative blood collection and supply mode suitable for Liaocheng area and improve the blood demand satisfaction rate of RhD negative patients.Methods Under different collection and supply modes(collection mode:in 2020,not advocate walk-in donation by RhD negative repeat blood donors,but in 2021 and 2022 were the opposite;supply mode:in 2020,type A,B,O and AB RBCs were frozen within 6 days of blood collection without inventory,but in 2021 and 2022,they were stored of 2-6 U and the remaining were frozen within 6 days of blood collection),RhD negative blood was divided into Type A,B,O and AB,appointment donation and walk-in donation,first donation and repeat donation,cold storage red blood cells(RBCs),frozen RBCs and frozen thawed deglycerolized RBCs,and the collection and supply data of each observation group from 2020 to 2022 were compared.Based on whether blood demand of RhD negative patients was met,the patients were divided into the group of going to other places for medical treatment,the group of RhD positive blood transfusion and the group of RhD negative blood transfusion to analyze the blood usage.Results From 2020 to 2022,the proportion of RhD negative blood donated by repeat appointment donors decreased year by year(P<0.05);the proportion of RhD negative blood donated by repeat walk-in donors increased year by year(P<0.05);the proportion of frozen thawed deglycerolized RBCs to RhD negative RBCs increased year by year(P<0.05);the proportion of cold storage RBCs distributed as RhD negative and RhD positive decreased year by year respectively(P<0.05);the proportion of the increase in frozen RBCs inventory to the current year′s frozen RBCs inventory decreased year by year(P<0.05).The satisfaction rate of blood demand of RhD negative patients increased year by year(P<0.05),with the number of patients with RhD positive blood transfusion and going to other places for medical treatment decreased year by year respectively(P<0.05).Conclusion In Liaocheng area,it is appropriate to encourage RhD negative blood donors to donate blood randomly,and A,B,O and AB type cold storage RBCs kept in 2-6 U inventory respectively.When exceeding the inventory,frozen RBCs are prepared within 6 days,which can improve the blood demand satisfaction rate of RhD negative patients and avoid sending excessive RhD negative RBCs to clinical use as RhD positive RBCs.