Rh(D)阴性患者输血分析及应急抢救用血预案的建立

Analysis of blood transfusion in Rh(D)negative patients in a hospital in Changzhou and establishment of blood mechanism for emergency rescue

目的:分析2016—2018年Rh(D)阴性患者应急输血案例,建立Rh(D)阴性患者输血应急方案,旨在保障临床Rh(D)阴性患者紧急用血。方法:对输血治疗的13例Rh(D)阴性患者进行输血情况调查,了解输血后抗体产生情况以及输血的疗效分析。结果:13例Rh(D)阴性患者中12例输注了Rh(D)阴性红细胞或血浆,其中1例由于出血量较大,进行配合性输注Rh(D)阳性红细胞。13例患者均得到了及时的救治,12例未出现Rh抗体,1例大量输注了Rh(D)阳性红细胞在输注3个月后出现了抗-D抗体,效价为4,4个月后效价为32。结论:Rh(D)阴性患者如需急诊输血,输注红细胞类制品时,首选ABO、Rh(D)同型的红细胞制品,也可以输注"O"型Rh(D)同型洗涤红细胞;在现有Rh(D)阴性制品不能满足要求,又需大剂量输注红细胞制品时,可根据"配合型输血"的原则输注Rh(D)阳性红细胞。如需输注血小板制品,若时间允许尽量输注Rh(D)阴性血小板,紧急情况下可以输注Rh(D)阳性血小板。血浆、冷沉淀制品的输注则无需区分Rh(D)血型。

Objective:To establish a blood transfusion emergency plan for patients with Rh(D)negative in our hospital by analyzing the cases of emergency transfusion in patients with Rh(D)negative in 2016-2018,and ensure emergency blood use in clinical Rh(D)negative patients. Method:Thirteen Rh(D)-negative patients who were transfused in our hospital from 2016 to 2018 were investigated for blood transfusion.The screening of antibodies after transfusion and the efficacy analysis of blood transfusion were analyzed. Result:Thirteen patients with Rh(D)negative were infused with Rh(D)negative red blood cells or plasma.One of them was given a complex infusion due to excessive loss of blood,and Rh(D)positive red blood cells were infused.Thirteen patients were treated promptly,12 patients did not have Rh antibody.The patient with excessive bleeding received a large amount of Rh(D)-positive red blood cells,anti-D antibody appeared after three months of infusion and the titer was 4.Four months later,the titer was 32.Conclusion:When Rh(D)-negative patients need emergency blood transfusion,the ABO/Rh(D)isotype matching red blood cell products,or 'O' type Rh(D)negative isotype washing red blood cells might be good choices.According to 'combination type blood transfusion',when the Rh(D)negative products cannot meet the requirements,the Rh(D)positive red blood cells can be used.For the platelet transfusions,Rh(D)-negative platelets can be used as time permits,and Rh(D)-positive platelets can be infused in an emergency.For plasma,there is no necessary to distinguish Rh blood type.