Yamada Takashi, Mori Hiroshi, Ueki Minoru
Department of Pathology, Osaka Medical College, Osaka, Japan.
Acta Obstet Gynecol Scand. 2005 Mar;84(3):255-9. doi: 10.1111/j.0001-6349.2005.00698.x.
Several studies have shown that autologous blood storage during pregnancy is relatively safe for mother and fetus. However, the need for reappraisal of autologous blood transfusion in obstetric patients has been proposed.
We retrospectively reviewed the cases of placenta previa and low-lying placenta among pregnancies at our hospital during an 18-year period, 1985-2002. The utility of autologous blood transfusion program, which started in 1994 for those with placental positional disorders, was evaluated.
Of the pregnancies reviewed, there were 158 cases (1.9%) of placenta previa or low-lying placenta. The number of patients transfused with homologous blood decreased from 27.6% (21/76) in the period before implementation of the autologous blood transfusion program to 8.5% (7/82) after its implementation in 1994. In the latter time period, 39.0% (32/82) of patients with placenta previa and low-lying placenta were phlebotomized and had blood stored. Of those, 71.9% (23/32) were reinfused where one patient (3.1%) needed homologous blood as well. The volume of collected blood per phlebotomy was 367 +/- 65 ml, the total volume of collected blood per patient was 803 +/- 350 ml, and the total of estimated blood loss per patient was 1326 +/- 873 ml. The volume of reinfused blood per patient was 578 +/- 326 ml.
The program of autologous blood collection and transfusion in patients with placenta previa resulted in a decrease in homologous blood transfusion. In our program, we recommend starting blood collection and storage at 32 weeks' gestation and phlebotomize 400 ml per week to reach a volume of stored blood of 1200-1500 ml.
多项研究表明，孕期自体血储存对母亲和胎儿相对安全。然而，有人提议对产科患者的自体输血进行重新评估。
我们回顾性分析了我院1985年至2002年18年间妊娠合并前置胎盘和低置胎盘的病例。评估了1994年开始为胎盘位置异常患者实施的自体输血方案的效用。
在所回顾的妊娠病例中，有158例（1.9%）为前置胎盘或低置胎盘。输注异体血的患者比例从自体输血方案实施前的27.6%（21/76）降至1994年实施后的8.5%（7/82）。在后期，39.0%（32/82）的前置胎盘和低置胎盘患者进行了采血和储血。其中，71.9%（23/32）的患者进行了回输，其中1例患者（3.1%）也需要异体血。每次采血的血量为367±65ml，每位患者的总采血量为803±350ml，每位患者的估计总失血量为1326±873ml。每位患者的回输血量为578±326ml。
前置胎盘患者的自体血采集和输血方案减少了异体输血。在我们的方案中，我们建议在妊娠32周开始采血和储血，每周采血400ml，以使储存血量达到1200 - 1500ml。
