【摘要】：目的探討免疫性輸血反應的預防策略,建立本地區(qū)臨床輸血預警體系,促進臨床輸血治療的安全有效。方法 7 227例申請輸注紅細胞和血小板治療的患者樣本,應用微柱凝膠抗球蛋白法、凝聚胺法和固相凝集法等新技術,進行輸血前免疫性抗體檢測;選擇急性白血病誘導化療后完全緩解、同時微小殘留病(minimal residual disease MRD)陰性的33例患者,根據(jù)與患者溝通情況,分為研究組(18例)和對照組(15例)。研究組患者在其化療間歇期骨髓造血恢復時進行自體血小板的采集,24 h內(nèi)加入5%二甲基亞砜(DMSO)于-80℃冰凍保存?zhèn)溆?當患者Plt10×10~9/L或有出血癥狀時,2組患者分別輸注解凍后自體血小板和異體新鮮血小板。通過血小板計數(shù)、CCI值和TEG凝血指標,評價自體冰凍血小板質(zhì)量和臨床輸注效果。結果 7 227份患者樣本中,共檢出免疫性抗體37例,其中紅細胞血型抗體23例,血小板相關抗體14例,陽性率0.51%(37/7227);男14例,女23例,女性患者的陽性率明顯高于男性(P0.05);23例紅細胞血型抗體以Rh系統(tǒng)為主,占43.48%(10/23);MN系統(tǒng)次之,占17.39%(4/23)。免疫性抗體的臨床分布以反復輸血的血液腫瘤患者為主,占78.38%(29/37)。納入統(tǒng)計資料的16例研究組患者,共采集自體血小板24次,采集血小板總量為154.18×10~11個,分裝成66個治療量的血小板進行冰凍保存。每治療量自體血小板冰凍保存前后血小板含量分別為(2.36±0.23)×10~11個和(1.94±0.17)×10~11個(P0.01);血小板聚集功能分別為(70.38±4.98)mm和(77±5.41)mm(P0.01);研究組輸注自體冰凍血小板53例次,對照組輸注異體新鮮血小板55例次,輸注血小板24 h后CCI值,分別為(11.25±6.45)×10~9/L和(10.49±5.72)×10~9/L,總有效率為81.13%(43/53)和83.63%(46/55),兩者比較差異無統(tǒng)計學意義(P0.05)。結論免疫性抗體的檢測和自體輸血技術可以提高輸血療效,預防免疫性輸血反應的發(fā)生;建立臨床輸血預警體系,對輸血關鍵環(huán)節(jié)監(jiān)控,可以保障臨床輸血安全有效。
[Abstract]:Objective to explore the preventive strategy of immune transfusion reaction and to establish a clinical blood transfusion warning system in order to promote the safety and effectiveness of clinical transfusion therapy. Methods A total of 7,227 patients who applied for erythrocyte and platelet transfusion were examined by microcolumn gel anti-globulin method, polyacrylamide method and solid phase agglutination method. Thirty-three patients with complete remission after induction chemotherapy were divided into study group (n = 18) and control group (n = 15) according to their communication with patients. Patients in the study group underwent autologous platelet collection during bone marrow hematopoietic recovery during intermittent chemotherapy, and 5% dimethyl sulfoxide (DMSO) was added to cryopreservation at -80 鈩，

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