Background: Allogeneic blood transfusion-induced immunomodulation (TRIM) and its adverse effect on the prognosis of patients treated surgically for cancer remain complex and controversial. However, the potential risk ...Background: Allogeneic blood transfusion-induced immunomodulation (TRIM) and its adverse effect on the prognosis of patients treated surgically for cancer remain complex and controversial. However, the potential risk associated with allogeneic blood transfusion has heightened interest in the use of autologous blood transfusion. In the present study, the serum concentrations of neopterin, interferon-gamma (IFN-γ), T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and a possible association between these variables were investigated. The purpose was to further evaluate the effect of autologous versus allogeneic blood transfusion on immunological status in patients undergoing surgery for gastric cancer. Methods: Sixty ASA I～II (American Society of Anesthesiologists) patients undergoing elective radical resection for stomach cancer were randomly allocated to receive either allogeneic blood transfusion (n=30) or autologous blood transfusion (n=30). Serum concentrations of the neopterin, IFN-γ and T lymphocyte subsets in the recipients were measured before induction of anesthesia, after operation, and on the 5th postoperative day. Results: Both two groups, serum neopterin, IFN-γ, percentages of T-cell subsets (CD3+, CD4+), and CD4+/CD8+ ratio had significantly decreased after operation, but decreased more significantly in group H (receiving allogeneic blood transfusion) than those in group A (receiving autologous whole blood transfusion) (P<0.05). On the 5th postoperative day, serum neopterin, IFN-γ, CD3+, CD4+ T-cells, and CD4+/CD8+ ratio returned to the baseline values in group A. In contrast, the above remain decreasing in group H, where there were no significant relations between serum neopterin and IFN-γ. Conclusion: Perioperative surgical trauma and stress have an immunosuppressive impact on gastric cancer patients. Allogeneic blood transfusion exacerbates the impaired immune response. Autologous blood transfusion might be significantly beneficial for immune-compromised patients in the perioperative period, clearly showing its superiority over allogeneic blood transfusion.展开更多
Whole blood and its respective blood components are indispensable in today’s medical practice and their use is associated with significant costs. Blood utilization and blood transfusion costs are generally perceived ...Whole blood and its respective blood components are indispensable in today’s medical practice and their use is associated with significant costs. Blood utilization and blood transfusion costs are generally perceived to be increasing at a time when healthcare budgets continue being constricted. This may have far reaching consequences, particularly in resource limited settings where healthcare spending is mainly foreign funded. A cost-activity based blood transfusion study was carried out at a large urban hospital in Harare, Zimbabwe on 100 patients prospectively. The inclusion criteria took into consideration only pregnant women between the ages 15 and 50 years receiving blood transfusion. Activity based costing was achieved through prospectively following the activities of blood transfusion from the point of collection, storage, matching, pre-transfusion preparations, transfusion and post-transfusion, as well as hospitalisation services costs. The average cost of blood transfusion was found to be $540.71 from the provider’s perspective. This cost was compared with the gross domestic per capita and the poverty datum line of Zimbabwe. A continuous review of transfusion systems to alter the supply chain system into a very economic system was recommended.展开更多
Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular c...Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.展开更多
