Packed red blood cell transfusions as a risk factor for parenteral nutrition associated liver disease in premature infants

AIM To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease. METHODS A retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell(PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin(db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells(the median value). KaplanMeier plots estimated the median volume of packedred blood cells received in order to develop parenteral nutrition associated liver disease.RESULTS Parenteral nutritional associated liver disease(PNALD) was noted in 21(43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17(64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.CONCLUSION In this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.

Red Blood Cell Transfusion in a Neonatal Tertiary Care Center: A Moroccan Study

Background: Red Blood Cell (RBC) transfusion is a common therapy in neonatal practice and data from different international neonatal centers are available, however, there is paucity of Moroccan data regarding blood components usage. We aim to study trends and outcomes of RBC transfusions in our department and emphasize the need for transfusion guidelines. Material and method: This retrospective study was performed in a Moroccan tertiary neonatal intensive care center. The records of all neonates admitted from January 2015 to March 2016 were screened for RBC usage and indications. The data were statistically analyzed by using Microsoft ExcelTM software. Results: A total of 60 neonates received 77 RBC transfusions. Postnatal age at transfusion ranged from 1 to 30 days with an average of 13 days, and 30% of our patients were aged ≥21 days. RBC Transfusion was given once in 48 patients (80%), twice in 8 patients (13.3%) and ≥ thrice in 4 patients (6.7%). More than one type of blood components was needed in 23 (38%) neonates. 70% of patients were critically ill, 60% were born before 37 weeks’ gestation and 57% were small for gestational age. Mean hemoglobin at the time of transfusion of RBC was 8.59 g/dl (2 - 11.6 g/dl). Sepsis and anemia with mechanical ventilation for severe respiratory illness were the commonest indications. All gestational ages were considered, and mortality was noted in 66% of our cases and worsening in 13%;21% of the infants showed improvement. Conclusion: Judicious implementation of guidelines for RBC transfusions would decrease their inappropriate use.

Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer

BACKGROUND Gastric cancer(GC)is still a prevalent neoplasm around the world and its main treatment modality is surgical resection.The need for perioperative blood transfusions is frequent,and there is a long-lasting debate regarding its impact on survival.AIM To evaluate the factors related to the risk of receiving red blood cell(RBC)transfusion and its influence on surgical and survival outcomes of patients with GC.METHODS Patients who underwent curative resection for primary gastric adenocarcinoma at our Institute between 2009 and 2021 were retrospectively evaluated.Clinicopathological and surgical characteristics data were collected.The patients were divided into transfusion and non-transfusion groups for analysis.RESULTS A total of 718 patients were included,and 189(26.3%)patients received perioperative RBC transfusion(23 intraoperatively,133 postoperatively,and 33 in both periods).Patients in the RBC transfusions group were older(P<0.001),and had morecomorbidities(P=0.014),American Society of Anesthesiologists classification III/IV(P<0.001),and lower preoperative hemoglobin(P<0.001)and albumin levels(P<0.001).Larger tumors(P<0.001)and advanced tumor node metastasis stage(P<0.001)were also associated with the RBCtransfusion group.The rates of postoperative complications(POC)and 30-d and 90-d mortalitywere significantly higher in the RBC transfusion group than in the non-transfusion group.Lowerhemoglobin and albumin levels,total gastrectomy,open surgery,and the occurrence of POC werefactors associated with the RBC transfusion.Survival analysis demonstrated that the RBCtransfusions group had worse disease-free survival(DFS)and overall survival(OS)compared withpatients who did not receive transfusion(P<0.001 for both).In multivariate analysis,RBCtransfusion,major POC,pT3/T4 category,pN+,D1 lymphadenectomy,and total gastrectomywere independent risk factors related to worse DFS and OS.CONCLUSIONPerioperative RBC transfusion is associated with worse clinical conditions and more advancedtumors.Further,it is an independent factor related to worse survival in the curative intentgastrectomy setting.

