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.
Objective To evaluate the platelet transfusion threshold, demand, transfusion efficiency and engraftment kinetics of inpatients undergoing autologous hematopoietic stem cell transplantation（ASCT）, as well as the influence of different conditioning regimens on platelet transfusion. Methods This study was a single-center retrospective clinical study,and enrolled 94 patients who underwent ASCT and received platelet transfusions from November 2013 to March 2021 in the Department of Hematology,HuaShan Hospital affiliated to FuDan University. The influence of different conditioning regimens was compared on nucleated cell count,CD34+ stem cell dose,platelet transfusion threshold,total platelet transfusion dosage,transfusion efficiency and platelet engraftment kinetics. Results The mean value of nucleated cell and CD34+ stem cell reinfusion was（3.02±1.28）×108/kg and（4.76±2.25）×106/kg respectively,the average platelet transfusion per capita was 2.16 dose,the overall transfusion efficiency was 74.38%,and the median time of platelet engraftment was 12 days. Platelet transfusion dosage,effective transfusion rate,engraftment time and transfusion effect were similar between the groups of patients with platelet count below or over 10×109/L. Patients was subgrouped into three groups with melphalan monotherapy,BuCy regimen,and CEC regimen,and there was no difference in blood type distribution,nucleated cell count,CD34+ stem cell dose and baseline platelets count among three groups. The data showed the amount of platelet transfusion in BuCy group was more than that of melphalan monotherapy group and CEC group（P<0.05）,the rate of platelet reduction in BuCy group was faster than that in melphalan monotherapy group and CEC group（P<0.05）, as well as the engraftment time was longer in BuCy group （P<0.05）. Conclusion In ASCT, on the basis of effective controlling complications and avoiding drug-related thrombocytopenia, the prophylactic platelet transfusion threshold can be triggered with 10×109/L to reduce the risk of serious bleeding events. Compared with melphalan monotherapy and CEC regimen,BuCy regimen has a greater impact on the platelet reduction and engraftment time and patients require more platelet transfusions. However,due to the similar transfusion efficiency,there is no need to increase the platelet transfusion threshold.
Objective To explore the impact of erythrocyte storage duration on blood indexes in children with-open heart surgery by cardiopulmonary bypass（CPB）,and providing laboratory basis for the safety of clinical blood transfusion. Methods A total of 90 consecutive pediatric patients from January 2019 to July 2020 who received the open heart surgery by CPB in our hospital were retrospectively studied. They were divided into the fresher blood group（≤14 d,n=49）and the older blood group（14~35 d,n=41） according to the erythrocyte storage duration. The CRP,blood routine,blood electrolyte level, renal function,myocardial enzymes and coagulation function were collected and their differences were compared between the two groups after 48 hours of surgery. Results After surgery,there were no significant difference between the two groups in the changes of the CRP level,the count of WBC,the HGB level,the count of PLT ,the K+, Na+,CL- and Ca2+ level,the CO2,BUN,Cr and UA level,the AST,LDH,CK,CK-MB and α-HBDH level before and after surgery（P>0.05）. There was no significant difference in the changes of PT,INR and FIB between the two groups （P>0.05）,but the APTT changes in the older blood group 2.00（-1.65,6.90）s was significantly longer than that in the fresher blood group 0.00 （-4.30,2.90）s（P<0.05）. Conclusion The results showed that different erythrocyte storage duration has little effect on blood indexes of patients with the open heart surgery by CPB,but it is more important to pay attention to monitor coagulation function changes in the older blood group.
Objective To explore the titer distribution and influencing factors of children with preliminary positive platelet antibody screening. Methods A total of 21 230 cases of platelet antibodies were detected by solid phase agglutination method from January 2019 to March 2021 in Beijing Children's Hospital,and 60 children were strong positive (4+) of platelet antibody screening. The titers of the positive samples were tested by continuous dilution and solid phase agglutination. Then the differences of the titers were compared in different groups which were divided according to gender, age, blood transfusion history and diseases. Results The titer distribution range of 60 children was 2, 4, 8, 16, 32 and 64, which were 5 cases (8.33%), 8 cases (13.33%), 15 cases (25.00%), 21 cases (35.00%), 9 cases (15.00%) and 2 cases (3.33%) respectively. No significant differences among these groups (P>0.05) were found. Conclusion The titer range of children with strong positive platelet antibody is 8 to 16, but the level of titer is not statistically related to gender, age, blood transfusion history and clinical diseases.
