Gauvin France, Lacroix Jacques, Robillard Pierre, Lapointe Hélène, Hume Heather
Intensive Care Unit, Department of Pediatrics, Sainte-Justine Hospital, University of Montréal, Montréal, Québec, Canada.
Transfusion. 2006 Nov;46(11):1899-908. doi: 10.1111/j.1537-2995.2006.00995.x.
Acute transfusion reactions (ATRs) are probably underdiagnosed in critically ill children because associated symptoms can frequently be attributed to the patient's underlying disease. This study was undertaken to determine the incidence, type, imputability, and severity of ATRs observed in a tertiary care pediatric intensive care unit (PICU).
All transfusions of labile blood product administered to consecutive patients admitted to our PICU, between February 2002 and February 2004, were prospectively recorded. For each transfusion, the bedside nurse recorded the patient's status before, during, and up to 4 hours after the transfusion, as well as the presence of any new sign or symptom suggesting an ATR. Three independent experts retrospectively reviewed all transfusion event reports and hospital charts. The presence, type, imputability, and severity of ATRs were adjudicated by consensus of two of three experts (Delphi method), with predefined criteria.
A total of 2509 transfusions were administered to 305 patients during the study. Forty transfusion events (1.6%) were confirmed to be ATRs by expert consensus: 24 febrile nonhemolytic, 6 minor allergic, 4 isolated hypotension, 3 bacterial contamination, 1 major allergic (anaphylactic shock), 1 TRALI, and 1 hemolytic reaction. Imputability of ATRs was probable or possible in 35 cases (88%). ATRs led to an immediate vital threat in 15 percent of cases.
Improved surveillance of transfusions given to PICU patients and better knowledge of these reactions by health care professionals should improve the safety of transfusions in the PICU.
急性输血反应（ATR）在重症儿童中可能未得到充分诊断，因为相关症状常常可归因于患者的基础疾病。本研究旨在确定在一家三级医疗儿科重症监护病房（PICU）中观察到的ATR的发生率、类型、可归因性和严重程度。
前瞻性记录了2002年2月至2004年2月期间入住我们PICU的连续患者所接受的所有不稳定血液制品的输血情况。对于每次输血，床边护士记录了输血前、输血期间以及输血后长达4小时的患者状况，以及任何提示ATR的新体征或症状。三位独立专家回顾性审查了所有输血事件报告和医院病历。通过三位专家中的两位达成共识（德尔菲法），依据预定义标准判定ATR的存在、类型、可归因性和严重程度。
在研究期间，共对305例患者进行了2509次输血。经专家共识确认40次输血事件（1.6%）为ATR：24次发热性非溶血性反应、6次轻度过敏反应、4次孤立性低血压、3次细菌污染、1次重度过敏反应（过敏性休克）、1次输血相关急性肺损伤（TRALI）和1次溶血性反应。35例（88%）ATR的可归因性为可能或很可能。15%的病例中，ATR导致了即刻的生命威胁。
加强对PICU患者输血的监测以及医护人员对这些反应的更好了解，应可提高PICU输血的安全性。