Comparison of the conventional tube and erythrocyte-magnetized technology in titration of red blood cell alloantibodies

BACKGROUND Erythrocyte alloantibodies are mainly produced after immune stimulation,such as blood transfusion,pregnancy,and transplantation,and are the leading causes of severe hemolytic transfusion reactions and difficulty in blood grouping and matching.Therefore,antibody screening is critical to prevent and improve red cell alloantibodies.Routine tube assay is the primary detection method of antibody screening.Recently,erythrocyte-magnetized technology(EMT)has been increasingly used in clinical practice.This study intends to probe the application and efficacy of the conventional tube and EMT in red blood cell alloantibody titration to provide a reference for clinical blood transfusion.AIM To investigate the application value of conventional tube and EMT in red blood cell alloantibody titration and enhance the safety of blood transfusion practice.METHODS A total of 1298 blood samples were harvested from blood donors at the Department of Blood Transfusion of our hospital from March 2021 to December 2022.A 5 mL blood sample was collected in tubing,which was then cut,and the whole blood was put into a test tube for centrifugation to separate the serum.Different red blood cell blood group antibody titers were simultaneously detected using the tube polybrene test,tube antiglobulin test(AGT),and EMT screening irregular antibody methods to determine the best test method.RESULTS Simultaneous detection was performed through the tube polybrene test,tube AGT and EMT screening irregular antibodies.It was discovered that the EMT screening irregular antibody method could detect all immunoglobulin G(IgG)and immunoglobulin M(IgM)irregular antibodies,and the results of manual tube AGT were satisfactory,but the operation time was lengthy,and the equipment had a large footprint.The EMT screening irregular antibody assay was also conducted to determine its activity against type O Rh(D)red blood cells,and the outcomes were satisfactory.Furthermore,compared to the conventional tube method,the EMT screening irregular antibody method was more cost-effective and had significantly higher detection efficiency.CONCLUSION With a higher detection rate,the EMT screening irregular antibody method can detect both IgG and IgM irregular antibodies faster and more effectively than the conventional tube method.

Effect of Point-of-care Hemoglobin/Hematocrit Devices and Autologous Blood Salvage on Reduction of Perioperative Allogeneic Blood Transfusion

Objective To evaluate the effect of point-of-care hemoglobin/hematocrit(POC HGB/HCT) devices and intraoperative blood salvage on the amount of perioperative allogeneic blood transfusion and blood conservation in clinical practice. Methods A total of 46 378 medical records of 22 selected hospitals were reviewed. The volume of allogeneic red blood cell and plasma, number of patients transfused, number of intraoperative autologous blood salvage, total volume of autologous blood transfusion, and amount of surgery in the year of 2011 and 2013 were tracked. Paired t-test was used in intra-group comparison, while t-test of two isolated samples carried out in inter-group comparison. P<0.05 was defined as statistically significant difference. Results In the hospitals where POC HGB/HCT device was used(n=9), the average allogeneic blood transfusion volume per 100 surgical cases in 2013 was significantly lower than that in 2011(39.86±20.20 vs. 30.49±17.50 Units, t=3.522, P=0.008). In the hospitals without POC HGB/HCT meter, the index was not significantly different between 2013 and 2011. The average allogeneic blood transfusion volume was significantly reduced in 2013 than in 2011 in the hospitals where intraoperative autologous blood salvage ratio [autologous transfusion volume/(autologous transfusion volume+allogeneic transfusion volume)] was increased(n=12, t=2.290, P=0.042). No significant difference of the above index was found in the hospitals whose autologous transfusion ratio did not grow. Conclusion Intraoperative usage of POC HGB/HCT devices and increasing autologous transfusion ratio could reduce perioperative allogeneic blood transfusion.

Severe hyperkalemia following blood transfusions:Is there a link?