Objective To detect platelet antibody in children with autoimmune thrombocytopenia and explore its correlation with autoimmune disorders. Methods The results of platelet antibody were retrospectively analyzed in children with autoimmune diseases of Shanghai Children's Medical Center from January 2018 to December 2020 and the results were statistically analyzed by Graphpad prism 8 statistical software. Results In 94 children with autoimmune diseases, the positive rate of platelet antibody was 50%, the positive rate of autoantibody was 36%, and the positive rate of platelet antibody was higher than that of autoantibody. There was correlation between platelet antibody and autoantibody, but no significant difference between them in autoimmune diseases, according to statistical analysis. Conclusion In the advanced stage of autoimmune disorders, platelet antibodies and autoantibodies can exist simultaneously, both of which are the causes of autoimmune thrombocytopenia.
Objective To continuously improve the clinical service ability of blood stations. Methods Through the construction of clinical blood transfusion service information platform, convenient, fine and systematic electronic services related to clinical blood transfusion for hospitals have been provided. Results Business processes have been optimized and standardized, including the blood appointment, blood supply, taking blood at the scene, blood testing, blood use qualification application, satisfaction survey, quality feedback, blood use reduction. Conclusion The establishment of clinical blood transfusion service information platform has effectively improved the service quality and technical level of blood stations for clinical blood transfusion.
Objective Further improve the blood safety management level of blood donors and plasma donors in Zhejiang province. Methods On July 2020, a provincial donors interval information sharing system was established to block blood or plasma donation before reaching inter-donation intervals (IDIs). Results Blood stations and plasma stations have unified the sharing standards of blood donors and plasma donors, and realized the IDIs information sharing through query services. Conclusion The establishment of the system reduces the risk of intensive blood donation and plasma donation before reaching IDIs, and further improves the blood donation management and blood safety in Zhejiang province.
Objective The purpose of this study was to retrospectively analyze independent risk factors for HLA and/or HPA antibodies detected in patients with platelet transfusion refractoriness（PTR）. Methods The clinical data of 910 patients with PTR and their status of HLA and/or HPA antibodies were collected. The influence of sex,age,blood group, disease,blood transfusion times,hemogram parameters and coagulation index before PTR occurrence were analyzed. Results HLA and/or HPA antibodies were more easily observed in sera from women and women with a history of pregnancy. The average age of antibody-positive patients was significantly higher than that of antibody-negative patients （51.46±18.49 year vs. 40.68±20.08 year,P<0.001）. The average number of blood transfusion in antibody-positive patients was significantly lower than that in antibody-negative patients （13.13±18.64 vs. 18.66±22.52,P=0.024）. The incidence of antibody was not correlated with the number of blood transfusion. The platelet counts （13.13±18.64×109/L vs. 18.66±22.52×109/L, P=0.021） and hemoglobin levels （72.41±18.64 g/L vs. 78.61±21.66 g/L,P=0.009）in antibody-positive patients were also significantly lower than those in antibody-negative patients. The independent risk factors for antibody production were over 60 years old,female,MDS,frequency of transfusions and platelet counts. Conclusion The understanding of risk factors for the formation of HLA and/or HPA antibody is helpful for clinicians to take appropriate measures to avoid PTR and improve the efficacy of platelet transfusion.
Objective To identify three novel alleles of HLA-A, analyze their nucleotide and amino acid sequences. Methods Three novel alleles were initially detected by DNA sequencing typing (Sanger sequencing), then the sample sequenced by Next Generation Sequence (NGS) to confirm the mutation allele and locus. Results The first new allele sequence was different from that A*02:07:01 at the position 520 (G>A) in exon 3, which results in an amino acid change from Ala to Thr at codon 174. The second new allele sequence was different from that A* 02:06:01 at the position 641 (C>T) in exon 4, which results in an amino acid change from Thr to Ile at codon 214. The third new allele sequence was different from that A* 02:01:01 at the position 652 (G>C) in exon 4, which results in an amino acid change from Val to Leu at codon 218. Conclusion All three alleles were new HLA-A alleles which have been designated as: HLA-A*02:897, HLA-A*02:898, HLA-A*02:899 by the Word Health Organization (WHO) HLA Nomenclature Committee.
