重型β地中海贫血患者输注保存不同时间红细胞后血红蛋白浓度的变化  

Changes of hemoglobin levels in patients with β- thalassemia major for different duration of preservation after infusing red blood cells

作　　者：何圆圆[1] 曾丽红[2] 庄远[3] 耿志丽[1] 岑艳陶[2] 谭丽荻 周雪花[2] 吴慧[1] 周天红[1] 尹晓林[1] 张新华[1] 汪德清[3] 

机构地区：[1]解放军第三〇三医院血液科,广西南宁530021 [2]解放军南宁血站解放军第三〇三医院输血科 [3]解放军总医院输血科

出　　处：《中国输血杂志》2015年第11期1351-1354,共4页Chinese Journal of Blood Transfusion

基　　金：卫生行业科研专项(201002005)

摘　　要：目的探讨重型β地中海贫血(TM)患者输注红细胞的疗效及红细胞保存时间对TM输血效果的影响。方法将采集后6-8 h完成白细胞过滤、血细胞比容(Hct)45%-47%、常规检测合格的血液52(人)份(400 m L/份),各自等分成2份1 U的少白红细胞(少白RBC)备用;给按研究标准纳入的52名TM患者分别输注采自同一献血者储存至d3(新鲜血)和d17(陈旧血)的少白RBC各1 U(200 m L/U),并在输血前、输血后24 h和输血后d14分别做血细胞分析。结果本组52例TM中,除10例脱落外,有42例完成研究,其血清铁蛋白(SF)为125 1.00-7406.07(中位值343 4.6)ng/m L,其中重度铁过载28例,肝大16例,脾大38例。5次检测Hb(g/L)依次为80.9+16.1、100.7+14.5、83.4+12.8、100.9+12.2和82.1+12.6。TM患者输新鲜血和陈旧血后每10 kg体重Hb(g/L)分别提升33.0+8.5和29.4+10.0(P<0.05),输血后d14 Hb(g/L)分别下降30.4+14.3和32.1+11.6(P>0.05)。新鲜血输注后Hb降低量与SF和重度铁过载呈正相关关系;陈旧血输注后Hb降低量与肝大呈正相关关系。结论铁超载、肝脏增大影响TM患者输血的效果。保存时间短的红细胞(新鲜血)提升Hb的幅度大于保存时间长的红细胞(陈旧血)。Objective To discuss the changes of hemoglobin（ HGB） levels in patients with β- thalassemia major（ TM） for different duration of preservation after infusing red blood cells. Methods Fifty two qualified leukoreduced RBCs of 400 ml blood were prepared by filtration following 6 to 8 hours in blood collection with leukoreduced hemostix from blood donors with hematocrit（ Hct） ranging from 45% to 47%. Each leukoreduced RBC was divided into 2 identical RBC units,then stored for three days（ termed as fresh blood） and seventeen days（ termed as old blood） for transfusion,respectively.Each subject was transfused with 1 unit RBC（ 200 m L / U） of fresh and old blood from the same blood donor. Changes in hemocyte indexes were quantified before transfusion,24 hours and 14 days after transfusion of fresh and old blood,respectively. Results Among 52 patients,10 patients were ruled out. Serum ferritin（ SF） levels ranged from 1 251. 00 to 7 406. 07 ng / m L（ the median was 3 434. 6 ng / m L）,with 28 cases of severe iron overload. Hepatomegaly and splenomegaly were found in 16 cases and 38 cases,respectively. The HGB levels（ g / L） before fresh blood transfusion,24 hours after fresh blood transfusion,14 days after fresh blood transfusion（ the same as before old blood transfusion）,24 hours after old blood transfusion and 14 days after old blood transfusion were 80. 9 ＋ 16. 1,100. 7 ＋ 14. 5,83. 4 ＋ 12. 8,100. 9 ＋ 12. 2 and 82. 1＋ 12. 6,respectively. Comparing to old blood transfusion,fresh blood transfusion induced a higher HGB increment per 10 kg weight infusion at 24 hours after transfusion（ 33. 0 ＋ 8. 5 vs. 29. 4 ＋ 10. 0; P〈 0. 05）. However,no statistical significance was observed in decreasing HGB levels（ g / L） at 14 days after 24 hours of transfusion（ 30. 4 ＋ 14. 3 vs. 32. 1 ＋ 11. 6; P〉 0. 05）.The decreasing HGB levels after fresh transfusion had positive correlation with SF and severe iron overload. Likewise,the decreasing HGB levels after old transfusio

关 键 词：β地中海贫血 重型 输血 血液保存时间 红细胞 血红蛋白 血清铁蛋白 

分 类 号：R457.1[医药卫生—治疗学] R556.61[医药卫生—临床医学]