过客淋巴细胞综合征监测流程及输血策略探讨*

doi:10.3969/j.issn.1671-2587.2021.06.001

临床输血与检验 ›› 2021, Vol. 23 ›› Issue (6): 681-685.DOI: 10.3969/j.issn.1671-2587.2021.06.001

• 组织器官移植输血专题（二） • 下一篇

过客淋巴细胞综合征监测流程及输血策略探讨^*

张嵘, 王文婷, 顾顺利, 胡兴斌, 尹文

710032 西安,中国人民解放军空军军医大学第一附属医院输血科

收稿日期:2021-07-24 出版日期:2021-12-20 发布日期:2021-12-21
通讯作者: 尹文, 男,教授,博士生导师,主要从事临床输血和输血相关研究,（E-mail）yinwen@fmmu.edu.cn。
作者简介:张嵘（1986-）,女,山西运城人,输血技师,硕士,主要从事临床输血检验和血液管理研究,（E-mail）zhang_rong86@126.com。
基金资助:
*本课题受国家自然科学基金（No.81873448）资助

Discussion on Monitoring Process and Blood Transfusion Strategy of Passenger Lymphocyte Syndrome

ZHANG Rong, WANG Wen-ting, GU Shun-li, et al

Blood Transfusion Department of First Affiliated Hospital of Air Force military Medical University 710032

Received:2021-07-24 Online:2021-12-20 Published:2021-12-21

摘要/Abstract

摘要： 目的基于本院发现的2例ABO血型次要不合肝移植术后过客淋巴细胞综合征（passenger lymphocyte sydrome,PLS）对交叉配血及临床输血造成的干扰,拟初步建立ABO血型次要不合实体器官移植术后PLS监测流程并探讨该流程下PLS患者的输血策略。方法建立实体器官移植患者信息登记表,采集移植患者基本信息（包括年龄,性别,原发疾病,ABO和RhD血型,手术名称,手术时间等）和供者基本信息（包括年龄,性别,ABO和RhD血型,疾病史等）。动态监测移植后患者皮肤黄染情况、血红蛋白值和其他溶血指标（血清胆红素水平、网织红细胞计数、乳酸脱氢酶（lactic dehydrogenase,LDH）、结合珠蛋白值、直接抗人球蛋白试验结果等）、抗体筛查结果等并进行记录。结果建立移植后PLS监测流程可早期诊断和干预PLS。依据监测指标变化及时调整输血策略,为患者筛选和制备适当的血液成分,避免患者术后血红蛋白进行性下降,改善患者预后。结论建立ABO血型次要不合实体器官移植术后PLS长期监测流程具有重要的临床意义,未来或可为PLS对移植患者预后影响及供受者多种因素（如患者原发疾病、免疫状态、供受者年龄和性别、血型等）与PLS相关性研究提供真实可靠的数据支持,有望为改善移植方案、减少术后并发症及提高移植成功率提供依据。

关键词: 移植, 过客淋巴细胞综合征, 监测, 输血

Abstract: Objective Based on the interference of two cases of passenger lymphocyte syndrome（PLS）after minor ABO-incompatible liver transplantation to cross-matching test and clinical blood transfusion,this paper intends to establish a preliminary monitoring process of PLS after minor ABO-incompatible solid organ transplantation and to explore the blood transfusion strategy of PLS patients under this process. Methods The registration form of solid organ transplant patient information was established, and the basic information of transplant patients （including age,sex,primary disease,ABO and RhD blood group,operation name,operation time,etc.） and basic donor information（including age,sex,ABO and RhD blood type,disease history,etc.）were collected. The yellow staining of skin, the levels of hemoglobin value and other hemolytic indicators（serum bilirubin level,reticulocyte count,LDH,haptoglobin value,direct antiglobulin test results,etc.）,and the results of antibody screening were dynamically monitored and recorded. Results The establishment of post-transplant PLS monitoring process can be used to early diagnose and interfere with PLS. We can timely adjust the blood transfusion strategy according to the changes of monitoring indexes,screen and prepare appropriate blood components for patients,avoid the progressive decrease of postoperative hemoglobin and improve the prognosis of patients. Conclusion It is of great clinical significance to establish a long-term monitoring process of PLS. In the future,it may provide true and reliable data support for the study of the influence of PLS on the prognosis of transplant patients and the correlation between PLS and multiple factors （such as patients' primary disease,immune status,age and sex of donors and recipients,blood type,etc.）. It is expected to provide a basis for improving the transplantation scheme,reducing postoperative complications and improving the success rate of transplantation.

Key words: Transplantation, Passenger lymphocytic syndrome, Monitoring, Blood transfusion

中图分类号:

R457

张嵘, 王文婷, 顾顺利, 胡兴斌, 尹文. 过客淋巴细胞综合征监测流程及输血策略探讨^*[J]. 临床输血与检验, 2021, 23(6): 681-685.

ZHANG Rong, WANG Wen-ting, GU Shun-li, et al. Discussion on Monitoring Process and Blood Transfusion Strategy of Passenger Lymphocyte Syndrome[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2021, 23(6): 681-685.

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过客淋巴细胞综合征监测流程及输血策略探讨^*

Discussion on Monitoring Process and Blood Transfusion Strategy of Passenger Lymphocyte Syndrome

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