小儿血液病成分输血的临床分析
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摘要
目的：探讨成分输血的输注指征，以便提高临床输血的效果，减少输血不良反应的发生，从而指导临床合理输血。
方法：回顾分析1997年1月—2001年12月小儿血液病经输血治疗的189例患儿共661例次输血的临床资料。应用分类资料频数表及统计圆图对近5年成分输血率、输血适当性及各种成分输血的输注效果、不良反应进行统计分析。
结果：近5年来小儿血液病成分输血率均在90％以上，其中红细胞输注率为61.57％；输血适当性达85.78％，但存在营养性贫血患儿红细胞输注及特发性血小板减少性紫癜(ITP)患儿血小板输注指征掌握欠严格现象，还有血浆输注扩大化及不合理的现象。全血输注治疗贫血的有效率为67.86％，不良反应发生率为9.65％；红细胞输注治疗贫血的总有效率为89.86％，不良反应发生率为0.98％；血小板输注病因不同其效果不一：治疗恶性血液病化疗后血小板减少的有效率为72.41％，治疗ITP的有效率为36.00％，血小板输注不良反应发生率为1.85％；粒细胞输注治疗恶性血液病化疗后粒细胞减少的有效率为25.00％，不良反应发生率达100.00％；血浆输注治疗恶性血液病化疗后感染有效率为38.10％，治疗血友病出血有效率为78.95％，血浆输注不良反应发生率为3.28％；冷沉淀制剂、Ⅷ因子浓缩剂输注治疗血友病出血有效率为100.00％，无不良反应发生。
结论：成分输血(除外粒细胞输注)的输注效果好，不良反应少，并能
血．多山门I约血源。严格掌握成分输血的输4甘8征，可更好的提
高成分输血．效果，减少输血．不良反应的发牛。
Objective: The present paper assess the indication of blood components transfusion in order to improve the effect and reduce the side effect of blood transfusion and to serve as a guide for the clinical blood transfusion. Methods: The clinical information of 661 times blood transfusion in 189 children with disease of the blood treated with blood transfusion from January 1997 to December 2001 were analyzed in this paper. Frequency tables and Statistic graphs were applied to indicate the ratio of blood components transfusion , the effect and side effect as well as suitability of blood components transfusion.
Results: The ratio of blood component transfusion was above 90% in which 61.57% belongs to red blood cell transfusion. The suitability of blood transfusion was 85.78%, while indications were not strictly detected in red blood cell transfusion for trophoanemia and in platelet transfusion for treatment of idiopathic thrombocytopenic purpura (ITP). Besides blood transfusion was not properly applied, the effect and side effect were 67.86% and 9.65% in whole blood transfusion, 89.86% and 0.98% reflect the effect and side effect in red blood cell transfusion. The effect of platelet transfusion varies with different pathogenesis: 72.41% in malignant disease of the blood and 35.56% in ITP, with 1.85% side effect detected; The effect of fresh frozen plasma transfusion was 38.10% for treatment of malignant disease of
the blood and 78.95% for treatment of hemophilia with the side effect of
3.28%; The effect of Neutrophil transfusion was 25.00% with its side effect
of 100%; the effect of cryoprecipitate and factor D transfusion is 100%
for haemophilia with no side effect detected.
Conclusion: Blood components transfusion (except Neutrophil transfusion)
has high clinical effects and low risks, that is recommended for use in
different cases in order to save blood resources.
Indications should be carefully held in blood components transfusion in order
to raise the clinical effects and reduce the side effect.
