Buiting A M J, van Aken W G
Kwaliteitsinstituut voor de Gezondheidszorg CBO, Postbus 20.064, 3502 LB Utrecht.
Ned Tijdschr Geneeskd. 2005 Nov 19;149(47):2613-8.
The revised and expanded practice guideline 'Blood transfusion' describes the whole transfusion chain within the hospital for the first time. Despite compatibility tests before transfusion (determination of the ABO and Rhesus blood groups and detection of clinically relevant antibodies (C, c, D, E, e, Fy(a), Fy(b), Jk(a), Jk(b), M, S and s)), transfusion reactions can occur. So that a transfusion reaction can be recognised in time, the patient must be observed intensively for the first 5-10 minutes after the start of any new transfusion and the vital functions must be recorded. In patients with a Hb level of 4-6 mmol/l, the decision whether or not to transfuse should be made dependent on the patient's other characteristics. Thrombocyte transfusion is not indicated in case of thrombopenia due to increased breakdown or pooling. If leukaemia, tumour infiltration or drug toxicity is the underlying cause of thrombopenia, then a platelet count of 10 x 10(9)/l or 20 x 10(9)/l should be the transfusion trigger. Reduction of the number of blood transfusions can be achieved by the administration of epoetin in case of renal insufficiency: transfusion can thus be avoided in more than 70% of the patients concerned. Autotransfusion during surgery with severe blood loss also results in a reduction of the number of allogenic blood transfusions.
修订和扩充后的实践指南《输血》首次描述了医院内的整个输血链。尽管在输血前进行了相容性检测（确定ABO和Rh血型以及检测临床相关抗体（C、c、D、E、e、Fy(a)、Fy(b)、Jk(a)、Jk(b)、M、S和s）），但仍可能发生输血反应。为了能及时识别输血反应，在任何新输血开始后的最初5至10分钟内必须对患者进行密切观察，并记录生命体征。对于血红蛋白水平为4 - 6 mmol/l的患者，是否输血应根据患者的其他特征来决定。因破坏增加或聚集导致血小板减少时，不建议输注血小板。如果血小板减少的根本原因是白血病、肿瘤浸润或药物毒性，那么血小板计数为10×10⁹/L或20×10⁹/L应作为输血触发指标。对于肾功能不全患者，通过使用促红细胞生成素可减少输血次数：这样可避免超过70%的相关患者输血。手术中严重失血时进行自体输血也可减少异体输血次数。
