Lawrence-Brown M M, Couch C, Halliday M, Hellings M, Barr A, Marshall L
Vascular Surgery Unit, Royal Perth Hospital, Western Australia.
Aust N Z J Surg. 1989 Jan;59(1):67-70. doi: 10.1111/j.1445-2197.1989.tb01467.x.
Autotransfusion of operatively salvaged blood is an increasingly attractive and used practice. The fear of precipitating a coagulopathy, however, has retarded the acceptance of autotransfusions and the efficiency and convenience of banked homologous blood has proved too competitive in recent years. The risk of transmitting diseases with bank homologous blood has seen a resurgence in the development of autotransfusion. The current alternatives to pre-operative autologous banking or dilution are the reinfusing of filtered salvaged blood, and of blood which has been further processed by washing which involves the extra cost of time, personnel and equipment. Washing removes possible harmful products, but also removes coagulation factors. D-Dimer levels were estimated by monoclonal antibody techniques in salvaged blood before and after washing in 10 patients undergoing aortic surgery and in 10 u of homologous banked blood. The D-Dimer levels in the unwashed blood were increased 85 times, but were normal in the washed blood. D-Dimers are an indication of activation of the coagulation and fibrinolytic systems and the presence of fibrin degradation products.
手术中回收血的自体输血是一种越来越有吸引力且被广泛应用的做法。然而，对引发凝血病的担忧阻碍了自体输血的接受度，而且近年来库存异体血的效率和便利性已被证明更具竞争力。通过库存异体血传播疾病的风险促使了自体输血的发展。目前，术前自体储血或血液稀释的替代方法是回输过滤后的回收血，以及经过洗涤进一步处理的血液，这涉及到时间、人员和设备的额外成本。洗涤可去除可能的有害产物，但也会去除凝血因子。采用单克隆抗体技术对10例接受主动脉手术患者的回收血洗涤前后以及10单位库存异体血中的D - 二聚体水平进行了评估。未洗涤血液中的D - 二聚体水平升高了85倍，但洗涤后的血液中该水平正常。D - 二聚体是凝血和纤溶系统激活以及纤维蛋白降解产物存在的指标。