方法：回顾分析1997年1月—2001年12月小儿血液病经输血治疗的189例患儿共661例次输血的临床资料。应用分类资料频数表及统计圆图对近5年成分输血率、输血适当性及各种成分输血的输注效果、不良反应进行统计分析。
结果：近5年来小儿血液病成分输血率均在90％以上，其中红细胞输注率为61.57％；输血适当性达85.78％，但存在营养性贫血患儿红细胞输注及特发性血小板减少性紫癜(ITP)患儿血小板输注指征掌握欠严格现象，还有血浆输注扩大化及不合理的现象。全血输注治疗贫血的有效率为67.86％，不良反应发生率为9.65％；红细胞输注治疗贫血的总有效率为89.86％，不良反应发生率为0.98％；血小板输注病因不同其效果不一：治疗恶性血液病化疗后血小板减少的有效率为72.41％，治疗ITP的有效率为36.00％，血小板输注不良反应发生率为1.85％；粒细胞输注治疗恶性血液病化疗后粒细胞减少的有效率为25.00％，不良反应发生率达100.00％；血浆输注治疗恶性血液病化疗后感染有效率为38.10％，治疗血友病出血有效率为78.95％，血浆输注不良反应发生率为3.28％；冷沉淀制剂、Ⅷ因子浓缩剂输注治疗血友病出血有效率为100.00％，无不良反应发生。
结论：成分输血(除外粒细胞输注)的输注效果好，不良反应少，并能
血．多山门I约血源。严格掌握成分输血的输4甘8征，可更好的提
高成分输血．效果，减少输血．不良反应的发牛。
Objective: The present paper assess the indication of blood components transfusion in order to improve the effect and reduce the side effect of blood transfusion and to serve as a guide for the clinical blood transfusion. Methods: The clinical information of 661 times blood transfusion in 189 children with disease of the blood treated with blood transfusion from January 1997 to December 2001 were analyzed in this paper. Frequency tables and Statistic graphs were applied to indicate the ratio of blood components transfusion , the effect and side effect as well as suitability of blood components transfusion.
Results: The ratio of blood component transfusion was above 90% in which 61.57% belongs to red blood cell transfusion. The suitability of blood transfusion was 85.78%, while indications were not strictly detected in red blood cell transfusion for trophoanemia and in platelet transfusion for treatment of idiopathic thrombocytopenic purpura (ITP). Besides blood transfusion was not properly applied, the effect and side effect were 67.86% and 9.65% in whole blood transfusion, 89.86% and 0.98% reflect the effect and side effect in red blood cell transfusion. The effect of platelet transfusion varies with different pathogenesis: 72.41% in malignant disease of the blood and 35.56% in ITP, with 1.85% side effect detected; The effect of fresh frozen plasma transfusion was 38.10% for treatment of malignant disease of
the blood and 78.95% for treatment of hemophilia with the side effect of
3.28%; The effect of Neutrophil transfusion was 25.00% with its side effect
of 100%; the effect of cryoprecipitate and factor D transfusion is 100%
for haemophilia with no side effect detected.
Conclusion: Blood components transfusion (except Neutrophil transfusion)
has high clinical effects and low risks, that is recommended for use in
different cases in order to save blood resources.
Indications should be carefully held in blood components transfusion in order
to raise the clinical effects and reduce the side effect.
