Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Box 608, 601 Elmwood Avenue, Rochester, NY 14642, USA.
Transfus Clin Biol. 2023 Feb;30(1):31-34. doi: 10.1016/j.tracli.2022.09.005. Epub 2022 Sep 9.
Recipient safety measures play a key role in overall transfusion efficacy. The key advances in safety over the first century of transfusion medicine have been the development of techniques to prevent hemolytic transfusion reactions, hemolytic disease of the newborn and transmission of viral pathogens. While these risks remain important, they affect many fewer patients than previously. We propose that some of the most important current safety issues relate to toxicities broadly encompassed by the immunomodulatory effects of allogeneic transfusion. These include (1) universal leukoreduction to mitigate nosocomial infections, inflammation and organ injury, (2) removal of stored supernatant and its attendant toxic contents that cause dysfunctional immunity and organ injury, (3) avoiding infusing ABO incompatible antigen and antibody that can lead to bleeding, platelet refractoriness and inflammation, (3) minimizing prophylactic transfusions (particularly of plasma and platelets) except where benefit is proven, and (4) avoiding use of normal saline which is linked to renal failure and possibly hemolysis. Accompanying these safety measures will be the continued growth of one of the most important safety measures, patient blood management, which has as one benefit the avoidance of unnecessary and harmful transfusions. Reducing the toxicity of transfusions will enhance the improved clinical outcomes seen with patient blood management.
受血者安全措施在整体输血疗效中起着关键作用。输血医学一个世纪以来的安全主要进展是开发了预防溶血性输血反应、新生儿溶血病和病毒病原体传播的技术。虽然这些风险仍然很重要，但它们影响的患者比以前少得多。我们认为，目前一些最重要的安全问题与同种异体输血的免疫调节作用所涵盖的毒性有关。这些问题包括：（1）普遍进行白细胞减少处理，以减轻医院获得性感染、炎症和器官损伤；（2）清除储存的上清液及其引起免疫功能障碍和器官损伤的毒性物质；（3）避免输注 ABO 不相容抗原和抗体，以防止出血、血小板反应性降低和炎症；（3）除了有明确获益的情况下，尽量减少预防性输血（尤其是血浆和血小板）；（4）避免使用与肾衰竭和可能溶血相关的生理盐水。伴随这些安全措施的将是患者血液管理这一最重要的安全措施之一的持续发展，其一个益处是避免不必要和有害的输血。减少输血的毒性将增强患者血液管理带来的改善的临床结果。
