Prevention: strict management of blood bank maintenance fluid and blood transfusion equipment, effective prevention of heat source, strict aseptic operation.
Treatment: If the reaction is mild, you can relieve the symptoms by slowing down the number of drops. If it is serious, stop blood transfusion, closely observe vital signs, treat the symptoms, and inform the doctor. If necessary, give antipyretic and analgesic drugs and antiallergic drugs, such as promethazine or adrenocortical hormone according to the doctor's advice.
(2) allergic reaction
Prevention: 1 Don't choose blood donors with allergic history.
Blood donors should not eat high-protein and high-fat foods within 4 hours before blood collection, and use a small amount of light diet or sugar water easily.
Treatment: If allergic reaction 1 occurs, slow down the speed of blood transfusion, continue to observe, and stop blood transfusion immediately in severe cases.
People with dyspnea should take oxygen, those with severe laryngeal edema should be tracheotomy, and those with circulatory failure should be treated with anti-rest.
According to the doctor's advice, give 0. 1% epinephrine 0.5~ 1ml subcutaneous injection, or use antiallergic drugs and hormones such as promethazine, hydrocortisone or dexamethasone.
(iii) Hemolytic reaction
Prevention: Do a good job in blood group identification and cross matching test, check carefully before blood transfusion, put an end to mistakes, strictly implement blood storage regulations, and do not use deteriorated blood.
Treatment: 1 Stop blood transfusion, notify the doctor, keep the remaining blood, collect the patient's blood sample and redo the blood group identification and cross matching test.
2. Maintain intravenous infusion channels and supply antihypertensive drugs and other drugs.
Intravenous injection of sodium bicarbonate alkalizes urine to prevent hemoglobin crystals from blocking renal tubules.
4. Both sides of the waist are closed, and hot water bags are applied to the kidneys on both sides to relieve renal vasospasm and protect the kidneys.
5. Close observation of vital signs and urine volume, and make records. Oliguria and urinary incontinence should be regarded as acute renal failure.
6 shock symptoms, that is, according to anti-shock treatment.
Reactions related to massive blood transfusion
A large amount of blood transfusion generally means that the amount of emergency blood transfusion is greater than or equal to the total blood volume of the patient within 24 hours. Common reactions include circulatory overload, bleeding tendency and sodium citrate poisoning.
Treatment: closely observe the patient's consciousness, blood pressure, pulse and other changes, pay attention to whether there is blood on the skin, mucosa or surgical wound, and inject new blood or platelet suspension at regular intervals according to the doctor's advice to supplement enough platelets and coagulation factors; When the blood in the bank is greater than 1000ml, calcium ion should be supplemented by intravenous injection of 10% calcium gluconate or 10ml sodium chloride according to the doctor's advice.
Prevention and measures of transfusion reaction [2]
Blood transfusion is one of the commonly used clinical treatments. Despite the continuous progress of medical technology, adverse reactions of blood transfusion still occur from time to time, which have adverse effects on disease treatment and even serious consequences. Therefore, how to reduce or avoid the occurrence of adverse reactions in blood transfusion has always been a hot topic in clinical blood transfusion. The author reviewed the clinical data of 4 1096 patients with blood transfusion in this area, and analyzed the characteristics of adverse blood transfusion reactions, so as to provide reference for clinical prevention of adverse blood transfusion reactions. The report is as follows.
1 data and methods
1. 1 general information
2065438+2065438+July-June, 2007, 4 1096 patients were treated in several hospitals in our region, because of surgery, trauma or pregnancy. There are 20,367 males and 20,729 females. The age ranged from 9 to 81year, with an average of (52.311.8) years. Among them, 9746 cases were ≤ 18 years old, > 18 ~ < 60 years old 18483 cases, and over 60 years old 12867 cases. There were 72 cases with pregnancy or blood transfusion history 17 172 cases, and 23924 cases without pregnancy or blood transfusion history. All patients had no heart disease, lung disease, liver disease, kidney disease and hematopoietic system diseases.
1.2 method
* * * 4 1096 patients received blood transfusion treatment, and 97 patients had adverse reactions due to blood transfusion, accounting for 0.24% of the total number of blood transfusion patients. Among them, the incidence of adverse reactions caused by whole blood infusion and cryocoagulation factor were 65,438 0.57% and 65,438 0.46% respectively. The relationship between the occurrence of adverse reactions after infusion and the types of patients is shown in Table 2. The results showed that the incidence of adverse reactions in patients over 60 years old after blood transfusion was 0.37%, which was significantly higher than that in patients under 18 years old and patients under 18 ~ < 60 years old. The incidence of adverse reactions after blood transfusion in patients with pregnancy or blood transfusion history was 0.37%, which was significantly higher than that in patients without pregnancy or blood transfusion history. The difference between the two groups was statistically significant.
