目的 分析不同献血总次数的男性单采血小板献血者血常规中血小板与白细胞相关指标的变化,评估献血次数对献血者外周血液学相关指标的影响.方法 选择2020年4月23日～2021年4月23日在本中心成功捐献单采血小板且献血总次数分别为初次、十的整数倍次及百次以上的448名男性自愿无偿献血者,其中十次以上的献血者年献血次数≥8次,比较献血者末次单采前外周血中PLT、PDW、MPV、P-LCR、PCT、WBC、NEUT#、LYMPH#、MONO#、EO#和BASO#指标的变化.结果 总献血次数百次以上男性单采血小板献血者的WBC、PLT、PCT、NEUT#和LYMPH#相较于初次男性单采血小板献血者差异有统计学意义(P<0.01),其中WBC、PCT、NEUT#虽差异有统计学意义,但两组献血者三项指标中位数仍在正常参考值范围内,PLT则在可捐献单采血小板血液检查要求(≥150×109/L且<450×109/L)范围内.百次以上男性单采血小板献血者LYMPH#低于正常参考值发生率为86.21％,初次男性单采血小板献血者LYMPH#低于正常参考值发生率为6.37％,差异有统计学意义(P<0.01);献血次数越多的单采血小板献血者,LYMPH#水平整体显著更低;献血次数为20、30次的单采血小板献血者中LYMPH#低于正常参考值者高达46.38％,且随着献血次数的增多,LYMPH#低于正常参考值者占比逐步增高.结论 多次数捐献单采血小板会导致献血者LYMPH#水平低于正常参考值,采供血机构在单采血小板献血者招募工作中应重视该现象.

目的 了解十二指肠乳头癌行Whipple手术患者术前贫血及围术期输血情况.方法 回顾性分析1959例十二指肠乳头癌行Whipple手术患者临床资料.结果 十二指肠乳头癌行Whipple手术患者术前贫血率为54.87％(1075/1959),从低到高3个年龄段患者贫血发生率分别为44.92％(≤50岁,190/423)、52.82％(51～64岁,506/958)、65.57％(≥65岁,379/578) (P＜0.05),贫血率最高的年龄段为65岁以上.不同身体质量指数(BMI)患者贫血发生率也有较大的差异(P＜0.05).中重度贫血患者相比轻度贫血患者围术期输注了更多的红细胞(P＜0.05).输血患者平均住院时长为27.25d,未输血组为22.22d(P＜0.05).腹腔镜、机器人手术患者术中出血量、住院时长均显著低于开腹手术患者(P＜0.05).住院期间单纯使用药物进行贫血干预的患者仅占24.09％ (186/772),大部分患者通过输血来干预贫血(75.91％,586/772).结论 十二指肠乳头癌行Whipple手术患者术前贫血发生率存在显著差异,BMI指数偏小、WBC异常、围术期输血均为住院时间延长的高危因素,而贫血则不会导致患者住院时间延长.

Allergic transfusion reaction (ATR) caused by plasma transfusion is one of the main adverse transfusion reactions, and severe allergic reactions may even endanger the patient's life. Currently, ATR is mainly prevented and controlled by drug prevention and symptomatic treatment, and there still lack of preventive measures such as in vitro experiments. It has been shown that mast cells and basophils are the main effector cells of allergic reactions, and histamine is one of the main mediators of IgE-mediated allergic reactions. Some experiments can be used to identify patients with allergies or plasma components containing allergens, such as detection of serum-specific IgE, IgA, anti-IgA antibody, tryptase and histamine, mast cell degranulation test, basophil activation test, and so on. The basophil activation test can also be used for functional matching of plasma in vitro. Research of in vitro experiment of ATR is good for directing the precise infusion of plasma, reducing waste of resources, and avoiding the risk of blood transfusion. As a pre-transfusion laboratory test for clinical use, in vitro experiment of functional matching provides a new way to prevent ATR.

目的 通过对普通血浆袋的改进,实现可测定血浆的中心温度;比较两种水浴温度37℃和45℃条件下,相同血浆容量、相同中心温度时解冻时间的差异,通过缩短血浆解冻时间,以保障临床急诊用血特别是急诊科“绿色通道”患者的紧急用血.方法 改进常规血浆袋,将温度测定装置通过特殊管道插入并固定在血浆袋的中心位置,以准确测定血浆的中心温度;使用温度记录仪可实时监测并记录不同处理过程血浆中心温度的变化,通过温度记录比较两种水浴温度血浆解冻时间的差异.结果 两种水浴温度下解冻100mL容量血浆,提高水浴温度到45℃相比常规37℃可缩短38.4％～43.4％的解冻时间;解冻200mL容量血浆,提高水浴温度到45℃相比常规37℃可缩短38.1％～38.8％的解冻时间.结论 提高水浴温度至45℃可缩短接近40％的时间,可以更快地完成血浆解冻,从而在急诊紧急用血情况下,更快速地保障临床用血,为抢救生命争取时间.