Patients with gastrointestinal bleeding often require large volume blood transfusion. Among the various side effects of blood transfusion,the increase of potassium levels is a serious one which is often overlooked. We report a case of severe hyperkalemia in a patient with gastric bleeding after large volume transfusion of packed red blood cells. The patient had hyperkalemia at baseline associated with his receiving medication as well as acute renal failure following hypovolemia. The baseline hyperkalemia was further aggravated after massive transfusions of packed red blood cells in a short period of time. The associated pathogenetic mechanisms resulting in the increase of potassium levels are presented. A number of risk factors which increase the risk of hyperkalemia after blood transfusion are discussed. Moreover,appropriate management strategies for the prevention of blood transfusion associated hyperkalemia are also presented. Physicians should always keep in mind the possibility of hyperkalemia in cases of blood transfusion.

Cost of allogeneic blood transfusion

Blood is a scarce and costly resource to society. Therefore, it is important to understand the costs associated with blood, blood components, and blood transfusions. Previous studies have attempted to account for the cost of blood but, because of different objectives, perspectives, and methodologies, they may have underestimated the true(direct and indirect) costs associated with transfusions. Recognizing these limitations, a panel of experts in blood banking and transfusion medicine gathered at the Cost of Blood Consensus Conference to identify a set of key elements associated with whole blood collection, transfusion processes, follow-up, and to establish a standard methodology in estimating costs. Activity-based costing(ABC), the proposed allinclusive reference methodology, is expected to produce standard and generalizable estimates of the costof blood transfusion, and it should prove useful to payers, buyers, and society(all of whom bear the cost of blood). In this article, we argue that the ABC approach should be adopted in future cost-of-transfusion studies. In particular, we address the supply and demand dilemma associated with blood and blood components; evaluate the economic impact of transfusion-related adverse outcomes on overall blood utilization; discuss hemovigilance as it contributes not to the expense, but also the safety of transfusion; review previous cost-oftransfusion studies; and summarize the ABC approach and its utility as a methodology for estimating transfusion costs.

Analysis of Factors Influencing the Effect of Red Blood Cell Suspension Infusion in Children

Objective: The related factors of no improvement of hypoxia and ineffective infusion were analyzed to provide new ideas, clinical observation and evaluation pathway for RBC transfusion in clinical children. Methods: Retrospective analysis from January 2020 to December 2020, Guangzhou women and children’s medical center hospital in the emergency observation room of 249 children under 1 month to 18 years of blood cell suspension infusion, analyze the clinical effect of red blood cell infusion and children gender, age, fever after transfusion, disease type, delay transfusion. The possible influencing factors were analyzed by logistic regression. Results: Invalid transfusion was associated with the type of transfusion product (P = 0.032), logistic regression analysis showed that patients infused with washed RBC suspension were 3.231 times more likely to not achieve the expected effect than those infused with RBC suspension (P = 0.025). Failure transfusion was associated with the type of transfusion products. In ineffective transfusion was closely related to post-transfusion fever (P P P = 0.031). Logistic regression analysis showed that fever after transfusion was a risk factor for no improvement of hypoxia (OR = 5.809, P = 0.001), and the improvement of hypoxia in adolescent children was 10.744 times higher than that of infants (0 - 3 years old). Late transfusion hypoxia improvement was 4.212 times more likely to achieve no effect than timely transfusion. If ineffective infusion of red blood cells is considered and hypoxia after transfusion is not improved, univariate suggests a close correlation with fever after transfusion (P = 0.002), logistic regression analysis showed that fever after transfusion was an independent risk factor (OR = 7.258, P = 0.002). Conclusion: There was no correlation between the ineffective transfusion of red blood cells and the type of disease affected in the child. Infusion of red cell suspension has an advantage over the wash red cell infusion. Ineffective RBC transfusion and no improvement in hypoxia after transfusion were closely related to post-transfusion fever, with no difference between children in all age groups. Red blood cell infusion in pediatric clinical treatment activities should pay attention to adolescent children, especially female children to give more attention, and give timely red blood cell infusion as much as possible.