目的分析影响老年髋部骨折患者围术期异体红细胞输血的相关因素以期实现针对性干预措施的制定和实施以降低围术期异体红细胞输注率和保证用血安全。方法选取2021年8月至2022年8月入住骨科的老年髋部骨折患者200例,根据是否进行异体红细...目的分析影响老年髋部骨折患者围术期异体红细胞输血的相关因素以期实现针对性干预措施的制定和实施以降低围术期异体红细胞输注率和保证用血安全。方法选取2021年8月至2022年8月入住骨科的老年髋部骨折患者200例,根据是否进行异体红细胞输血分为输血组(n=96)和非输血组(n=104),收集患者术前、术中和术后等围术期临床资料,比较2组患者术后发生并发症的情况及围术期各资料的差异并分析独立影响因素。结果200例老年髋部骨折患者中行围术期异体红细胞输血96例,未进行异体红细胞输血104例,围术期异体红细胞输血率为48.00%(96/200)。输血组术后发生感染性、心脑血管、应激性溃疡和血栓情况高于非输血组,2组患者术后并发症总发生率比较,差异有统计学意义(P<0.05)。2组患者性别、年龄、体重指数(BMI)、骨折类型、服用抗血小板聚集药物、入院时Hb、HCT、ALB、Cr、ASA麻醉分级、麻醉类型、手术方式、手术持续时间、术中失血量、术后引流管放置情况、术后Hb和异体红细胞输注量比较差异有统计学意义(P<0.05)。多因素Logistic回归分析模型发现:高龄、低BMI、股骨粗隆间骨折、入院时低血清血红蛋白(Hb)、低红细胞比容(HCT)、低白蛋白(ALB)、高血肌酐(Cr)、ASA麻醉分级≥Ⅲ级、全身麻醉、手术持续时间长、术中失血量大和术后放置引流管是老年髋部骨折患者围术期异体红细胞输血的独立影响因素(P<0.05)。根据多因素Logistic回归分析得出的结果构建的老年髋部骨折患者围术期异体红细胞输血预测模型全局性Omnibus检验有统计学意义(P<0.001);进一步进行拟合优度Hosmer and Lemeshow检验(χ^(2)=9154,P=0.226),表明模型具有较好的拟合度。绘制ROC曲线预测围术期异体红细胞输血的曲线下面积(AUC)为0.851,灵敏度为79.50%,特异度为80.50%。结论老年髋部骨折患者围术期异体红细胞输血受高龄、低BMI、股骨粗隆间骨折、入院时低Hb、低HCT、低ALB、高Cr、ASA麻醉分级≥Ⅲ级、全身麻醉、手术持续时间长、术中失血量大和术后放置引流管等多种因素影响,构建输血预测模型有助于输血方案的个体化制定。展开更多
目的荟萃分析回收式自体输血(IOCS)在前置胎盘剖宫产术中的安全性和有效性。方法计算机检索PubMed、Web of Science、Embase、the Cochrane Library of clinical trials、中国知网(CNKI)及万方数据知识服务平台。检索时限设定为建库至2...目的荟萃分析回收式自体输血(IOCS)在前置胎盘剖宫产术中的安全性和有效性。方法计算机检索PubMed、Web of Science、Embase、the Cochrane Library of clinical trials、中国知网(CNKI)及万方数据知识服务平台。检索时限设定为建库至2022年12月。采用R 4.1.2与Stata 12.0软件计算IOCS组和异体输血(ABT)组之间的标准化均数差(SMD)或相对危险度(RR)及95%置信区间(CI)和预测区间(PI)。结果本次Meta分析共纳入5项随机对照试验和10项回顾性队列研究。队列研究的合并结果显示,与ABT组相比,接受IOCS的前置胎盘孕产妇术后血红蛋白(Hb)浓度(SMD=0.626,95%CI:0.103~1.149;95%PI:-1.320~2.572)与红细胞压积较高(SMD=0.617,95%CI:0.130~1.104;95%PI:-1.084~2.317)。在随机对照试验中,接受IOCS的前置胎盘孕产妇发生不良事件的风险比ABT组低72.7%(RR=0.273,95%CI:0.082~0.904)。IOCS组和ABT组术后凝血酶原时间(PT)、活化凝血酶原时间(APTT)、纤维蛋白原(Fib)浓度、血尿素氮(BUN)和肌酐(Cr)差异均无无统计学意义。结论接受IOCS的前置胎盘孕产妇术后Hb浓度和Hct均高于接受ABT的妇女。IOCS对术后凝血参数和肾功能参数无显著影响。在接受剖宫产术的前置胎盘孕产妇中,IOCS与较低的输血相关不良事件发生风险有关。展开更多
基金Project supported by the Health Department of Zhejiang Province(No. 2004A040)the Education Department of Zhejiang Province (No. G20030486), China
文摘Background: Allogeneic blood transfusion-induced immunomodulation (TRIM) and its adverse effect on the prognosis of patients treated surgically for cancer remain complex and controversial. However, the potential risk associated with allogeneic blood transfusion has heightened interest in the use of autologous blood transfusion. In the present study, the serum concentrations of neopterin, interferon-gamma (IFN-γ), T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and a possible association between these variables were investigated. The purpose was to further evaluate the effect of autologous versus allogeneic blood transfusion on immunological status in patients undergoing surgery for gastric cancer. Methods: Sixty ASA I～II (American Society of Anesthesiologists) patients undergoing elective radical resection for stomach cancer were randomly allocated to receive either allogeneic blood transfusion (n=30) or autologous blood transfusion (n=30). Serum concentrations of the neopterin, IFN-γ and T lymphocyte subsets in the recipients were measured before induction of anesthesia, after operation, and on the 5th postoperative day. Results: Both two groups, serum neopterin, IFN-γ, percentages of T-cell subsets (CD3+, CD4+), and CD4+/CD8+ ratio had significantly decreased after operation, but decreased more significantly in group H (receiving allogeneic blood transfusion) than those in group A (receiving autologous whole blood transfusion) (P<0.05). On the 5th postoperative day, serum neopterin, IFN-γ, CD3+, CD4+ T-cells, and CD4+/CD8+ ratio returned to the baseline values in group A. In contrast, the above remain decreasing in group H, where there were no significant relations between serum neopterin and IFN-γ. Conclusion: Perioperative surgical trauma and stress have an immunosuppressive impact on gastric cancer patients. Allogeneic blood transfusion exacerbates the impaired immune response. Autologous blood transfusion might be significantly beneficial for immune-compromised patients in the perioperative period, clearly showing its superiority over allogeneic blood transfusion.
