ABO血型不合的异基因造血干细胞移植后患者输注异型成分血不良反应系统评估分级  

Systematic evaluation and classification of adverse reactions to incompatible blood component transfusion in patients undergoing ABO-incompatible allogeneic hematopoietic stem cell transplantation

作　　者：田园[1] 卢文敏 翁娇娇 周淑娟[1] TIAN Yuan;LU Wenmin;WENG Jiaojiao;ZHOU Shujuan(Department of Hematology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院血液内科,浙江温州325000

出　　处：《中国输血杂志》2022年第11期1127-1131,共5页Chinese Journal of Blood Transfusion

摘　　要：目的 分析和评估本院输注异型成分血不良反应发生情况,为临床ABO血型不合的异基因造血干细胞移植患者输注异型成分血安全管理提供依据。方法 回顾性分析本院血液移植中心2021年6月~2021年12月期间467次输注异型成分血患者的病例资料,根据患者输血前后临床表现及变化、相关实验室检查等对发生的输血不良反应进行诊断评估,从反应类型的肯定程度、严重程度、输血相关可能性大小三个方面进行评估分级。结果 输注异型成分血不良反应总发生率为30.19%(141/467)。发生率最高的血制品是悬浮红细胞,占42.86%(15/35),接下来依次是单采血小板,占39.25%(73/186),冰冻血浆,占28.26%(26/92),冷沉淀凝血因子,占19.05%(8/42)和洗涤红细胞,占16.96%(19/112)。洗涤红细胞和悬浮红细胞的不良反应发生率,P<0.05。不良反应的类型以过敏反应为主,占67.37%(95/141),其次为非溶血性发热反应,占22.69%(32/141),输血相关移植物抗宿主病、急性溶血性输血反应和输血相关性低血压发生率相等,均为2.84%(4/141),其它不良反应2例,占1.42%(2/141)。141次不良反应等级评估,“肯定”113例,占80.14%(113/141),“基本肯定”20例,占14.19%(20/141),“疑似”8例,占5.67%(8/141);“轻微”130例,占92.20%(130/141),“中等”10例,占7.09%(10/141),“严重”1例,占0.71%(1/141);“相关性极高”117例,占82.98%(117/141),“很可能相关”17例,占12.06%(17/141),“相关性较小”7例,占4.96%(7/141)。结论 将输注异型成分血不良反应进行评估分级,能够加深临床医务人员的认知,能够增加其对不良反应判断的准确性和严谨性,在一定程度上防止了不良反应的漏报和误报,为制定输注异型成分血不良反应统一标准奠定了基础。Objective To analyze and evaluate the occurrence of adverse reactions to incompatible blood component transfusion in patients undergoing ABO-incompatible allogeneic hematopoietic stem cell transplantation(ABO-incompatible allo-HSCT) in our hospital, and provide a basis for clinical safety management of incompatible blood component transfusion. Methods The case data of 467 ABO-incompatible allo-HSCT patients with incompatible blood components transfused in our hospital from June 2021 to December 2021 were retrospectively analyzed, and the adverse reactions to blood transfusion that occurred were diagnosed according to the clinical manifestations and changes before and after blood transfusion as well as the results of related laboratory tests. The evaluation was based on three aspects as the degree of certainty of the type of reaction, the severity of it, and its probablity associated with blood transfusion. Results The overall incidence of adverse reactions to transfusion of incompatible blood components was 30.19%(141/467). The incidence occurred in suspended red blood cells were 42.86%(15/35), apheresis platelets 39.25%(73/186), frozen plasma 28.26%(26/92), cryoprecipitated coagulation factors 19.05%(8/42) and washed red blood cells 16.96%(19/112). The incidence of adverse reactions of washed red blood cells and suspended red blood cells was statistically different(P<0.05). The types of adverse reactions were mainly allergic reactions(67.37%,95/141), followed by non-hemolytic febrile reactions(22.69%,32/141),transfusion-related graft-versus-host disease(2.84%,4/141), acute hemolytic transfusion reactions(2.84%,4/141), transfusion-related hypotension(2.84%,4/141) and 2 cases(1.42%,2/141) of other adverse reactions. A total of 141 adverse reactions were graded: 113 cases(80.14%,113/141) were "sure", 20 cases(14.19%,20/141) were "basically sure", 8 cases were "suspected"(5.67%,8/141);130 cases(92.20%,130/141) were "mild", and 10 cases(7.09%,10/141) were"moderate”, 1 case was "severe"(0.71%,1/141). As to the occur

关 键 词：血型不合 造血干细胞移植 输注异型成分血 不良反应 评估分级 

分 类 号：R457.13[医药卫生—治疗学]