ABO反定型试剂红细胞的质量控制

已知血型的试剂红细胞是ABO血型的血清学鉴定中检测抗体必不可少的试剂。为了提高ABO血型检定结果的准确性，解决自制试剂红细胞无标准和无质控的问题，本研究组建立了ABO反定型试剂红细胞的质控方法，进行了试剂红细胞的特异性和亲和性检测、振荡检测、流式细胞术和原子显微镜观察。通过筛选建立了质控参考品，并在此基础上确定质量检定标准及质控方法，同时对制备的3批次试剂红细胞进行了评价。研究结果表明：制备的反定型试剂红细胞既能保证质量和性能的稳定，又能最大限度地降低批次间的差异。结论：制备的AB0反定型试剂红细胞解决了自制红细胞的质控问题，并能提高血型检定结果的准确性。     

直抗阳性导致交叉配血次侧不合的肿瘤患者红细胞输注疗效观察

目的观察微柱凝胶法直抗(DAT)阳性交叉配血次侧不合的肿瘤患者红细胞输注疗效。方法收集2014年1月-2015年12月期间我院交叉配血主侧相合次侧不合,DAT阳性的25例输血肿瘤患者作为实验组,随机挑选100例同类型疾病但配血主次侧均相合且DAT阴性的患者作为对照组,比较两组白蛋白(ALB)、球蛋白(GLB)以及输血前后的胆红素(TBIL、DBIL、IBIL)、血红蛋白(Hb)、红细胞压积(Hct)、红细胞(RBC);并评估红细胞输注的临床疗效。结果实验组输血前后的Hb、Hct、RBC显著性升高(P0.05),TBIL、DBIL、IBIL无明显变化(P0.05);实验组比对照组GLB显著性升高(P0.05),实验组和对照组TBIL、DBIL、IBIL、ALB以及输血前后血象的变化无显著性差异(P0.05)。实验组无效输血率16%,与对照组无显著性差异(P0.05)。结论红细胞输注对于DAT阳性导致交叉配血次侧不合的肿瘤患者是安全有效的。     

不同麻醉方法对髋关节置换术后红细胞内源性恢复的影响

目的 比较蛛网膜下腔-硬膜外腔联合阻滞（combined spinal—epidural anesthesia，CSEA）、静吸复合全麻（general anesthesia，GA）和全麻复合硬膜外麻醉（combined epidural and general anesthesia，CA）三种麻醉方法对髋关节置换术后病人红细胞总量恢复的影响。方法 48例ASAⅠ～Ⅲ级，拟行髋关节置换术患者随机分为CSEA、GA和CA三组，记录术中失血量，检测术前、术后第1、3、5d血常规，根据Nadler公式计算血容量．红细胞总量为血容量乘以单位红细胞计数。结果 三组病人术中失血量差异无统计学意义（F分别=0．22、0．25．P．均〉0．05）；术后第1天与术前相比，CSEA、GA、CA三组病人红细胞总量显著下降，差异均有统计学意义（t分别=3．65、3．48、3．66，P均〈0．05）。CSEA组与术前比较，术后第5天开始出现红细胞内源性恢复，差异有统计学意义（t=2．03，P〈0．05），而GA、CA组比较，差异无统计学意义（t=0．08、0．09，P均〉0．05），未出现红细胞内源性恢复。术后第3、5天CSEA组与GA、CA组比较，红细胞总量差异均有统计学意义（t分别=2．04、2．03、1．71、3．15，P〈0．05）。结论 CSEA下行髋关节置换术病人内源性红细胞总量的恢复较GA和CA组迅速。     

Clinical outcome of transfusions with extended red blood cell matching in β-thalassemia patients: A single-center experience

Background

The development of alloantibodies may complicate the management of patients with β-thalassemia. An extended antigenic matching may reduce the risk of alloimmunization. Our previous study showed that the introduction of molecular red blood cell (RBC) typing allows finding suitable blood units for multi-transfused patients. The aim of this study was to evaluate the benefit of RBC transfusion with extended antigenic match.

Usefulness of color doppler sonography and 99m Tc-RBC scintigraphy for preoperative diagnosis of a venous malformation of the small intestine in a 2-year-old child

Venous malformations of the small intestine are rare in children, and the preoperative diagnosis of a venous malformation in the small bowel can be very difficult. We report the case of a 2-year-old girl with a solitary cavernous venous malformation of the small intestine that caused gastrointestinal bleeding and anemia and review the usefulness of the combination of color Doppler sonography and 99m Tc-RBC scintigraphy for the diagnosis of venous malformation of the small intestine.     

Flow cytometric determination of RBC survival in autoimmune hemolytic anemia

BACKGROUND: In cases of warm autoimmune hemolytic anemia (WAIHA), crossmatch incompatible RBCs are most often used for transfusion. The determination of the in vivo survival of transfused and autologous RBCs in WAIHA is helpful in the assessment of the efficacy of transfusion and other therapeutic interventions. CASE REPORT: A 38-year-old man presented with acute WAIHA, thrombocytopenia, and neutropenia. Steroids and IVIG therapy were ineffective, and the patient received RBCS: Because of increasing hemolysis and persisting thrombocytopenia, splenectomy was performed, resulting in partial remission. Further improvement was achieved by immunosuppressive therapy. MATERIALS AND METHODS AND RESULTS: Survival of transfused and autologous RBCs was determined, using a flow cytometric method based on the determination of different blood group antigens of patient and donor RBCS: The survival of autologous and transfused RBCs before splenectomy was determined on two consecutive days. The life span of autologous RBCs remained rather stable at 69 and 64 hours on Days 10 and 11, respectively, whereas the life span of transfused RBCs decreased from 186 hours to 25 hours. After splenectomy, the life span of transfused RBCs almost normalized: 43 days at postsplenectomy Day 3 and 87 days at postsplenectomy Day 69. CONCLUSION: Flow cytometry was successfully used to determine changing hemolytic activity during the clinical course of WAIHA. Additionally, the survival of transfused RBCs could be measured, which may be helpful to judge for the compatibility of allogeneic RBCS: Thus, we were able to show the therapeutic inefficacy of steroids and immunoglobulins, and quick improvement after splenectomy.     