引文
1．王憬惺编著．血液制品血．北京：人民卫生出版社，1998年，第1版，P18-20
2．哈得俊，晏惠英，原耀光．成分输血的现状与前景．新医学，1996；4(27)：215-217
3．李明珍．成分输血的临床应用．中华内科杂志，1995；11(34)：782-786
4．胡开瑞，金宗壤．成分输血的国内外现状及我国存在的问题．广州医学，1999；2(10)：1-3
5．张香兰，雷登平，钱晓燕．成分输血的临床应用．青海医药杂志，2001；4(31)：60-65
6．沈溪英，袁著忻，叶明亮，等．更新观念，大力开展成分输血．解放军医学高等专科学校学报，1999；3：74-77
7．廖清奎，罗春华．重视输血医学研究，提高临床输血水平．中华儿科杂志[J]，1999：37：7-9
8．王如文编著．现代儿科血液学临床应用指导．乌鲁木齐：新疆科技卫生出版社(K)，1996年，第1版，P293-295
9．卢新天．输血与儿科临床：第一讲血细胞输注．中国实用儿科杂志，2002；17(1)：46-47
10. Bloom, Steven L, Ramin, et al. Blood and blood component theraphy. Primary Care Update for OB/GYNS, 1997;5(4):200-207
11．王培华编著．输血技术学．北京：人民卫生出版社，1998年，第1版，P18-24
12．廖清奎．临床输血技术规范．中国临床医生，2000；28(12)：23-24
13．廖清奎，孙启风，马廉，等．贫血患者的红细胞输注指征和常用红细胞制剂的适应症．中国输血杂志，1998；3(11)：164-166
14．Hogmen CF. Heamotherary with red cell concentrates and a new red cell storage medium. Lancet, 1998; 1(19):26-31
15．张晓林．红细胞输注的临床应用．四川医学，2000；5(21)：423-425
16．马伴吟．贫血的输血治疗．中国实用儿科杂志，1997；12(4)：211-214
17．贾苍松，廖清奎．谨防输血过量所致循环负荷过重．小儿急救医学，2001；8(3)：178-179
18．周晨燕，廖清奎，孙启凤，等．血小板输注的临床应用．中国实用儿科杂志，1998；13(2)：121-124
19．Gebauer E, Vijatov G. Idiopathic thrombocytopeniC purpura in children. Med Pregl, 1998; 51(3):127-130
20．中华医学会儿科分会血液组．特发性血小板减少性紫癜诊疗建议(修订草案)．中国实用儿科杂志，1999；14(7)：441-442
21．陈会友，田兆嵩．出血性疾病患者的成分输血．中国输血杂志，1999；12(4)：269-275
22．汪传喜，田兆嵩．血小板输注的现状与展望．中国输血杂志，2000：13(4)：28-31
23．何威逊．血浆输注和血浆置换．中国实用儿科杂志，1997；12(4)：204-205．
24．廖清奎，马廉．常见小儿血液病输血．国外医学输血及血液学分册，1994；17(3)：145-147
25．廖清奎．输血不良反应．中国小儿血液学，1998；6(3)：275-279
26. MohandasK. Transfusion requirement, risks and costs for patient with maligancy. Transfusion, 1995; 35:427-430
27．周密，廖清奎．输血与儿科临床：第二讲输血相关性急性肺损伤及移植物抗宿主病．中国实用儿科杂志，2002；17(2)：116-117
28．罗春华，孔佩艳．输血相关性移植物抗宿主病．国外医学输血及血液学分册，1996；19(5)：295-298
29. Metha J, Pomles R, Singhal S, et al. Transfusion requirenment after bone marrow transplantation from HLA-indentical siblings: effects of donor-receipt ABO incompatibility. Bone Morrow Transplant, 1996; 18(1):151-157
30．翟晓文，吴月．输血对机体免疫功能的影响．国外医学儿科学分册，2000；27(3)：116-117
31. Blajchman MA, Bordin JC. The tumor growthpromoting effect of allogeneic blood tansfusions. Immunol Invest, 1995;25:311-317
32. Seghatchian J. Bacterial contamination of blood components. Transfusion and Apheresis Science, 2001;2(25):147-150
33. Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, confrolled clinical of transfusion requirements in critical care. NEngl J Med, 1999; 340:409-452
34． Kao KK, MLU der R. Role of class-Ⅱ Major histocompatibility complex (MHC) antigen-positive donor leukocytes in transfusion induce alloimmunization to donor class-I MHC antigens. Blood, 1998; 92:690-693
35． Chow MP, Hu Hy, Lyou Jy, et al. Red cells HLA and platelet antibody formation in patients with multiply transfusion. Taiwan Acta Haematol, 1994; 92 (2) :57-60