Objective By analyzing the blood use of the deceased patient during his last hospitalization, we explored the lifetime blood consumption probability, and advocated active healthy and age-appropriate blood donation. Methods According to the principles of the International Classification of Diseases, blood donation age and blood composition classification, the blood volume of 8 053 hospitalized patients who died from 2011 to 2020 in this hospital was statistically analyzed. Results From 2011 to 2020, the average transfusion rate of inpatients in the hospital was 13.13%, and the average transfusion rate of patients who died was 47.42%.The top three diseases with the highest transfusion rate of deceased patients were pregnancy, childbirth and puerperium, blood hematopoietic immune diseases, and digestive system diseases, with the transfusion rate of 90%, 89.74% and 79.52%, respectively. The rate of blood transfusion decreased gradually in patients under 18, 18~60 and over 60 years old, which was 64.13%, 56.00% and 44.80 % respectively (P<0.05) .The average red blood cell transfusion volume per deceased patient was 2.05 U, plasma 4.19 U and platelet 2.8 U, respectively. Conclusion The higher rate of blood transfusion before death in hospitalized patients suggests that we should actively participate in unpaid blood donation when we are healthy at the right age, so as to improve the consciousness of blood donation and promote the development of unpaid blood donation in China.
Objective To investigate the genetic polymorphism of HPA1-5 alleles in people of childbearing age from Yunnan Province and to provide valuable data for diagnosis and treatment of FNAIT and other diseases. Methods PCR-SSP was adopted to genotype the HPA1-5 system in 576 cases from different nationalities, Gene frequency and noncooperative rate of the population in Yunnan were calculated and were compared with each other. Platelet antibody screening was carried out among 630 women of childbearing age in Yunnan, andresults were analyzed according to gene frequency of different nationalities. Results None of HPA-b was found in Jingpo population samples and all the HPA-4 genotypes of Jingpo were aa. aa homozygosity was predominant except HPA-3. HPA-1a frequency of Achang was significantly different from that other populations in same study. HPA-2 frequency of Jingpo was significantly different from that other populations in our study.The MP of HPA-5 system in Han group was significantly lower than that in other ethnic groups. Platelet antibody-screening results showed that antibodies against-HPA3 system were the most in positive cases. Conclusion The distribution of HPA1-5 gene frequency in different ethnic groups in Yunnan has its own characteristics, and the influence of ethnic factors should be considered in the prevention, diagnosis and treatment of obstetric diseases.
Objective To retrospectively analyze the use of intraoperative cell salvage (ICS) in our hospital in recent years, and to analyze the indication to ICS during cesarean section. Methods A total of 1 108 women with cesarean section in our hospital from January 2018 to December 2019 were included, 673 cases in the reinfusion group and 435 cases in the non-reinfusion group. The basic information and clinical data between two groups were analyzed by SPSS 23.0. Results The reinfusion rates of ICS between Jan. 2018 and Dec. 2019 were 60.74%. In the reinfusion group, there was a linear correlation between the amount of blood lost and reinfusion during the operation. There were significant differences in placenta previa, placenta accreta, placental abruption, scarred uterus, preeclampsia and the amount of blood lost between the two groups (P<0.05). Logistic regression analysis showed that placenta previa, placental accreta, placental abruption and scarred uterus can increase the risk of autologous blood transfusion. Conclusion Placenta previa, placental accreta, placental abruption and scarred uterus are indications for autologous blood transfusion. ICS is recommended for cesarean section in these pregnant women.
Objective To study RHD genotyping and RhD alloimmunization among perinatal women with RhD initial typing negative,and further accumulate relevant data for RhD-HDFN diagnosis and early intervention consensus. Methods Confirmatory test for Rh negative and RhCcEe phenotyping were performed by conventional serological methods. The screening of unexpected antibody was conducted by salt medium and antiglobulin methods. Further,specificity of antibodies and antibody titer were determined. DNA was extracted and RHD genotyping was detected by PCR-SSP and sequencing. Results Among 108 samples,6 cases were positive in RHD confirmatory test,and the most common Rh types were ccee （61 cases） and Ccee （37 cases）. According to RHD genotyping,a total of 67 cases of RHD*01N.01,23 cases of RHD*01EL.01（Asia type DEL）,10 cases of RHD*01N.03,2 cases of RHD*06.03.01,3 cases of RHD*15,1 case of RHD*05.03, 1 case of RHD*01W.33,1 case of RHD*01N.25 mutation and 1 case of new allele c.509 T>G（Genbank：MW923730）were detected. Unexpected antibodies were detected in 11 samples,including 1 case of anti-D and anti-C （RHD*01N.01）,10 cases of anti-D （8 cases of RHD*01N.01,1 case of RHD*01N.03, and 1 case of RHD*06.03.01）. None of anti-D was detected in 23 cases of Asia type DEL . Conclusion There are many variants of RHD gene,and each subtype may have different immune states of anti-D. No Asia type DEL has been found to produce anti-D,which has a low risk of anti-D alloimmunity.
