反复单采血小板对献血者外周血象的影响

<正>随着机器单采血小板在临床上的广泛应用,单采血小板以浓度高、纯度好的特性,受到临床的普遍欢迎,但其影响因素较多,主要包括献血者的自身因素献血者采前血小板(PLT)、采前外周血红蛋白浓度(Hb)、红细胞平均体积(MCV)平均血红蛋白含量(MCH)、平均血红蛋白浓度(MCHC)、血小     

Transcatheter Arterial Embolization for Gastrointestinal Bleeding Associated with Gastric Carcinoma: Prognostic Factors Predicting Successful Hemostasis and Survival

Purpose

To evaluate outcomes of transcatheter arterial embolization (TAE) for gastric cancer–related gastrointestinal (GI) bleeding and factors associated with successful TAE and improved survival after TAE.

疏风解毒胶囊口服给药14 d对幼鼠的毒性作用研究

目的观察10日龄健康SD大鼠重复ig给予疏风解毒胶囊(SFJD)后所产生的毒性反应,为SFJD的婴幼儿临床应用提供参考。方法取10日龄健康SD大鼠30只,分为SFJD组(4 g/kg)和对照组,每天给药1次,连续14 d。每天观察动物的死亡率及一般体征,每周2次监测动物体质量变化,观察门齿萌出、张耳、睁眼和腹部出毛的发生时间,考察幼鼠的自主活动及学习记忆能力;在给药结束时进行血液学、血清生化检测及血清睾酮、雌二醇、胰岛素样生长因子含量测定,分析T、B淋巴细胞亚群的变化;并进行系统尸检、脏器质量及系数检查,测定幼鼠麻醉状态下的体长和尾长。结果给药后幼鼠出现稀便及药物颜色相关的橙色尿液;体质量增长前期减缓,后期改善;尿密度略增加;脾脏质量及肝脏、脾脏、肾脏的脏体系数与脏脑系数增加;有2只幼鼠红细胞计数(RBC)和网织红细胞数(Ret)较对照组显著降低。结论 4 g/kg的SFJD ig给药后,幼鼠耐受性较好,临床大剂量长期应用时需关注可能出现的稀便及RBC、Ret降低等情况。     

Association between anemia and postoperative complications in infants undergoing pyloromyotomy

BackgroundAlthough preoperative anemia has been suggested to predict postsurgical morbidity and mortality among infants < 1 year of age, the data were drawn from heterogeneous patient cohorts including severely ill infants undergoing complex, high-risk procedures. We aimed to determine whether untreated preoperative anemia was associated with increased risk of postoperative complications in infants < 1 year of age who underwent pyloromyotomy, a common and relatively simple surgery.MethodsInfants < 1 year of age undergoing pyloromyotomy were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric database. Preoperative anemia was defined as a hematocrit ≤ 40% for infants 0–30 days of age and ≤ 30% for infants more than 30 days of age. Patients who received pre- or postoperative blood transfusions were excluded.ResultsWe identified 2948 patients who met our inclusion criteria, of whom 843 were anemic (29%). The overall rate of complications in this cohort was 6%. The most common postoperative complications were readmission (97 cases), surgical site infection (43), reoperation (39), prolonged hospital stay (24), urinary tract infection (3), 30-day mortality (3) and cardiac arrest (2). We found no differences in the incidence of complications in anemic versus nonanemic patients on bivariate analysis or multivariable logistic regression (adjusted odds ratio = 1.2; 95% confidence interval: 0.8–1.7; P = 0.319).ConclusionsIn relatively healthy infants undergoing pyloromyotomy, untreated preoperative anemia was not associated with postoperative compilations and should not be considered a significant risk factor.Level of evidence III.     

