血液仍然致命:进一步降低异体输血相关死亡率的六项策略。
Blood still kills: six strategies to further reduce allogeneic blood transfusion-related mortality.
机构信息
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
出版信息
Transfus Med Rev. 2010 Apr;24(2):77-124. doi: 10.1016/j.tmrv.2009.11.001.
After reviewing the relative frequency of the causes of allogeneic blood transfusion-related mortality in the United States today, we present 6 possible strategies for further reducing such transfusion-related mortality. These are (1) avoidance of unnecessary transfusions through the use of evidence-based transfusion guidelines, to reduce potentially fatal (infectious as well as noninfectious) transfusion complications; (2) reduction in the risk of transfusion-related acute lung injury in recipients of platelet transfusions through the use of single-donor platelets collected from male donors, or female donors without a history of pregnancy or who have been shown not to have white blood cell (WBC) antibodies; (3) prevention of hemolytic transfusion reactions through the augmentation of patient identification procedures by the addition of information technologies, as well as through the prevention of additional red blood cell alloantibody formation in patients who are likely to need multiple transfusions in the future; (4) avoidance of pooled blood products (such as pooled whole blood-derived platelets) to reduce the risk of transmission of emerging transfusion-transmitted infections (TTIs) and the residual risk from known TTIs (especially transfusion-associated sepsis [TAS]); (5) WBC reduction of cellular blood components administered in cardiac surgery to prevent the poorly understood increased mortality seen in cardiac surgery patients in association with the receipt of non-WBC-reduced (compared with WBC-reduced) transfusion; and (6) pathogen reduction of platelet and plasma components to prevent the transfusion transmission of most emerging, potentially fatal TTIs and the residual risk of known TTIs (especially TAS).
在回顾了当今美国异体输血相关死亡率的相关频率后,我们提出了 6 种可能的策略,以进一步降低此类输血相关死亡率。这些策略包括:(1) 通过使用基于证据的输血指南避免不必要的输血,以减少潜在致命(感染性和非感染性)输血并发症;(2) 通过使用来自男性供体或未怀孕或未显示出白细胞 (WBC) 抗体的女性供体的单供体血小板,减少血小板输注受者发生输血相关急性肺损伤的风险;(3) 通过增加患者身份识别程序的信息技术,以及通过预防可能需要多次输血的患者产生额外的红细胞同种抗体,预防溶血性输血反应;(4) 避免使用混合血制品(如混合全血来源的血小板),以降低新兴输血传播感染 (TBI) 和已知 TBI(特别是输血相关败血症 [TAS])的剩余风险;(5) 在心脏手术中输注的细胞血液成分中减少白细胞,以预防与接受非白细胞减少(与白细胞减少相比)输血相关的心脏手术患者中观察到的死亡率增加,这种情况尚不清楚;(6) 减少血小板和血浆成分中的病原体,以预防大多数新兴的、潜在致命的 TBI 以及已知 TBI(特别是 TAS)的输血传播风险。
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