Effect of packed red blood cell transfusion on the prognosis of patients with upper gastrointestinal bleeding:a retrospective analysis of eICU-CRD v2.0 multicenter critically ill patients database

Background:The effects of packed red blood cell(PRBC)transfusion on the prognosis of patients with upper gastrointestinal bleeding(UGIB),particularly on the 30-day mortality rate,are unclear.This study aimed to determine the prognostic influence of PRBC transfusion in patients with UGIB with different hemoglobin(Hb)levels.Methods:The subjects in this study were selected from the Philips Electronic ICU Collaborative Research Database Version 2.0 multi-center critically ill patient database from January 2014 to December 2015.A total of 4689 patients were included in this study.The Hb levels were divided into 3 groups:Hb<6 g/dL(Group 1),6 g/dL≤Hb<8 g/dL(Group 2),and Hb≥8 g/dL(Group 3).Based on the ad-ministration of PRBC transfusion,each group was subdivided into PRBC and non-PRBC groups.Results:A total of 4689 patients were enrolled in the study,including 825,2195,and 1669 patients in Groups 1,2,and 3,respectively.Furthermore,the PRBC and non-PRBC groups consisted of 1847 and 2842 patients,respectively.There was no significant difference in the 30-day mortality rate between Group 1 and Group 2 or between the PRBC and non-PRBC subgroups.In Group 3,the 30-day mor-tality rate of patients who received transfusion was higher than that of patients who did not(13.29%vs 9.14%,P=0.029).For the PRBC group,the difference in 30-day mortality rate was not statistically significant among the 3 groups,whereas for the non-PRBC group,the 30-day mortality rate in Group 3 was the lowest,and there was a significant difference among the 3 groups(P=0.003).There was no significant difference in the subgroup analysis of bleeding at different sites and etiologies.Conclusion:Packed red blood cell transfusion does not improve prognosis or reduce mortality in patients with UGIB but may increase mortality in patients with Hb levels greater than 8 g/dL.

Perioperative Single-Donor Platelet Apheresis and Red Blood Cell Transfusion Impact on 90-Day and Overall Survival in Living Donor Liver Transplantation

Background： Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation （LT）, few studies described the influence of single-donor platelet apheresis transfusion in living donor LT （LDLT）. This study aimed to assess the effect of blood products on outcomes for LDLT recipients, focusing on apheresis platelets. Methods： This retrospective study included 126 recipients who underwent their first adult-to-adult LDLT. Twenty-four variables including consumption of blood products of 126 LDLT recipients were assessed for their link to short-term outcomes and overall survival. Kaplan-Meier survival curve and the log-rank test were used for recipient survival analysis. A multivariate Cox proportional-hazard model and a propensity score analysis were applied to adjust confounders after potential risk factors were identified by a univariate Cox analysis. Results： Patients who received apheresis platelet transfusion had a lower 90-day cumulative survival （78.9% vs. 94.2%, P = 0.009）, but had no significant difference in overall survival in the Cox model, compared with those without apheresis platelet transfusion. Units of apheresis platelet transfusion（hazard ratio[HR]=3.103,95% confidence interval[CI]：1.720–5.600,P〈0.001）and preoperative platelet count（HR=0.170,95% CI：0.040–0.730,P=0.017）impacted 90-day survival independently.Multivariate Cox regression analysis also found that units of red blood cell（RBC）transfusion（HR=1.036,95% CI：1.006–1.067,P=0.018）,recipient＇s age（HR=1.045,95% CI：1.005–1.086,P=0.025）,and ABO blood group comparison（HR=2.990,95% CI：1.341–6.669,P=0.007）were independent risk factors for overall survival after LDLT. Conclusions： This study suggested that apheresis platelets were only associated with early mortality but had no impact on overall survival in LDLT. Units of RBC, recipient＇s age, and ABO group comparison were independent predictors of long-term outcomes.