36． Blajchma MA. Allogeneic blood transfusion immunomodulation and postoperative bacterial infection. Transfusion, 1997; 37:121-125
37． 吴强，张林杰，姚立人．同种同品系输血对小鼠16黑色素瘤肺转移的 促进作用．肿瘤防治研究，1994；21(5) ：278-280
38． Horviers JG, van de Velde CJ, van de Watering LM, et al. Transfusion of cells is associated with increased incidence of bacterial infection after colorectal surgery. Transfusion, 1997; 37:1260-1263
39． Blajchman MA. Transfusion-associated immunomodulation and universal white cell reduction : are we putting the cart before the horse? Transfusion, 1999; 39:665-670
40． Verdoncok LF, Petersen EJ, Lokhorst HM, et al. Donor leukocyte infusions for marrow transplantation: impact of infused and residual donor T cells. Bone Marrow Transplant, 1998 ;
22:1057-1063
41. Jerard Seghatchian. New developments in blood components: focus on improved safety of blood components through process modification. Transfusion and Apheresis Science, 2001; 2(24):231-235
42. Vignon D. Keukodepletion of labile blood products. Ann Pharm Fr, 1999; 57:61-65
43．任红，王秋实，徐刚．儿科重症血液病的成分输血效果．小儿急救医学，2000；3(7)：156-157
44．陈澍英，邹小立，林伟，等．66例血液病患者血小板输注效果与HLA关联的研究．广东医学，1999；20(7)：492-493
45．伍曼仪，杨慧敏，廖国仪，等．血小板输注的临床效果．中国小儿血液学，2000；1(5)：5-7
46．阎石，韩平，陈稚勇．血小板输注无效的临床问题．中华血液杂志，1993；14(12)：659-661
47．陈根本，马廉，李彤，等．小儿白血病临床输血的效果．白血病，1999；8(2)：100-101
48．廖清奎．出凝血疾病时凝血因子及血小板输注问题．中国实用儿科杂志，1994；9(4)：216-218
2．哈得俊，晏惠英，原耀光．成分输血的现状与前景．新医学，1996；4(27)：215-217
3．李明珍．成分输血的临床应用．中华内科杂志，1995；11(34)：782-786
4．胡开瑞，金宗壤．成分输血的国内外现状及我国存在的问题．广州医学，1999；2(10)：1-3
5．张香兰，雷登平，钱晓燕．成分输血的临床应用．青海医药杂志，2001；4(31)：60-65
6．沈溪英，袁著忻，叶明亮，等．更新观念，大力开展成分输血．解放军医学高等专科学校学报，1999；3：74-77
7．廖清奎，罗春华．重视输血医学研究，提高临床输血水平．中华儿科杂志[J]，1999：37：7-9
8．王如文编著．现代儿科血液学临床应用指导．乌鲁木齐：新疆科技卫生出版社(K)，1996年，第1版，P293-295
9．卢新天．输血与儿科临床：第一讲血细胞输注．中国实用儿科杂志，2002；17(1)：46-47
10. Bloom, Steven L, Ramin, et al. Blood and blood component theraphy. Primary Care Update for OB/GYNS, 1997;5(4):200-207
11．王培华编著．输血技术学．北京：人民卫生出版社，1998年，第1版，P18-24
12．廖清奎．临床输血技术规范．中国临床医生，2000；28(12)：23-24
13．廖清奎，孙启风，马廉，等．贫血患者的红细胞输注指征和常用红细胞制剂的适应症．中国输血杂志，1998；3(11)：164-166
14．Hogmen CF. Heamotherary with red cell concentrates and a new red cell storage medium. Lancet, 1998; 1(19):26-31
15．张晓林．红细胞输注的临床应用．四川医学，2000；5(21)：423-425
16．马伴吟．贫血的输血治疗．中国实用儿科杂志，1997；12(4)：211-214
17．贾苍松，廖清奎．谨防输血过量所致循环负荷过重．小儿急救医学，2001；8(3)：178-179
18．周晨燕，廖清奎，孙启凤，等．血小板输注的临床应用．中国实用儿科杂志，1998；13(2)：121-124
19．Gebauer E, Vijatov G. Idiopathic thrombocytopeniC purpura in children. Med Pregl, 1998; 51(3):127-130
20．中华医学会儿科分会血液组．特发性血小板减少性紫癜诊疗建议(修订草案)．中国实用儿科杂志，1999；14(7)：441-442
21．陈会友，田兆嵩．出血性疾病患者的成分输血．中国输血杂志，1999；12(4)：269-275
22．汪传喜，田兆嵩．血小板输注的现状与展望．中国输血杂志，2000：13(4)：28-31
23．何威逊．血浆输注和血浆置换．中国实用儿科杂志，1997；12(4)：204-205．
