红细胞无效输注、临床输咽仟若干问题-兰炯采教授课件.ppt

红细胞无效输血 临床输血若干问题;一,重视红细胞无效输血研究 节约血液 二,减少/避免无效输血的措施 三，临床输血的其它有关问题 ;一,重视红细胞无效输血研究 节约血液 ; ㈠重视红细胞输血效果, 避免无效输血 解决临床用血紧张的有力措施:一是扩大无偿献血队伍;二是重视红细胞输血效果, 避免无效输血 ; 输血行业有两部经典著作 1, 临床输血 P.L.Mollison. Blood Transfusion in Clinical Medicine 2,输血技术 AABB.Technical Manual. ;㈢ AABB.Technical Manual.16ed. 2008 关于红细胞无效输血的论述 ⑴Noninfectious Complications of Blood Transfusion , 723 When laboratory evidence of hemolysis is not evident, demonstration of decreased red cell survival may aid in the diagnosis. Serial hemoglobin levels may be adequate, or red cell survival studies may be required in more complex cases. ;⑵Noninfectious Complications of Blood Transfusion, 739 In some cases, the hemolysis occurs without causing clinical symptoms. These patients present with unex- plained anemia or do not experience an increase in hemoglobin following transfusion. ⑶Positive DAT and Immune-Mediated Hemolysis , 503 Immune-mediated hemolysis is the shortening of red cell survival by the product(s) of an immune response. If the marrow is able to adequately compensate, the reduced red cell survival may not result in anemia. ;⑷Identification of Antibodies to Red Cell Antigens,466 A clinically significant red cell antibody is defined as an antibody that is frequently associated with….. hemolytic transfusion reactions, or with a notable decrease in the survival of transfused red cells. The degree of clinical significance varies among antibodies with the same specificity; some cause destruction of incompatible red cells within hours or even minutes, whereas others cause a decrease in the red cell survival by only a few days ;AABB技术手册 在: 多处,反复,明确→指出: 有些病人,输血后没有溶血的临床体征, 只表现为红细胞寿命缩短,Hb降低 用中文来 通俗形象表达 无效输血; ㈣RBC无效输血的回顾性临床调查 红细胞无效输血诊断标准 每次输红细胞≥3袋,无输血反应记录,无继续失血,无输液稀释,输血后24小时内复查,Hb升高不到预期值 供者Hbg/L×输血量ml Hb↑（g/L)= ×90％ 患者