Lane Thomas A, Gernsheimer Terry, Mohandas Kala, Assmann Susan F
University of California, San Diego School of Medicine, Pathology Department, La Jolla 92093-0612, USA.
Transfusion. 2002 Feb;42(2):265-74. doi: 10.1046/j.1537-2995.2002.00036.x.
RBC transfusion is associated with fever and other reactions in some patients. The Viral Activation Transfusion Study randomly assigned patients to receive either unmodified or WBC-reduced RBCs and thus offered an opportunity to assess the effect of WBC-reduced RBCs on the incidence of transfusion reactions prospectively.
This prospective, randomized, double-blind, multicenter study compared prestorage WBC-reduced RBCs to unmodified RBCs in HIV-infected, CMV-seropositive, and transfusion-naive persons who required transfusions for anemia. Primary endpoints were survival and change in the plasma HIV RNA level at 7 days after transfusion. The incidence of transfusion reactions was prospectively evaluated.
The two groups had similar baseline characteristics and study endpoints; 3864 RBC units (median storage age, 9 days) were administered to 531 patients during 1745 transfusions. The most frequent signs reported were elevated temperature and hypotension. Subjects who reported fever within the week prior to transfusion were more likely to have an elevation in temperature associated with transfusion. The administration of RBCs that were less than 10 days old was associated with a marginal increase in the incidence of transfusion-associated temperature elevation among recipients of unmodified RBCs, but not among recipients of WBC-reduced RBCs. Caregivers reported fewer instances of both elevated temperature and hypotension than were identified by review of transfusion records.
The incidence of elevated temperature and hypotension associated with transfusion in this population was unexpectedly high. Use of WBC-reduced RBCs had no effect on the overall rates of elevated temperature or hypotension associated with transfusion of RBCs. The occurrence of a pre-existing fever was associated with a higher frequency of transfusion-associated elevated temperature.
在一些患者中，红细胞输注与发热及其他反应相关。病毒激活输血研究将患者随机分配接受未处理的或白细胞去除的红细胞，从而提供了一个前瞻性评估白细胞去除的红细胞对输血反应发生率影响的机会。
这项前瞻性、随机、双盲、多中心研究，在因贫血需要输血的HIV感染、巨细胞病毒血清学阳性且未接受过输血的患者中，将储存前白细胞去除的红细胞与未处理的红细胞进行比较。主要终点是输血后7天的生存率和血浆HIV RNA水平的变化。对输血反应的发生率进行前瞻性评估。
两组具有相似的基线特征和研究终点；在1745次输血过程中，给531例患者输注了3864个红细胞单位（中位储存时间为9天）。报告的最常见体征是体温升高和低血压。在输血前一周内报告发热的受试者，更有可能出现与输血相关的体温升高。输注储存时间小于10天的红细胞，在未处理红细胞接受者中，与输血相关体温升高的发生率略有增加有关，但在白细胞去除红细胞接受者中并非如此。与通过审查输血记录确定的情况相比，护理人员报告的体温升高和低血压情况较少。
该人群中与输血相关的体温升高和低血压发生率意外地高。使用白细胞去除的红细胞对与红细胞输血相关的体温升高或低血压的总体发生率没有影响。既往发热的发生与输血相关体温升高的频率较高有关。