3 discussion
3. 1 Adverse reactions of blood transfusion and its mechanism
Adverse reaction of blood transfusion refers to the new symptoms and signs that can't be explained by the primary disease during or after blood transfusion treatment, which are often manifested as fever, allergy, phlebitis, citrate poisoning, acute lung injury and so on. The occurrence of adverse reactions is mostly related to allergic reactions or non-hemolytic reactions. Stop transfusion immediately when there are adverse reactions to blood transfusion, pay attention to keeping veins unobstructed, and then give symptomatic treatment such as antihistamine and physical cooling, and actively find out the reasons. The classified query of periodical articles is in the periodical database.
In this study, the clinical data of 4 1096 patients with blood transfusion were counted, and it was found that 97 patients had adverse reactions to blood transfusion, and the incidence of adverse reactions was 0.24%. Among them, the incidence of adverse reactions such as transfusion of whole blood, cold precipitation of coagulation factors and fresh frozen plasma is high. It is higher than the average level of adverse reactions of all patients in this study; The adverse reactions after blood transfusion may be related to the following factors: ① The incompatibility of ①①HLA or leukocyte antibody causes antigen-antibody reaction in recipients, which causes leukocyte agglutination, destruction, dissolution and release of endogenous pyrogen in mononuclear phagocyte system; ② It is related to cytokines produced in blood preservation solution, and some protein, such as cytokines and interleukin, produced and released by blood leukocyte activation during preservation are immunogenic; ③ Allergy, denaturation of protein in blood products and existence of other antibodies in blood products; ④ Due to pyrogen in blood preparation, adverse reactions may occur, including fever, chills, allergies and phlebitis. The research results once again remind medical workers that strict aseptic operation should be carried out in the process of blood collection, blood preparation and blood transfusion, which is the most basic requirement and the most effective measure to reduce or avoid adverse reactions of blood transfusion. The adoption of new technology may reduce pyrogens or allergens in blood products, thus reducing the probability of adverse reactions after blood transfusion.
3.2 Safe blood transfusion and reasonable blood transfusion
According to the patient's condition, choose different blood preparations. Whitening suspended red blood cells can remove almost all white blood cells in suspended red blood cells through a white blood cell filter, which can not only prevent non-hemolytic febrile transfusion reaction, but also prevent HLA allogeneic immunity, and has been widely used. Washing red blood cells is suitable for patients who are allergic to whole blood or plasma protein, need to continue blood transfusion, autoimmune hemolytic anemia, hyperkalemia and hepatic and renal insufficiency. Blood irradiation can be used to prevent patients who have developed allogeneic immunity after repeated blood transfusion, patients with ineffective platelet transfusion, immunodeficiency or immunosuppression.
3.3 Strict blood transfusion witness and matching test.
The results suggest that the probability of adverse blood transfusion reactions in people over 60 years old is obviously increased, which may be related to the change of immune status after aging. Patients with a history of blood transfusion or pregnancy are more likely to have adverse reactions to blood transfusion than patients without a history of blood transfusion or pregnancy. It may be that antibodies appear in patients with a history of blood transfusion and pregnancy, which increases the chance of adverse reactions after blood transfusion. Those who are older, have a history of blood transfusion or pregnancy must be screened for antibodies. When irregular antibodies are detected, corresponding antigen-negative red blood cells must be found for cross-matching test.
3.4 The establishment of blood early warning system
There are foreseeable and unpredictable risks in blood transfusion, and the incidence of adverse reactions in blood transfusion is closely related to the quality of blood components and the level of clinical blood transfusion management. Blood stations should improve the hospital blood transfusion reaction register, recover blood transfusion reaction cards in time, actively find out the reasons, and establish a blood early warning system, which mainly includes blood product supervision and clinical blood transfusion process monitoring. When patients receive treatment, they should observe the changes of their condition in time, review the relevant laboratory indexes such as HB \ coagulation function, and accurately evaluate and record the curative effect of blood transfusion. If people with adverse reactions to blood transfusion have their own blood transfusion files, they should record when and where. After receiving blood component infusion, it covers all links in the blood transfusion chain, and is a monitoring management system for reporting, tracking, identifying and handling adverse reactions to prevent the recurrence of adverse reactions in blood transfusion. Therefore, only by strengthening the standardized management of blood transfusion, strictly abiding by the Administrative Measures for Clinical Blood Use in Medical Institutions and the Technical Specification for Clinical Blood Transfusion, strictly grasping the indications of clinical blood transfusion, rationally using blood, preventing people prone to adverse blood transfusion reactions, and attaching importance to the application of new technologies can we minimize or avoid the occurrence of adverse blood transfusion reactions and ensure the safety of clinical blood transfusion.
References:
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