目的 分析我院羊水栓塞患者的临床资料及诊治经过,总结羊水栓塞致弥散性血管内出血（DIC）患者输血治疗救治经验。方法 回顾性分析2016年1月1日—2022年12月31日在广州医科大学附属第二医院番禺院区分娩并发羊水栓塞患者的症状、实验室辅助检查、用药诊治经过及妊娠结局。结果 在6 104次孕晚期分娩记录中,共发生3例羊水栓塞,高龄产妇1例、经产妇2例、多产1例。3例均并发DIC,产后出血1 500~3 000 mL。其中1例行子宫切除术,2例保留子宫,均抢救成功,无患者死亡。结论 根据有限数据推论羊水栓塞罕见、凶险,病情进展快,多继发产后出血、DIC,主要依靠临床表现进行诊断,早期识别诊断和处理,产科快速反应团队及多学科协作,给予高级生命支持,有效止血并科学地成分输血纠正凝血功能障碍及DIC,是改善孕产妇结局的关键。

Objective To analyze the clinical data,diagnosis and treatment of patients with amniotic fluid embolism in our hospital,and to summarize the experience of blood transfusion treatment for disseminated intravascular coagulation（DIC） patients with amniotic fluid embolism. Methods From January 1,2016 to December 31,2022,the symptoms,laboratory tests,drug treatments and pregnancy outcomes of patients with amniotic fluid embolism during delivery in Panyu Hospital,the Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. Results There were 3 cases of amniotic fluid embolism in 6 104 late pregnancy records,accounting for 1/3 of the elderly parturients,2/3 of the multiparas and 1/3 of the prolific parturients．All three cases had DIC and postpartum hemorrhage of 1 500-3 000 mL．Among them,1 case underwent hysterectomy and 2 cases saved the uterus,all of which were successfully rescued without death. Conclusions Amniotic fluid embolism is rare,dangerous disease with rapid progression,often followed by secondary postpartum hemorrhage and DIC,and mainly relies on clinical manifestations for diagnosis．Early identification,diagnosis and treatment,rapid response team in obstetrics and multidisciplinary collaboration,advanced life support,effective hemostasis and scientific component blood transfusion to correct coagulation dysfunction and DIC,are the keys to improve maternal outcomes．

目的 探究抗-M抗体影响血型鉴定及对临床输血的影响,分析不规则抗体筛查必要性,以期进一步提升临床输血的安全性及有效性。方法 分析2020年1月—2023年4月于蚌埠医学院第二附属医院输血科检查的100例O型红细胞对照管凝集患者样本资料,使用全自动血型仪微柱凝胶卡、反定型试管法对样本进行血型鉴定和抗体检查,使用抗人球蛋白实验检测抗体类型及特异性,并分析抗-M抗体在不同环境温度下的效性。结果 血型仪微柱凝胶法显示100例标本中存在正反定型不符89.00%,正反定型相符11.00%;反定型试管法复核显示100例标本A、B、O细胞管均为阳性,对照管均为阴性。对89例正反定型不符的样本予以分析,抗-M是最主要影响抗体,占比56.18%;IgM、IgG是最主要影响抗体类型;13例未鉴定出抗体特异性,占比14.61%。89例正反定型不符的样本中男25例、女64例;71例存在妊娠史或输血史,占比79.78%,其中的11例合并妊娠史和输血史。50例抗-M抗体标本在不同气温下呈现不同效价,在4 ℃、22 ℃下会出现凝集梯度;在37 ℃下,50例样本中反应强烈31例,占比62.00%,阴性19例,占比38.00%。结论 抗-M类不规则抗体是影响血型鉴定、威胁输血安全的主要因素,临床需加强输血前血型鉴定,明确抗-M抗体临床检测的意义,通过多种途径提升鉴定准确性,对合并高危险因素的患者更需要着重关注,保障输血安全。

目的 调查儿科急诊非急诊手术患儿输血后红细胞恢复的影响因素。方法 回顾2020年1月—2020年12月期间广州市妇女儿童医疗中心珠江新城院区儿科急诊1月~18岁患儿的输血情况,其中分为Hb提升达预期组（n=93）,Hb提升未达预期组（n=156）,根据年龄、性别、体质量、是否恶性肿瘤、是否发热、有无延迟输血、输血前血红蛋白水平、输注红细胞类型情况,分析输血疗效及影响因素。结果 2组患儿的性别、年龄、体质量、有无恶性肿瘤、是否发热、输血等待时间、输血前后血红蛋白值、输注红细胞悬液量以及有无及时输血均无统计学差异;输注红细胞类型组间存在显著差异,Hb提升未达预期组更多输注了洗涤红细胞悬液（13.5% vs 5.4%,P=0.044）,输血后 Hb 值较低（中位数,73 g/L vs 84 g/L,P<0.001）,变化 Hb 值较小（中位数,18 g/L vs 30 g/L,P<0.001）,归因分析未发现影响因素。结论 输注洗涤红细胞可能是降低输血后红细胞提升的影响因素,输注洗涤红细胞时需严格输血指征同时注意红细胞提高预值的设定。