组织灌注导向红细胞输注策略对重症患者预后的影响

  目的  比较依据美国东部创伤外科学会/美国重症医学院/美国重症医学联合会(Eastern Association for Surgery of Trauma/American College of Critical Care Medicine/Society of Critical Care Medicine, EAST/ACCM/SCCM)成人创伤与重症患者输血指南(2009年)的红细胞(red blood cell, RBC)输注策略与组织灌注导向的RBC输注策略对重症患者预后影响的差异。  方法  北京协和医院重症医学科在2013年采用依据EAST/ACCM/SCCM成人创伤与重症患者输血指南(2009年)的RBC输注策略指导临床输血, 2014年采用组织灌注导向的RBC输注策略指导临床输血。比较两年所有重症监护病房(intensive care unit, ICU)患者和急性生理学及慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health Evaluation Ⅱ, APACHE Ⅱ)≥ 15分患者的住院死亡率、ICU停留时间、新发的器官功能损伤发病率、输RBC前平均血红蛋白(hemoglobin, Hb)水平、入ICU血乳酸水平(Lac_入)、输RBC前血乳酸水平(Lac_输RBC前)、人均RBC输注量, 以及输血相关并发症发生率。  结果  2014年ICU收治患者2638例, 2013年2110例。2014年患者平均入ICU APACHE Ⅱ评分及APACHE Ⅱ评分≥ 15分患者占所有患者比例均高于2013年(P < 0.05)。2014年输注RBC患者占所有患者比例显著低于2013年(P < 0.05)。两年间输血前Hb水平、Lac_入、Lac_入 < 4 mmol/L患者占所有患者比例差异均无统计学意义(P> 0.05)。2014年Lac_输RBC前显著高于2013年[(4.16±1.18)mmol/L比(2.78±1.03)mmol/L, P=0.031], 2014年输RBC患者中Lac_入 < 4 mmol/L患者占所有患者比例显著低于2013年(20.5%比33.4%, P=0.018), 人均RBC输注量2014年比2013年显著下降[(1.02±0.51)U比(1.55±0.70)U, P=0.037]。全部ICU患者两年间住院死亡率差异无统计学意义(2.77%比2.39%, P=0.749), 但平均ICU停留时间2014年明显较短[(5.31±1.98)d比(6.84±2.36)d, P=0.025];新发的急性肾损伤、急性肝损伤、急性心肌损伤及急性肺损伤的发病率两年间差异均无统计学意义(P>0.05)。而在APACHE Ⅱ ≥ 15分患者中, 2014年住院死亡率比2013年显著降低(7.00%比12.01%, P=0.018), 平均ICU停留时间显著短于2013年[(7.16±3.53)d比(12.44±5.27)d, P < 0.001], 新发的急性肾损伤、急性心肌损伤及急性肺损伤的发病率也显著低于2013年(P < 0.05)。两年均未发生输血相关感染及输血相关性溶血的不良事件。总ICU患者及APACHE Ⅱ ≥ 15分患者的非溶血性发热性输血反应及输血相关肺损伤发病率两年间差异无统计学意义(P>0.05)。  结论  组织灌注导向的RBC输注策略与EAST/ACCM/SCCM指南指导下的RBC输注策略相比, 能够有效降低ICU患者RBC输注量, 缩短ICU停留时间, 特别是对APACHE Ⅱ ≥ 15分的重症ICU患者, 还能有效降低其住院死亡率, 降低新发急性肾损伤、急性心肌损伤及急性肺损伤的发病率, 而不增加输血相关并发症发生率。     

A new approach for fat removal in a discontinuous autotransfusion device–concept and evaluation

Background

Fat present during blood salvage in orthopaedic or cardiac surgery can pose a risk of fat embolism and should be eliminated before transfusion. Based on observations of central fat accumulation at the bottom of Latham bowls, a fat reduction program was developed using two volume displacements, where blood temporarily is removed and respun in the bowl to force the fat through the RBC sediment.

Materials and methods

Pooled ABO‐matched RBC and FFP were adjusted to a haematocrit of 10%, and human fat tissue added to a concentration of 1·25 vol%. In six experiments, blood was processed with the new‐generation cell salvage device CS Elite in a newly developed fat reduction program in bowls of three sizes. Volumetric quantification of fat was performed after centrifugation of blood samples in Pasteur pipettes. From volumes, haematocrits and the concentrations of fat, RBC recovery and fat elimination rates were calculated.

