150例输血反应的调查分析

Investigation and analysis of 150 cases of blood transfusion reactions

摘要:

目的： 回顾性分析成都市第三人民医院输血反应发生情况，分析其临床表现，为促进临床安全用血提供数据支持。方法： 收集2017年8月至2020年2月的输血反应回报单，排除手术期间患者在多种血液制品输注过程中发生输血反应的相关数据，用卡方检验或Fisher确切概率法对其进行统计分析。结果： 两年半时间，输血反应总发生率为0.42%（153/36 391），不同血液成分输血反应发生率差异较大（P=0.000），血小板和悬浮红细胞输血反应发生率均大于血浆（ χ²=19.098、10.07，P=0.000、0.002）。悬浮红细胞致非溶血性发热反应（febrile non-haemolytic transfusion reactions，ＦNHTR）占总发热反应的71.26%，3例输血相关性循环超负荷（transfusion-associated circulatory overload，TACO）均在悬浮红细胞输注后发生（100%），过敏反应主要由血浆（58.73%）和血小板（25.40%）输注导致。血小板输血反应发生率最高（0.52%），红细胞成分多引起FNHTR和其他非特异临床症状（胸痛/气紧/呕吐等），血浆多引起过敏反应。过敏反应临床症状多样，从轻度的皮肤红疹到严重的过敏性休克均有发生。结论： 输血反应分类较多，不同类型可单独或同时发生，接受血液输注的患者多集中于血液、重症监护治疗病房（intensive care unit，ICU）等科室，这些患者常伴有多种基础疾病，容易干扰临床对输血反应的快速诊断，通过剖析本院因血液成分输注引起的输血反应病例，有助于为输血预警系统完善提供数据支持，进一步增强临床医护人员风险意识，保障患者用血安全。

Abstract:

Objective: To retrospectively analyze the characteristics of blood transfusion reactions in hospital，so as to provide data support for promoting clinical blood transfusion safety. Methods: Reports of blood transfusion reactions that occurred from August 2017 to February 2020 were collected，and reports of patients using multiple blood components during surgery were excluded. The related data were statistically analyzed by chi-square test or Fisher’s exact probability method. Results: In two and a half years，the incidence of blood transfusion reactions was 0.42%（153/36 391）. The incidence of blood transfusion reactions varied greatly among blood components transfusion（P=0.000），and the incidence of platelets and suspended red blood cells was higher than that of plasma（χ²=19.098，P=0.000； χ²=10.07，P=0.002）. Suspended red blood cells caused febrile non-haemolytic transfusion reactions（FNHTR） accounted for 71.26% of the total febrile reactions. The 3 cases of transfusion-associated circulatory overload（TACO） were all occurred after transfusion of suspended red blood cells（100%），and allergic reactions were mainly caused by plasma（58.73%） and platelets（25.40%）. The incidence of platelets transfusion reactions was the highest（0.52%）. Red blood cells caused FNHTR and other non-specific clinical symptoms（chest pain，tightness，vomiting，etc.），and plasma mostly caused allergic reactions. Clinical symptoms of allergic reactions varied from mild rash to severe anaphylactic shock. Conclusion: There is a wide classification of transfusion reactions，and different types can occur separately or together. The patients receiving blood transfusion are mostly concentrated in hematology and intensive care unit（ICU） departments，and these patients often have a variety of underlying diseases that can easily interfere with the rapid diagnosis of transfusion reactions. By analyzing the transfusion reactions caused by blood component in our hospital，we can help provide data support for the improvement of the transfusion early warning system，further enhance the risk awareness of clinical and nursing staff，and protect the safety of patients using blood.