Objective To investigate the influencing factors of blood transfusion efficacy in patients without emergency operations in pediatric emergency．Methods A retrospective analysis of the blood transfusion of pediatric emergency children（1 month~ 18 year of age）in Zhujiang New Town Branch of Guangzhou Women and Children's Medical Center from January 2020 to December 2020 was carried out,patients were divided into Hb elevation up to expectation group（n=93）and Hb elevation not up to expectation group（n=156）．The efficacy of blood transfusion and the factors affecting it were analyzed according to age,gender,body mass,with or without malignant tumor,whether fever was present,whether there was delayed transfusion,pre-transfusion hemoglobin level,and the type of red blood cells transfused．Results There were no significant differences in gender,age,weight,malignant tumor,fever,waiting time for blood transfusion,hemoglobin level before and after blood transfusion,infusion volume of red blood cell suspension and whether had timely blood transfusion between the two groups．Significant differences were found between groups of transfused red blood cell types,with more washed red blood cell suspensions transfused in the Hb elevation not meeting expectations group（13.5% vs 5.4%,P=0.044）,which had lower post-transfusion Hb values（median,73 g/L vs 84 g/L,P<0.001）,and smaller change Hb values（median,18 g/L vs 30 g/L,P<0.001）,and attribution analysis did not reveal influencing factors．Conclusions Transfusion of washed red blood cell may be an influencing factor that reduces the RBCs elevation after transfusion．Attention should be paid to strict indications for washed red blood cell transfusion and setting the expected Hb level.

目的 探讨在COVID-19流行期间血库资源紧张状态下输血时机对儿童输血效果及临床预后的影响。方法 本回顾性队列研究纳入2020年1月—2020年12月在广州市妇女儿童医疗中心儿科急诊就诊并申请输血的患儿的临床预后。结果 共566例发起红细胞和血小板的非手术输血申请的患儿纳入研究,包括 260 例的红细胞申请和306例血小板申请。260份红细胞申请中:209 例及时输血,40 例延时输血,11 例未输血;及时组和延时组的输血有效率分别为37.8%和35.0%(P=0.737);1名不良预后的死亡病例出现在及时组中,余病例临床预后均良好,3组的临床结局无统计学差异(组间P=0.886)。306份血小板申请中:195 例及时输血,108 例延时输血,3例未输血;1名不良预后的死亡病例出现在及时组中(0.51%),3名不良预后的死亡病例出现在延时组中(2.78%),余病例临床预后均良好,3组的临床结局无统计学差异(组间P=0.131)。结论 符合红细胞与血小板输血指征的非急诊手术用血的急诊患儿中,及时组、延时组和未输血组之间的临床结局没有差异。输血时机进一步需要大样本的循证研究加以确定。

Objective To investigate the influence of blood transfusion timing on blood transfusion efficacy and clinical prognosis in children under the strain of blood bank resources during COVID-19 pandemic. Methods This retrospective cohort study included clinical outcomes of pediatric emergency patients who applied for blood transfusion in Guangzhou Women and Children's Hospital from January 2020 to December 2020. Results A total of 566 children applicated blood transfusion for red blood cells and platelets for non-emergency surgical use were enrolled, including 260 red blood cells cases and 306 platelets cases. Among the 260 applications for red blood cells, 209 cases received timely transfusion, 40 cases received delayed transfusion, and 11 cases did not receive transfusion.The effective rate of transfusion for red blood cells was 37.8% in the timely group and 35.0% in the delayed group (P=0.737). One death case with poor prognosis was found in the timely transfusion group, and the clinical prognosis of the rest cases was good. There was no statistical difference in the clinical outcomes among the three groups (P=0.886). Among 306 applications for platelet, 195 cases had timely transfusion, 108 cases had delayed transfusion, and 13 cases did not had transfusion.One case with poor prognosis died in the timely transfusion group (0.51%), and three with poor prognosis died in the delayed transfusion group (2.78%). The rest of the cases had good clinical prognosis, and there was no statistical difference in clinical outcomes among the three groups (P=0.131). Conclusions There were no significant differences in clinical outcomes among the timely transfusion group, the delayed transfusion group, and the non-transfusion group for red blood cell and platelet transfusion respectively. The timing of transfusion may need to be determined by evidence-based studies with large samples.

