血液病患者输血不良反应分析

目的:探讨血液病患者发生输血不良反应的原因及预防策略。方法:回顾性分析2014年1月至2017年12月于北京市第六医院输血的150例血液病患者临床资料,共输血5 184例次,收集输血不良反应回报单,内容包括患者基本信息、诊断、输血类型、输血时间、是否有输血史、妊娠史、输血不良反应史,以及出现临床症状的详细记录,血库每周汇总输血不良反应回报单。结果:输血5 184例次共发生输血不良反应112例次,发生率2.16%,其中变态反应68例次（1.32%）,以输注血小板引起为主;发热44例次（0.85%）,以输注悬浮红细胞引起为主,未发现其他输血不良反应。有输血史、过敏史患者输血不良反应发生率均高于无输血史、过敏史患者,差异均有统计学意义[2.34%（102/4 350）比1.20%（10/834）, χ2=6.899, P=0.009;3.06%（98/3 200）比1.42%（14/984）, χ2=7.767, P=0.005];女性患者输血不良反应发生率高于男性患者,差异有统计学意义[2.82%（60/2 126）比1.70%（52/3 058）, χ2=8.356, P=0.004];年龄<18岁和≥18岁患者输血不良反应发生率差异无统计学意义[1.16%（3/259）比2.21%（109/4 925）, χ2=1.295, P=0.255]。 结论:成分输血不良反应主要表现为变态反应和非溶血性发热,临床医务人员需仔细把控输血指征,选择合适的血液成分,以减少输血不良反应,保障输血安全。

Analysis of adverse reactions of blood transfusion in patients with hematological diseases

Objective:To explore the causes and preventive strategies of adverse reactions of blood transfusion in patients with hematological diseases.Methods:The clinical data of 150 hematological patients who received 5 184 cases of blood transfusion in Beijing No.6 Hospital from January 2014 to December 2017 were retrospectively analyzed. The blood transfusion adverse reaction reporting forms were collected, and the content of the form included the basic information of the patient, diagnosis, blood transfusion type, blood transfusion time, blood transfusion history, pregnancy history, adverse reaction history of blood transfusion as well as detailed records of clinical symptoms. The blood bank summarized the blood transfusion adverse reaction reporting forms every week.Results:A total of 112 cases of adverse reactions occurred in 5 184 cases of blood transfusion, the incidence rate was 2.16%. Sixty-eight cases (1.32%) had anaphylaxis, mainly caused by platelet transfusion, and 44 cases (0.85%) had fever, mainly caused by transfusion of red blood cells suspension, and no other adverse reactions were found. The incidence rates of adverse reactions of blood transfusion in patients with blood transfusion history and anaphylaxis history were significantly higher than those in patients without blood transfusion history and anaphylaxis history, and the differences were statistically significant [2.34% (102/4 350) vs. 1.20% (10/834), χ2 = 6.899, P = 0.009; 3.06% (98/3 200) vs. 1.42% (14/984), χ2 = 7.767, P = 0.005]; the incidence rate of adverse reactions of blood transfusion in female patients was significantly higher than that in male patients, and the difference was statistically significant [2.82% (60/2 126) vs. 1.70% (52/3 058), χ2 = 8.356, P = 0.004]; there was no significant difference in the incidence rate of adverse reactions of blood transfusion between patients < 18 years old and ≥ 18 years old [1.16% (3/259) vs. 2.21% (109/4 925), χ2 = 1.295, P = 0.255]. Conclusions:The main manifestations of adverse reactions of component blood transfusion are anaphylaxis and non-hemolytic fever. Clinical medical staff must carefully control the blood transfusion indications and select the appropriate blood components to reduce the adverse reactions of blood transfusion and ensure the safety of blood transfusion.