文摘Whole blood and its respective blood components are indispensable in today’s medical practice and their use is associated with significant costs. Blood utilization and blood transfusion costs are generally perceived to be increasing at a time when healthcare budgets continue being constricted. This may have far reaching consequences, particularly in resource limited settings where healthcare spending is mainly foreign funded. A cost-activity based blood transfusion study was carried out at a large urban hospital in Harare, Zimbabwe on 100 patients prospectively. The inclusion criteria took into consideration only pregnant women between the ages 15 and 50 years receiving blood transfusion. Activity based costing was achieved through prospectively following the activities of blood transfusion from the point of collection, storage, matching, pre-transfusion preparations, transfusion and post-transfusion, as well as hospitalisation services costs. The average cost of blood transfusion was found to be $540.71 from the provider’s perspective. This cost was compared with the gross domestic per capita and the poverty datum line of Zimbabwe. A continuous review of transfusion systems to alter the supply chain system into a very economic system was recommended.
文摘Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.
文摘目的分析影响老年髋部骨折患者围术期异体红细胞输血的相关因素以期实现针对性干预措施的制定和实施以降低围术期异体红细胞输注率和保证用血安全。方法选取2021年8月至2022年8月入住骨科的老年髋部骨折患者200例,根据是否进行异体红细胞输血分为输血组(n=96)和非输血组(n=104),收集患者术前、术中和术后等围术期临床资料,比较2组患者术后发生并发症的情况及围术期各资料的差异并分析独立影响因素。结果200例老年髋部骨折患者中行围术期异体红细胞输血96例,未进行异体红细胞输血104例,围术期异体红细胞输血率为48.00%(96/200)。输血组术后发生感染性、心脑血管、应激性溃疡和血栓情况高于非输血组,2组患者术后并发症总发生率比较,差异有统计学意义(P<0.05)。2组患者性别、年龄、体重指数(BMI)、骨折类型、服用抗血小板聚集药物、入院时Hb、HCT、ALB、Cr、ASA麻醉分级、麻醉类型、手术方式、手术持续时间、术中失血量、术后引流管放置情况、术后Hb和异体红细胞输注量比较差异有统计学意义(P<0.05)。多因素Logistic回归分析模型发现:高龄、低BMI、股骨粗隆间骨折、入院时低血清血红蛋白(Hb)、低红细胞比容(HCT)、低白蛋白(ALB)、高血肌酐(Cr)、ASA麻醉分级≥Ⅲ级、全身麻醉、手术持续时间长、术中失血量大和术后放置引流管是老年髋部骨折患者围术期异体红细胞输血的独立影响因素(P<0.05)。根据多因素Logistic回归分析得出的结果构建的老年髋部骨折患者围术期异体红细胞输血预测模型全局性Omnibus检验有统计学意义(P<0.001);进一步进行拟合优度Hosmer and Lemeshow检验(χ^(2)=9154,P=0.226),表明模型具有较好的拟合度。绘制ROC曲线预测围术期异体红细胞输血的曲线下面积(AUC)为0.851,灵敏度为79.50%,特异度为80.50%。结论老年髋部骨折患者围术期异体红细胞输血受高龄、低BMI、股骨粗隆间骨折、入院时低Hb、低HCT、低ALB、高Cr、ASA麻醉分级≥Ⅲ级、全身麻醉、手术持续时间长、术中失血量大和术后放置引流管等多种因素影响,构建输血预测模型有助于输血方案的个体化制定。
文摘目的荟萃分析回收式自体输血(IOCS)在前置胎盘剖宫产术中的安全性和有效性。方法计算机检索PubMed、Web of Science、Embase、the Cochrane Library of clinical trials、中国知网(CNKI)及万方数据知识服务平台。检索时限设定为建库至2022年12月。采用R 4.1.2与Stata 12.0软件计算IOCS组和异体输血(ABT)组之间的标准化均数差(SMD)或相对危险度(RR)及95%置信区间(CI)和预测区间(PI)。结果本次Meta分析共纳入5项随机对照试验和10项回顾性队列研究。队列研究的合并结果显示,与ABT组相比,接受IOCS的前置胎盘孕产妇术后血红蛋白(Hb)浓度(SMD=0.626,95%CI:0.103~1.149;95%PI:-1.320~2.572)与红细胞压积较高(SMD=0.617,95%CI:0.130~1.104;95%PI:-1.084~2.317)。在随机对照试验中,接受IOCS的前置胎盘孕产妇发生不良事件的风险比ABT组低72.7%(RR=0.273,95%CI:0.082~0.904)。IOCS组和ABT组术后凝血酶原时间(PT)、活化凝血酶原时间(APTT)、纤维蛋白原(Fib)浓度、血尿素氮(BUN)和肌酐(Cr)差异均无无统计学意义。结论接受IOCS的前置胎盘孕产妇术后Hb浓度和Hct均高于接受ABT的妇女。IOCS对术后凝血参数和肾功能参数无显著影响。在接受剖宫产术的前置胎盘孕产妇中,IOCS与较低的输血相关不良事件发生风险有关。