Complement cascade plays an important role in the field of transfusion medicine. The study aimed to detect the complement levels of different blood components and different blood types to explore the risk of transfusion of stored blood. The samples including red blood cells (n = 110), fresh frozen plasma (n = 120), and platelet concentrates (n = 104) from healthy blood donors in our center were collected. Complement components (C3, C4, C3b, C3d, and CH50) were assayed to evaluate the activation of complement. The complement levels of various blood components at different storage times were observed. The differences in complement levels of four blood types in various blood components were compared. The complement levels of red blood cells in storage were low, with no significant changes (P > 0.05). C3b and C3d levels in platelets began to significantly increase after storage for 3 days (P < 0.05). The fresh frozen plasma during storage had higher complement levels, and the concentrations of C3 and C4 decreased and C3b and C3d increased at month 4 (P < 0.05). The differences in complement levels of four blood types in various blood components did not significantly change (P > 0.05), but the C3b and C3d levels of AB fresh frozen plasma remained stable during storage, which different from other blood types. The transfusion of red blood cells was relatively safe in terms of complement activation. The activation of complement proteins occurred during the storage of platelet and plasma, except group AB plasma.

目的 对比分析2013 ～2017年某医院献血中心采集的5种血源的检测结果数据,提出优化采血工作模式,减少血液不合格率的建议.方法 收集2013 ～2017年某医院院内团体献血、院外团体献血、成分献血、街头采血、互助献血五种血源ALT及血液感染性指标HBsAg、抗-HCV、抗-HIV、抗-TP数据进行统计分析.结果 2013～ 2017年五种血源标本共198662例,互助献血人群血液不合格率最高,其次是街头采血;5项检查中ALT不合格率居第一,其次为HBsAg;初筛可以有效降低采血后血液不合格率,其差异具有统计学意义.结论 优化献血流程,加强质量管理和规范操作,确保输血安全,减少浪费.

Objective To compare results of serological four items (HBsAg,Anti-HCV,Anti-TP and Anti HIV) in serum by ELISA between mutual aid blood donors and volunteer blood donors in our hospital,in order to provide a basis for further evaluating the risk of blood borne diseases in different blood donors.Methods We reviewed 29935 blood donors' results for determination of the serological four items in our hospital collected from January 2015 to November and retrospectively analyzed.According to the types of blood donors,the blood donors were divided into voluntary blood donation group and mutual aid group.Then the negative and positive results of the serological four items in two groups were statistically analyzed.Results There were 14940 cases of blood donors in the mutual aid blood donation group,628 cases of which were unqualified,accounted for 4.20％.The failure rates of HBsAg,Anti-HCV,Anti-TP and Anti-HIV were 2.23％,0.72％,1.14％ and 0.10％ respectively.Meanwhile,there were 14995 cases of blood donors in the voluntary blood donation group,154 cases of which were unqualified by results of the serological four items,accounted for 1.35％.The failure rates of HBsAg,Anti-HCV,Anti-TP and AntiHIV were 0.23％,0.42％,0.35％ and 0.02％ respectively.The total failure rate and the unqualified rates of HBsAg and Anti-TP had statistically significance between the mutual aidblood donation group and the voluntary blood donation group.Conclusion Blood safety from mutual blood donation seemed to be much lower than the voluntary blood donation.

Objective To discuss the feasibility of the preset frame quality control method in ELISA.Methods We evaluated consecutively 20 batches of internal quality control data at the same quality control batch number in ELISA.The data were analyzed by the Grubbs method,the preset frame quality control method and the Levery-Jennings method.We observed its situations in the control,alarm and out of control cases.Results Case one:In the Grubbs method,the 6th point of the 20 batches internal quality control data is the alarm and the rest of the data are in the control.In the preset frame quality control method,the 6th and the 7th point is out of control and the rest of the data are in the control cases.In the Levery-Jennings method,the 6th point is out of control case,the 7th point is alarm and the rest of the data are in the control cases.Case two:In the Grubbs method,all of the 20 batches are in the control cases.In the preset frame quality control method,the 22th point is alarm case and the rest of the data are in the control cases.In the Levery-Jennings method,the 22th point is alarm case and the rest of the data are in the control cases.Conclusion The preset frame quality control method can be used as an internal quality control method in ELISA.

Objective To understand the trends of blood infectious indicators in voluntary blood donors from 2012 to 2016 in our hospital in order to improve blood safety and blood quality,reduce the incidence of blood-transmitted diseases and provide better directions for the voluntary blood donation.Methods Screening results of the 5 indicators including ALT, HBsAg, anti-HCV, anti-HIV and anti-TP from 2012 to 2016 in our hospital were collected and analyzed.Results During 5 years, the overall positive rates of ALT、HBsAg、anti-HCV、anti-HIV and anti-TP in 206962 blood donors were 5.8%, 0.64%, 0.45%, 0.31% and 0.61%, respectively.For each unqualified indicator, the positive rate had significant difference between male and female.Positive rate of anti-HIV was 5.31 per 10000.Conclusion The positive rates of ALT took the first place in all unqualified indicators from blood samples, followed by that of anti-TP and HBsAg.The positive rate of HIV increased, indicating an intensive propaganda and consultation before donation should be performed to exclude the people with high risk behaviors.Regular voluntary blood donation team should be established to strengthen quality management, standardize the operation, and reduce the incidence of blood-transmitted diseases.