Results

Fat removal rates of 93·2 ± 2·8, 97·0 ± 2·1 and 99·6 ± 0·3% were observed with a 70‐ml, 125‐ml and 225‐ml bowl, respectively, and even higher rates when removal rates were calculated one cycle. At the same time, high RBC recovery and plasma elimination rates were maintained, not significantly different to the default program mode.

Conclusion

Modifications in process parameters and sequence led to a fat reduction program that significantly improves fat removal with the Cell Saver Elite from 77·4 ± 5·1% in the default mode to an average of 98·6 ± 1·1%, yielding results equivalent to the continuous cell salvage system (C.A.T.S).     

Extracellular vesicle characteristics in stored red blood cell concentrates are influenced by the method of detection

Extracellular vesicles (EVs), including microvesicles and exosomes, are small phospholipid vesicles (≤1 μm in diameter) that are present in blood products, accumulate during storage, and have a potential transfusion-related immunomodulatory role. Knowledge of EVs in stored blood products is limited due to the challenges and difficulties in detecting these heterogeneous submicron-sized vesicles. The aim of this study was to assess the impact of different approaches to characterize EVs in stored RBC products. Quantification and size-profiling of EVs in leukoreduced red cell concentrates (RCCs) were examined on day 3, 7, 21, and 42 of storage using tunable resistive plus sensing (TRPS), flow cytometer (FC), and dynamic light scatting (DLS) methods. Using the TRPS method, the concentration of EVs < 200 nm significantly increased throughout storage (p < 0.05). This change in exosome concentration was not detectable with FC or DLS due to limitations in their ability to resolve particles <200 nm and/or accurately determine EV concentration. Both the TRPS and FC demonstrate that the concentration of EVs ≥ 200 nm significantly increases in RCCs by day 42/43 compared to EVs present on day 3 (p < 0.001). As the DLS measures the average size of particles in suspension, only an increase in the zeta-average size was observed during storage. EV size and concentration in RBC products is significantly influenced by the length of storage. Overall, this study shows that combining technologies may be important to improve the characterization and study of EVs in stored RCCs.     

The effects of polyvinyl chloride and polyolefin blood bags on red blood cells stored in a new additive solution.

BACKGROUND AND OBJECTIVES: Red blood cells (RBCs) must be stored in polyvinyl chloride (PVC) bags plasticized with di-2-ethylhexyl phthalate or a similar plasticizer to achieve their full storage life with conventional storage solutions. Improved storage solutions might remove this requirement and allow blood storage in other plastics. Experimental Additive Solution-61 (EAS-61), which maintains RBCs for 9 weeks with reduced haemolysis and satisfactory 51Cr 24-h recovery, is an appropriate candidate improved RBC storage solution. MATERIALS AND METHODS: Twenty-four units of packed RBCs were pooled in groups of four units, each pool was realiquoted into four units and stored, six pooled units per arm, in one of the following: 100 ml of EAS-61 in PVC; 200 ml of EAS-61 in PVC; 100 ml of EAS-61 in polyolefin (PO); and 200 ml of EAS-61 in PO. Haemolysis, RBC morphology indices, RBC ATP concentrations, and other measures of RBC metabolism and function were measured weekly. RESULTS: RBC haemolysis exceeded 1% by 7 weeks in PO bags containing 100 ml or 200 ml of EAS-61. In PVC bags, haemolysis was less than 1% at 11 weeks. RBC ATP concentrations were 1 mol/g of haemoglobin (Hb) higher at 2 weeks in the PVC-stored units. CONCLUSIONS: RBCs stored in PVC had markedly less haemolysis and higher RBC ATP concentrations than those stored in PO. Haemolysis would limit RBC storage in PO bags to a duration of 6 weeks, even with EAS-61.