Blood Utilization After Primary Total Joint Arthroplasty in a Large Hospital Network

Background

Since a study in orthopedic hip fracture patients demonstrated that a liberal hemoglobin (Hb) threshold does not improve patient morbidity and mortality relative to a restrictive Hb threshold, the standard of care in total joint arthroplasty (TJA) should be examined to understand the variability of red blood cell (RBC) transfusion following TJA.

Questions/purposes

The study aimed to answer the following questions: (1) What is the blood utilization rate after primary TJA for individual surgeons within a large hospital network? (2) What is the comparison of hospital charges, length of stay (LOS), and discharge locations among TJA patients who were and were not transfused?

Methods

A retrospective study was conducted on 3,750 primary total knee arthroplasties (TKAs) and 2,070 primary total hip arthroplasties (THAs), and data was retrospectively collected over a 15-month period on the number of RBCs transfused per patient, along with demographic and cost details. The number of patients who received at least 1 RBC unit and the number of RBCs transfused per patient was calculated and stratified by surgeon.

Results

In the postoperative period, 19.3% TKA patients and 38.5% THA patients received a RBC transfusion. Transfusion rates following TJA varied widely between surgeons (TKA 4.8–63.8%, THA 4.3–86.8%). Transfused TKA patients received an average of 1.65 ± 0.03 RBCs, and THA patients received an average of 1.97 ± 0.14 RBCs. LOS and hospital charges for blood transfusion patients were higher than nontransfused patients.

Conclusion

Blood utilization after primary TJA varies greatly among surgeons, suggesting that resources may be misallocated. These findings highlight the need to standardize RBC transfusion practice following TJA.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-013-9327-y) contains supplementary material, which is available to authorized users.     

Maternal red blood cell alloimmunisation in south western Uganda

Aims/Objectives: To identify the frequency and nature of maternal red blood cell (RBC) alloimmunisation in Uganda and to determine the prevalence of RhD negativity and the rate of RBC alloimmunisation in Ugandan pregnant women. Background: Haemolytic disease of the foetus and newborn (HDFN) results from maternal alloimmunisation following exposure to allogeneic RBCs during pregnancy or blood transfusion. The prevalence of maternal RBC alloimmunisation in Ugandans is not known. Materials and Methods: Pregnant women at Mbarara Hospital, South Western Uganda, were investigated in a cross‐sectional study. Demographics, transfusion and obstetric histories were recorded. Maternal RBC alloimmunisation was demonstrated using immunohaematological techniques. Results: A total of 2001 pregnant women were recruited; 3·6% of them being RhD negative. Forty‐five women (2·2%; 95% CI: 1·6–2·9) were found to be alloimmunised to RBC antigens. There were 38 RBC alloantibodies of known specificity including anti‐S, 12; anti‐M, 11; anti‐Le^a, 6; anti‐D, 4 and 1 each of anti‐K, anti‐Fy^b, anti‐Jk^a, anti‐Lu^a and anti‐Kp^a. In two women (4·4%), there were antibody combinations (anti‐M+S and anti‐K+Kp^a). Obstetric history, gestational age and previous immunising events were not significantly associated with the rate of alloimmunisation. Conclusions: This study revealed a maternal RBC alloimmunisation rate of 2·2% which was comparable with findings from a Zimbabwean study where the prevalence was 1·7%. Given the 6·0% prevalence of anti‐D among RhD‐negative women in our study and the high immunogenicity of the D antigen, programmes for preventing anti‐D alloimmunisation and HDFN in Uganda should be considered seriously.     

Isoflavone supplementation reduces DNA oxidative damage and increases O-β-N-acetyl-d-glucosaminidase activity in healthy women

Phenolic compounds are believed to boost the human antioxidant defense system and health; therefore, the aim of this research was to investigate the hypothesis that soy isoflavones (IFs) provide antioxidant protection in healthy women by evaluating DNA resistance to oxidative damage and O-β-N-acetyl-d-glucosaminidase (OGA) activity. An IF supplement (80 mg/d) was given to 9 postmenopausal women and 13 young women for 6 months and then stopped up to the 14th month. The women were allowed to consume their normal diet. Blood samples were collected at the beginning of the study after 2, 4, and 6 months and then at the 8th and 14th months. Plasma concentrations of genistein and daidzein, total antioxidant capacity, plasma vitamin status, markers of oxidative stress (red blood cell membrane fluidity, activity of the red blood cell cytosolic enzyme OGA and lymphocyte DNA susceptibility to oxidative stress), and serum lipid profile were analyzed. Analysis of variance for repeated measures was used for statistical analysis. Plasma concentrations of IFs rose significantly during the supplementation period, and plasma total antioxidant capacity increased in young women; membrane fluidity and OGA activity increased, and DNA oxidative damage decreased (P < .05) at 4 months, then returned to the basal level. There was a significant inverse correlation between DNA damage and plasma IF concentrations (P < .01). The results indicated a positive effect of IF supplementation on oxidative stress in women, thus suggesting that the healthful action ascribed to soy consumption may be partially related to the antioxidant potential of IFs.