Use of donor-specific red blood cell transfusions for patients undergoing liver transplantation during the COVID-19 pandemic

Background:Increased risks have been found for patients undergoing liver transplantation due to the blood supply shortage following the ongoing coronavirus disease 2019(COVID-19)pandemic.Hence,exploring a method to alleviate this dilemma is urgent.This phase I,nonrandomized,prospective trial aimed to evaluate the safety and feasibility of using donor-specific red blood cell transfusion(DRBCT)as an urgent measurement to alleviate the blood supply shortage in deceased donor liver transplantation(DDLT).Methods:The outcomes of 26 patients who received DRBCT and 37 patients in the control group who only received 3rd party packed red blood cells(pRBCs)transfusion between May 2020 and January 2021 were compared.Results:Patients receiving DRBCT did not develop transfusion-related complications,and the incidence of postoperative infection was similar to that in the control group(23.1%vs.18.9%,P=0.688).Because the patients received the red blood cells from organ donors,the median volume of intraoperative allogeneic red blood cell transfusion from blood bank was 4.0 U(IQR 1.1-8.0 U)in the DRBCT group,which is significantly lower than that(7.5 U,IQR 4.0-10.0 U)in the control group(P=0.018).The peak aspartate aminotransferase(AST)level was significantly lower in the DRBCT group than in the control group(P=0.008)and so were the AST levels in the first two days after the operation(P=0.006 and P=0.033).Conclusions:DRBCT is a safe and effective procedure to lower the need for blood supply and is associated with a reduction in AST levels after transplantation.DRBCT is beneficial to patients receiving life-saving transplantation without sufficient blood supply during the COVID-19 pandemic.

Individualized red-cell transfusion strategy for non-cardiac surgery in adults:a randomized controlled trial

Background:Red-cell transfusion is critical for surgery during the peri-operative period;however,the transfusion threshold remains controversial mainly owing to the diversity among patients.The patient’s medical status should be evaluated before making a transfusion decision.Herein,we developed an individualized transfusion strategy using the West-China-Liu’s Score based on the physiology of oxygen delivery/consumption balance and designed an open-label,multicenter,randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively,providing valid evidence for peri-operative transfusion.Methods:Patients aged>14 years undergoing elective non-cardiac surgery with estimated blood loss>1000 mL or 20%blood volume and hemoglobin concentration<10 g/dL were randomly assigned to an individualized strategy,a restrictive strategy following China’s guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration<9.5 g/dL.We evaluated two primary outcomes:the proportion of patients who received red blood cells(superiority test)and a composite of in-hospital complications and all-cause mortality by day 30(non-inferiority test).Results:We enrolled 1182 patients:379,419,and 384 received individualized,restrictive,and liberal strategies,respectively.Approximately 30.6%(116/379)of patients in the individualized strategy received a red-cell transfusion,less than 62.5%(262/419)in the restrictive strategy(absolute risk difference,31.92%;97.5%confidence interval[CI]:24.42-39.42%;odds ratio,3.78%;97.5%CI:2.70-5.30%;P<0.001),and 89.8%(345/384)in the liberal strategy(absolute risk difference,59.24%;97.5%CI:52.91-65.57%;odds ratio,20.06;97.5%CI:12.74-31.57;P<0.001).No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.Conclusion:The individualized red-cell transfusion strategy using the West-China-Liu’s Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.Trial registration:ClinicalTrials.gov,NCT01597232.

Development of necrotizing enterocolitis after blood transfusion in very premature neonates