目的 分析酶联免疫法(ELISA)联合核酸检测技术(NAT)在献血者血液筛查和输血残余风险分析中的应用价值。方法 选取2019年1月—8月惠州市中心血站2 514例无偿献血者为研究对象,采集血液标本,分别应用两种不同ELISA试剂盒检测乙肝病毒表面抗原(HBsAg)、丙肝抗体(抗-HCV)、艾滋病抗体(抗-HIV),并以核酸扩增技术(NAT)进行HBV DNA、HCV RNA、HIV RNA检测,对ELISA检测阴性,而NAT检测阳性的标本进行进一步追踪分析。结果 ELISA检测结果显示27例阳性,阳性率1.07%,其中2例同时HBsAg阳性、丙肝抗体(抗-HCV)阳性。NAT技术检测结果显示12例阳性,阳性率0.48%,其中1例同时HBV DNA阳性、HCV RNA阳性。27例ELISA检测阳性中,10例经NAT技术检测证实为阳性,17例为阴性;2 487例ELISA检测阴性中,2例NAT技术检测HBV DNA阳性,2 485例为阴性。对2例ELISA检测阴性、NAT技术检测阳性者进行随访追踪证实HbsAg阳性。结论 2次ELISA筛查献血者血液仍然存在漏检误检风险,存在输血残余风险,联合应用NAT技术能够降低输血残余风险。

        目的   明确输血前各抗体的分布特点，探讨自身抗体和同种抗体在性别、年龄、输血史、妊娠史和不同疾病中的差异，并根据抗体血型血清学特性制定个体输血方案，以确保临床输血安全。方法    选取2021年6月—2024年8月在广东省第二人民医院输血科申请输注红细胞或手术备血的29 662例患者，采用低离子抗人球蛋白微柱凝胶法进行不规则抗体筛查，结果阳性的标本经科内讨论并送广州血液中心血型参比实验室进行抗体鉴定，通过统计血液中心回报结果分析各抗体的特异性。结果  29 662例患者标本中不规则抗体结果为阳性的有208例，阳性率为0.70%。同种抗体占比47.69%，Rh、MNS和Lewis红细胞血型系统共占同种抗体中的94.50%，其中常见意外抗体：抗-E占31.87%、抗-M占14.29%、抗-Mur占19.78%、抗-C占7.69%和抗-e占7.69%。同种抗体与自身抗体在性别、年龄、妊娠史等方面比较差异无统计学意义（P＞0.05）；在输血史及不同科室疾病等方面比较差异有统计学意义（P＜0.05）。结论    输血前进行输血相容性检测是必要的，应对拟申请红细胞的患者进行不规则抗体筛查，阳性者宜进行抗体鉴定，明确其抗体的特异性及临床意义，以确保临床输血安全。

       Objective  To clarify the distribution characteristics of each antibody before transfusion，to explore the differences between autoantibodies and homologous antibodies in gender，age，history of blood transfusion，history of pregnancy and different diseases，and to formulate individual transfusion protocols based on the serological characteristics of antibody blood groups to ensure the safety of clinical blood transfusion．Methods  A total of 29 662 patients who applied for red blood cell transfusion or surgical blood preparation in the hospital from June 2021 to August 2024 were selected for irregular antibody screening by low-ion anti-human globulin microcolumn gel method．The samples with positive results were discussed within the department and sent to the Blood Type Reference Laboratory of Guangzhou Blood Center for antibody identification．The specificity of each antibody was analyzed by blood center reported results．Results  Among 29 662 patients，208 were positive for irregular antibody，the positive  rate was 0.70%．The alloantibodies accounted for 47.69%，Rh，MNS and Lewis erythrocyte blood group system accounted for 94.50% of alloantibodies，among which the common unexpected antibodies were anti-E 31.87%，anti-M 14.29%，anti-MUR 19.78%，anti-C 7.69% and anti-E 7.69%．There were no significant differences between alloantibodies and autoantibodies in gender，age and pregnancy history（P＞0.05）．There were statistically significant differences in blood transfusion history and diseases in different departments（P＜0.05）．Conclusions  It is necessary to test the compatibility of blood transfusion before transfusion．Screening for irregular antibodies should be carried out in prospective transfusion patients，and antibody identification should be carried out in positive patients to clarify the specificity and clinical significance of their antibodies to ensure the safety of clinical transfusion．