Objective By introducing the performance excellence model in blood bank management, to improve the overall performance and ability in Shanghai Blood Center (SBC) as well as sustained development of blood transfusion services. Methods The Performance Excellence Model was integrated into various aspects of services and operations via implementing learning standards, setting up benchmark against superior organization at home and abroad, perfecting strategic planning, and optimizing system for performance measurement and evaluation. Results The newly established distinctive blood collection and supply industry and Shanghai blood center quality management model promote the further development of blood center in many aspects and achieve remarkable results. Conclusion The Performance Excellence Model served as an effective management method and tool for promoting the level of management as SBC continues to move forward and strive for excellence in the work of transfusion services.
Objective To explore the changes of KIR receptor and function of NK cells and CTL cells in patients with acquired hemophagocytic lymphohistiocytosis（HLH）. Methods The data of CD8+T cell function and KIR receptor and function of NK cells and CTL cells in 26 patients with HLH from February 2018 to February 2021 were collected retrospectively,and 17 healthy subjects were used as controls. The statistical analysis was carried out between the two groups. Results The proportion of lymphocytes and NK cells in patients with HLH were significantly lower than those in the control group（33.18±1.939 vs. 18.43±2.382,P<0.000 1;20.38±2.090 vs. 7.654±1.634,P<0.000 1）. The proportion of CTL cells was higher than that in the control group {45.5（35.275,50.375） vs. 35.2（30.2,37.9）,P=0.005}, but there was no significant difference in the proportion of T cells between the two groups（P=0.513）. Compared with the control group（0/17）,the gram-restricted expression of KIR receptor in NK cells increased significantly（7/26,P=0.031 0）; compared with the control group,the expression of Perforin in HLH group was decreased{93（67.35,97）vs. 96.6（95.1,97.8）, P=0.016 5}, but the expression of GranzymeB in the two group was no statistically different（P=0.871 7）. The expression proportion of Perforin and GranzymeB was not significantly different in CTL cells between the two groups（P=0.320 7,P=0.621 9）. Conclusion The pathogenesis of secondary HLH has no significant relationship with the expression of Perforin and GranzymeB in NK cells and CTL cells. The detection of Perforin can quickly exclude the deletion of PRF1 in primary HLH.
Objective To study the predictive value of plasma neutrophil gelatinase-associated lipocalin （NGAL） and B-type Natriuretic peptide（BNP）levels on renal function recovery in patients with acute kidney injury（AKI）. Methods A total of 130 AKI patients admitted to our hospital between January 2017 and December 2020 were selected. Based on whether AKI recovery or not,patients were divided into two groups：the AKI recovery group（84 cases）and the AKI non-recovery group （46 cases）. Clinical data, plasma NGAL and BNP levels were compared between two groups. The predictive value of plasma NGAL and BNP levels on renal function recovery was analyzed by ROC curve. Results The APACHE Ⅱ score and SOFA score in AKI recovery group were significantly lower than those in non-recovery group（P<0.05）,and there was no significant difference in the baseline serum Cr levels with AKI onset time between two groups（P>0.05）. At time of AKI diagnosis,the serum levels of Cr, NGAL and BNP in AKI recovery group were significantly lower than those in non-recovery group（P<0.05）. The in-hospital mortality and 28-day mortality of patients in AKI recovery group were significantly lower than those in non-recovery group（P<0.05）. The average length of stay（ALOS） in AKI recovery group was 18.48±4.22 days,which was significantly shorter than that in non-recovery group（21.04 ±6.41 days,P<0.05）. The AUC of NGAL for AKI recovery was 0.684 with a sensitivity of 92.48% and a specificity of 41.09%. The AUC,sensitivity and specificity of BNP for predicting AKI function recovery was 0.784,84.23% and 64.21% respectively. The AUC of NGAL in combination with BNP to predict the recovery of renal function in AKI patients was 0.803, with a sensitivity of 93.84% and a specificity of 59.06%. Conclusion NGAL,BNP alone and their combination have a certain predictive value on renal function recovery in AKI patients. NGAL combined with BNP has a better sensitivity to predict renal function recovery in AKI.