Background Prior studies report conflicting evidence on the association between packed red blood cell(PRBC)transfu-sions and necrotizing enterocolitis(NEC),especially in early weeks of life where transfusions are frequent and spontaneous intestinal perforation can mimic NEC.The primary objective of this study was to evaluate the association between PRBC transfusions and NEC after day of life(DOL)14 in very premature neonates.Methods A retrospective cohort analysis of very premature neonates was conducted to investigate association between PRBC transfusions and NEC after DOL 14.Primary endpoints were PRBC transfusions after DOL 14 until the date of NEC diagnosis,discharge,or death.Wilcoxon ranked-sum and Fisher's exact tests,Cox proportional hazards regression,and Kaplan-Meier curves were used to analyze data.Results Of 549 premature neonates,186(34%)received transfusions after DOL 14 and nine(2%)developed NEC(median DOL=38;interquartile range=32-46).Of the nine with NEC after DOL 14,all were previously transfused(P<0.001);therefore,hazard of NEC could not be estimated.Post hoc analysis of patients from DOL 10 onward included five additional patients who developed NEC between DOL 10 and DOL 14,and the hazard of NEC increased by a factor of nearly six after PRBC transfusion(hazard ratio=5.76,95%confidence interval=1.02-32.7;P=0.048).Conclusions Transfusions were strongly associated with NEC after DOL 14.Prospective studies are needed to determine if restrictive transfusion practices can decrease incidence of NEC after DOL 14.

血液成分二次制备后相关参数变化

目的 对成分血二次制备后的相关参数变化进行研究,旨在进一步提升血液成分产品质量。方法 选择不同的离心条件用于初次成分血去白细胞悬浮红细胞的制备,并对其进行质量检测,然后以去白细胞悬浮红细胞为二次制备的起始血液,通过ACP215红细胞处理系统去制备机制洗涤红细胞成分血,并对其进行质量检测,通过对成分血制备参数的变化进行观察研究比较,并从中进行优化调整。结果 不同的离心条件所带来的离心效果相当时,所分离制备的去白细胞悬浮红细胞和冰冻血浆初级血液成分,其容量、血红蛋白、血细胞比积、白细胞残留量等质量控制项目,均符合国家相关标准要求;同时以初次制备的去白细胞悬浮红细胞为起始血液制备的机制,洗涤红细胞二级血液成分,其容量、血红蛋白、上清蛋白含量等质量控制项目,除容量超出标准7~14 mL外,其余均符合国家相关标准要求,但导致容量超标的原因及采取的解决方法可控制容量达到标准范围,且在红细胞回收率和血浆蛋白清除率上,二者可分别达到75%和99%的水平。结论 本实验初次制备与二次制备的血液成分之间有着一定的关联,但血液成分二次制备可视实际情况进行相关参数的灵活调整,以确保制备的成分血产品质量符合国家相关标准要求,以及临床治疗效果和安全。

生理盐水洗涤DIC患者凝集红细胞用于血型鉴定的效果评价

目的探讨弥散性血管内凝血(disseminated intravascular coagulation,DIC)患者凝集红细胞生理盐水洗涤后血型鉴定的效果。方法选择浙江省杭州市第三人民医院2019年7月—2022年7月由于自身红细胞凝集导致血型鉴定困难的24例DIC患者为研究对象,ABO血型以基因分型结果为标准,生理盐水洗涤凝集红细胞前后手工方法(试管法和微胶柱法)ABO血型鉴定结果与标准组比较。结果凝集红细胞洗涤前ABO血型2例正反定型符合,与标准结果比较,其差异具有统计学意义(P<0.05)。生理盐水洗涤后的红细胞均匀散开,24例ABO血型检测结果正反定型符合,其中A型8例,B型5例,O型9例,AB型2例。洗涤后血型结果与标准结果比较,其差异无统计学意义(P>0.05)。结论采用生理盐水洗涤凝集红细胞的方法,血型鉴定效果良好,具有明显检测优势,为临床紧急用血提供了安全保障。

体外生产红细胞:进展与挑战

目前临床用血供不应求,尽管自体输血等血液保护技术可部分缓解此类情况,但红细胞作为主要的血液成分需求量巨大,而体外生产安全的红细胞则可解决这一难题。目前研究显示,可从胚胎干细胞、人诱导多能干细胞、脐带血、外周血和永生化红系祖细胞系几种来源分化出成熟红细胞。本文就体外生产红细胞的来源及应用进行综述,并分析目前所面临的挑战,以期为输血治疗提供新思路。