24．廖清奎，马廉．常见小儿血液病输血．国外医学输血及血液学分册，1994；17(3)：145-147
25．廖清奎．输血不良反应．中国小儿血液学，1998；6(3)：275-279
26. MohandasK. Transfusion requirement, risks and costs for patient with maligancy. Transfusion, 1995; 35:427-430
27．周密，廖清奎．输血与儿科临床：第二讲输血相关性急性肺损伤及移植物抗宿主病．中国实用儿科杂志，2002；17(2)：116-117
28．罗春华，孔佩艳．输血相关性移植物抗宿主病．国外医学输血及血液学分册，1996；19(5)：295-298
29. Metha J, Pomles R, Singhal S, et al. Transfusion requirenment after bone marrow transplantation from HLA-indentical siblings: effects of donor-receipt ABO incompatibility. Bone Morrow Transplant, 1996; 18(1):151-157
30．翟晓文，吴月．输血对机体免疫功能的影响．国外医学儿科学分册，2000；27(3)：116-117
31. Blajchman MA, Bordin JC. The tumor growthpromoting effect of allogeneic blood tansfusions. Immunol Invest, 1995;25:311-317
32. Seghatchian J. Bacterial contamination of blood components. Transfusion and Apheresis Science, 2001;2(25):147-150
33. Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, confrolled clinical of transfusion requirements in critical care. NEngl J Med, 1999; 340:409-452
34． Kao KK, MLU der R. Role of class-Ⅱ Major histocompatibility complex (MHC) antigen-positive donor leukocytes in transfusion induce alloimmunization to donor class-I MHC antigens. Blood, 1998; 92:690-693
35． Chow MP, Hu Hy, Lyou Jy, et al. Red cells HLA and platelet antibody formation in patients with multiply transfusion. Taiwan Acta Haematol, 1994; 92 (2) :57-60
36． Blajchma MA. Allogeneic blood transfusion immunomodulation and postoperative bacterial infection. Transfusion, 1997; 37:121-125
37． 吴强，张林杰，姚立人．同种同品系输血对小鼠16黑色素瘤肺转移的 促进作用．肿瘤防治研究，1994；21(5) ：278-280
38． Horviers JG, van de Velde CJ, van de Watering LM, et al. Transfusion of cells is associated with increased incidence of bacterial infection after colorectal surgery. Transfusion, 1997; 37:1260-1263
39． Blajchman MA. Transfusion-associated immunomodulation and universal white cell reduction : are we putting the cart before the horse? Transfusion, 1999; 39:665-670
40． Verdoncok LF, Petersen EJ, Lokhorst HM, et al. Donor leukocyte infusions for marrow transplantation: impact of infused and residual donor T cells. Bone Marrow Transplant, 1998 ;
22:1057-1063
41. Jerard Seghatchian. New developments in blood components: focus on improved safety of blood components through process modification. Transfusion and Apheresis Science, 2001; 2(24):231-235
42. Vignon D. Keukodepletion of labile blood products. Ann Pharm Fr, 1999; 57:61-65
43．任红，王秋实，徐刚．儿科重症血液病的成分输血效果．小儿急救医学，2000；3(7)：156-157
44．陈澍英，邹小立，林伟，等．66例血液病患者血小板输注效果与HLA关联的研究．广东医学，1999；20(7)：492-493
45．伍曼仪，杨慧敏，廖国仪，等．血小板输注的临床效果．中国小儿血液学，2000；1(5)：5-7
46．阎石，韩平，陈稚勇．血小板输注无效的临床问题．中华血液杂志，1993；14(12)：659-661
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