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一种预防与输注美国食品药品监督管理局批准的血液制品相关的严重不良事件的方法。

An approach to prevent the severe adverse events associated with transfusion of FDA-approved blood products.

作者信息

Valeri C Robert, Ragno Gina

机构信息

NBRL, Inc., Plymouth, MA 02360, USA.

出版信息

Transfus Apher Sci. 2010 Jun;42(3):223-33. doi: 10.1016/j.transci.2009.08.001. Epub 2010 Apr 13.

Abstract

There have been several retrospective studies reporting severe adverse events of mortality and morbidity associated with blood transfusions. Mortality and morbidity associated with posttransfusion infection, transfusion related acute lung injury (TRALI), and systemic inflammatory response syndrome (SIRS) have been reported in patients undergoing cardiac surgery, after massive transfusions for severe traumatic injuries, and after transfusions for elective and emergency indications. After 35 days of storage at 4 degrees C in additive solutions, RBC have 24-h posttransfusion survival values of 75% but do not function satisfactorily. For RBC to function satisfactorily shortly after transfusion, they should be stored at 4 degrees C for no more than 2 weeks. Yet while the FDA requires a 24-h posttransfusion survival value of 75%, there is no requirement for the function of the transfused RBC. It has been shown that red blood cells that circulate and function immediately or shortly after transfusion exert a very important hemostatic effect to reduce the bleeding time and nonsurgical blood loss in anemic and thrombocytopenic patients. Greater restoration of hemostasis is seen with viable and functional RBC transfusions than with platelets or plasma even though the platelets and plasma proteins may have satisfactory viability and function. The length of storage of the blood products affects their survival and function and the transfusion of nonviable compatible RBC, antibodies to granulocytes and WBC HLA antigens and biologically active substances affects the patient's clinical outcome. One of the easiest ways to prevent the severe adverse events that have been observed is to ensure that the transfused blood products survive and function at an optimum level and that the levels of antibodies to granulocytes and WBC HLA antigens and biologically active substances are eliminated or reduced. The best way to ensure this is to store liquid-preserved leukoreduced human red blood cells at 4 degrees C in additive solutions for no more than 2 weeks and leukoreduced platelets at room temperature for no more than 2 days. These liquid-preserved blood products can be used in conjunction with frozen RBC, platelets, and plasma stored in -80 degrees C mechanical freezers and will avoid the need for fresh whole blood and prevent the severe adverse events associated with the transfusion of blood products.

摘要

已有多项回顾性研究报告了与输血相关的严重不良事件,包括死亡率和发病率。心脏手术患者、严重创伤大量输血后以及择期和急诊输血后的患者中,均有与输血后感染、输血相关急性肺损伤(TRALI)和全身炎症反应综合征(SIRS)相关的死亡率和发病率的报告。红细胞在添加溶液中于4℃储存35天后,输血后24小时的存活率为75%,但功能并不理想。为使红细胞在输血后不久就能正常发挥功能,应在4℃下储存不超过2周。然而,虽然美国食品药品监督管理局(FDA)要求输血后24小时的存活率为75%,但对输注红细胞的功能并无要求。研究表明,输血后立即或不久后循环并发挥功能的红细胞对减少贫血和血小板减少患者的出血时间及非手术失血具有非常重要的止血作用。与输注血小板或血浆相比,输注有活力且功能正常的红细胞能实现更好的止血恢复,即便血小板和血浆蛋白可能具有令人满意的活力和功能。血液制品的储存时长会影响其存活和功能,输注无活力的相容红细胞、粒细胞抗体、白细胞HLA抗原以及生物活性物质会影响患者的临床结局。预防已观察到的严重不良事件的最简单方法之一,是确保输注的血液制品能在最佳水平存活并发挥功能,且消除或降低粒细胞抗体、白细胞HLA抗原以及生物活性物质的水平。确保这一点的最佳方法是,将液体保存的白细胞滤除的人红细胞在添加溶液中于4℃储存不超过2周,将白细胞滤除的血小板在室温下储存不超过2天。这些液体保存的血液制品可与储存在-80℃机械冷冻箱中的冷冻红细胞、血小板和血浆联合使用,这样将无需使用新鲜全血,并可预防与血液制品输注相关的严重不良事件。

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