输血不良反应发生情况调查分析  

Investigation and analysis on adverse transfusion reactions

作　　者：裴德翠 文思思 胡海春 罗庆华[2] PEI Decui;WEN Sisi;HU Haichun;LUO Qinghua(Department of Blood Transfusion,Huadu People＇s Hospital,Guangzhou,510800,China;Maternal and Child Health Care Hospital of Huadu District)

机构地区：[1]广州市花都区人民医院输血科,广州510800 [2]广州市花都区妇幼保健院

出　　处：《临床血液学杂志（输血与检验）》2018年第4期613-617,共5页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

摘　　要：目的:调查分析临床输血不良反应发生情况,探讨输血不良反应发生的预防措施,提高输血安全性。方法:收集2014-01—2017-12上报到输血科的不良反应患者,根据临床表现、实验室结果回顾性分析近4年输血不良反应发生情况。结果:28 996例输血患者中,输血不良反应135例(0.47%)。其中红细胞悬液输注发生93例(68.89%),血浆输注发生35例(25.93%),血小板输注发生4例(2.96%),其他3例(2.22%)由洗涤红细胞和冷沉淀输注导致。所有不良反应发生类型中,非溶血性发热反应(FNHTR)最常见,占所有不良反应的60.00%,其次为过敏反应,占34.81%,输血相关性循环超负荷(TACO)占1.48%,疑似输血不良反应占3.70%。有输血史或妊娠史的患者输血不良反应率显著性高于无输血史或妊娠史的患者(P<0.01)。血液成分与不良反应类型之间差异有统计学意义(P<0.01)。临床输血不良反应主要由红细胞悬液输注导致的FNHTR和血浆输注导致的过敏反应组成,除了2例诊断为TACO的严重不良反应外,没有溶血性及输血相关性急性肺损伤(TRALI)等严重输血不良反应和迟发型输血不良反应发生。结论:根据不同血液成分或不同患者发生不良反应情况,采用相应措施进行预防,有利于减少常见输血不良反应的发生。医院应加强医护人员输血不良反应监测及上报的培训,建立积极血液预警系统,减少严重不良反应的漏报,保障用血安全。Objective：To investigate and analyze the adverse transfusion reactions（ATRs）in a hospital and discuss the prevention of ATRs and improve transfusion safety.Method：ATRs reported to the Department of Transfusion from January 2014 to December 2017 were recorded and studied,The types and relative factors of ATRs were analyzed on the basis of their clinical features and lab tests.Result：Among 28996 cases,135 ATRs（0.47%）were reported.Of all the reported ATRs,93（68.89%）occurred with packed red cells,35（25.93%）occurred with Plasma,while platelets and other blood compositions transfusions were responsible for 4（2.96%）and（3）2.22%,respectively.The febrile nonhemolytic transfusion reactions（FNHTRs）were maximum（60.00%）followed by allergic reactions（34.81%）,transfusion-associated circulatory overload（TACO）（1.48%）and doubtful ATRs（3.70%）.The incidence of ATRs was significantly higher in patients with the history of transfusion and pregnancy than without（P0.01）,There was statistical significance between blood composition and types of ATRs.The majority of ATRs were FNHTRs from RBCs and allergic transfusion reactions from FFP,no serious and delayed transfusion reactions were reported except for TACO.Conclusion：It is helpful to decrease the occurrence of common ATRs according to the condition of ATRs from different blood compositions and patient characteristics and adopting corresponding measures.The hospital should strengthen the training for the monitoring and reporting of ATRs to medical and paramedical staff,establish positive hemovigilance system to reduce the underreporting of ATRs and guarantee transfusion safety.

关 键 词：输血不良反应 非溶血性发热反应 过敏反应 输血相关性循环超负荷 血液预警 

分 类 号：R681[医药卫生—骨科学]