洗涤红细胞和去白悬浮红细胞输注治疗自身免疫性溶血性贫血的效果

目的:探讨洗涤红细胞和去白悬浮红细胞输注治疗自身免疫性溶血性贫血(AIHA)的效果。方法:回顾性选取2020年3月—2023年3月蚌埠医学院第一附属医院收治的64例AIHA患者作为研究对象。根据治疗方法的不同将其分为试验组和对照组,各32例。对照组输注去白悬浮红细胞,试验组输注洗涤红细胞。比较两组输血后24 h临床疗效,输血前、输血后24 h相关指标,输血反应。结果:试验组总有效率高于对照组,差异有统计学意义(P<0.05)。输血后24 h,两组血红蛋白(Hb)、红细胞计数(RBC)升高,网织红细胞百分比(Ret)、总胆红素(TBIL)水平降低,试验组Hb、RBC高于对照组,差异有统计学意义(P<0.05)。两组输血反应发生率比较,差异无统计学意义(χ^(2)=1.016,P>0.05)。结论:对AIHA患者而言,在输血治疗中输注洗涤红细胞的总体有效率高于输注去白悬浮红细胞,并且Hb和RBC的提升效果更加明显。

人源化基因修饰猪红细胞与人血清免疫相容性的体外研究

目的 探讨野生型(WT)、四基因修饰(TKO/hCD55)和六基因修饰(TKO/hCD55/hCD46/hTBM)猪红细胞与人血清的免疫相容性和免疫差异。方法 收集20名不同血型志愿者的血液,将WT、TKO/hCD55和TKO/hCD55/hCD46/hTBM猪红细胞、ABO-相容(ABO-C)及ABO-不相容(ABO-I)人红细胞分别暴露于不同血型人血清中,检测血凝集、抗原抗体结合(IgG、IgM)水平和补体依赖细胞毒性,评估2种基因修饰猪红细胞与人血清的免疫相容性。结果 ABO-C组未出现明显凝集;WT组和ABO-I组凝集水平高于TKO/hCD55组和TKO/hCD55/hCD46/hTBM组(均为P<0.001)。WT组猪红细胞裂解水平高于ABO-C组、TKO/hCD55组和TKO/hCD55/hCD46/hTBM组;ABO-I组猪红细胞裂解水平高于TKO/hCD55组、TKO/hCD55/hCD46/hTBM组(均为P<0.01)。TKO/hCD55组猪红细胞IgM和IgG结合水平均低于WT组和ABO-I组;TKO/hCD55/hCD46/hTBM组猪红细胞IgG和IgM结合水平低于WT组,IgG低于ABO-I组(均为P<0.05)。结论基因修饰猪红细胞的免疫相容性优于野生型猪,并接近于ABO-C,人源化猪红细胞在血资源奇缺时可考虑作为血液来源。

体外模拟加压输血对悬浮红细胞质量影响的研究

目的探讨不同压力对悬浮红细胞质量的影响,为研制加压输血装置提供数据支撑。方法将25袋悬浮红细胞随机等分成5组,分别施加10、20、30、40和50 Kpa压力,实时记录血流速度;施压前后分别留取部分血样测定红细胞相关指标(RBC、HGB、HCT、MCV、MCH、MCHC)变化情况,测定血浆中钾离子、间接胆红素、乳酸脱氢酶、游离血红蛋白含量;检测红细胞渗透脆性并用电镜观察红细胞形态变化,从而评价不同压力对血液质量的影响。结果加压可显著提高输血速度。在不同压力下红细胞相关指标变化与K+、IBIL、LDH变化无统计学意义,游离血红蛋白与溶血率均符合国家有关规定。电镜下观察随着压力升高出现少量异形红细胞,胞膜电子密度有差异,网状结构破坏,网眼不均匀。结论在50 Kpa范围内加压对红细胞损伤影响不大,血液质量符合我国相关标准要求。