Objective To evaluate the incidence of gestational diabetes mellitus（GDM）in Binhu district of Hefei,we investigated the composition ratio within different types of GDM in each groups,and explored the difference of diagnosis of GDM in oral glucose tolerance test（OGTT）at different time points. Methods From January 2016 to September 2019,22 881 pregnant women who underwent routine obstetric examination in Binhu Hospital of Hefei were screened,and OGTT test had been performed in their 24~28 weeks of gestation. In order to evaluate the value of abnormal blood glucose at any time point and any two time points for the diagnosis of GDM,the area under the different ROC curves had been compared. Results According to the new IADPSD standard,the overall incidence of GDM in Binhu area of Hefei was 24.74%. With the increasing age,the incidence of GDM increased significantly. There were statistically differences between groups. The incidence of GDM in women aged ≥35 years was 40.05%,while the incidence was 15.40% in women aged <25 years. The distribution of patients with different types of GDM in each group obviously different. The area under the curves （AUC） of fasting blood glucose in diagnosis of GDM at any one point was significantly greater than that at any two points （Z=5.502,P<0.000 1）. The AUC of 1 h （Z=35.44,P<0.000 1）and 2 h（Z=31.18,P<0.000 1） in diagnosis of GDM at any two points was significantly greater than that any one point. Conclusion the incidence of GDM in Binhu district of Hefei is relatively high. The sensitivity and specificity of abnormal fasting blood glucose combined with 1 h or 2 h better than that of single 1h or 2h abnormal blood glucose. Same as above,among pregnant women aged ≥35 years,the AUC of fasting blood glucose in diagnosis of GDM at any one point was also statistically different from that at any two point （Z=2.064,P=0.039）
Objective To investigate the relationship between red blood cell distribution width （RDW） level and high-sensitivity C-reactive protein （hs-CRP）, homeostasis model assessment of insulin resistance（HOMA-IR）, Body Mass Index（BMI） and body fat percentage in patients with polycystic ovary syndrome（PCOS）, and analyze the clinical application value of RDW in PCOS. Methods A total of 136 patients with PCOS and 100 healthy women were enrolled as observation group and control group from January 2018 to September 2019. The clinical and laboratory data of the two groups were compared. Correlation was analyzed between RDW and laboratory parameters in the PCOS group. Receiver operating characteristic curve （ROC） analysis were used to compare the diagnostic value of RDW and testosterone for PCOS. Results The level of RDW in PCOS was significantly higher than that in the control group（13.22±1.37 vs. 12.61±0.79, P<0.001）. RDW levels were positively correlated with hs-CRP, HOMA-IR and BMI, but the correlation was not high. ROC curve analysis showed that the sensitivity of RDW diagnosis of PCOS （78.68% vs. 70.59%）and specificity （79.0% vs. 68.0%） were higher than testosterone, and the area under the curve（AUC）was statistically significant（P<0.05）. Conclusions Women with PCOS have higher levels of RDW and may be associated with potential chronic inflammation in PCOS patients.
Objective To investigate the value of the ratio of neutrophil to lymphocyte (NLR), monocyte to lymphocyte (MLR), platelet to lymphocyte (PLR), and systemic immune inflammatory index (SⅡ) in the diagnosis of lymph node metastasis of gastric cancer. Methods A total of 98 patients, which were screened for gastric cancer in our hospital from January 2017 to December 2019, were divided into gastric cancer group(61 cases) and gastric benign disease group(37 cases) by pathological diagnosis. According to the lymph node metastasis, gastric cancer group was further divided into lymph node metastasis group (35 cases) and non lymph node metastasis group (26 cases). NLR, MLR, PLR and SⅡ were calculated according to the results of preoperative blood routine test, and the efficiency of each index in the diagnosis of lymph node metastasis was analyzed. Results Among 61 cases of gastric cancer, 35 cases had lymph node metastasis, the metastasis rate was 57.38%. The levels of NLR, MLR, PLR and SⅡ in lymph node metastasis group were significantly higher than those in non lymph node metastasis group and gastric benign disease group(P<0.01). The area under ROC curve of NLR, MLR, PLR and SⅡ was 0.761, 0.708, 0.686 and 0.781, respectively. The critical values of NLR, MLR, PLR and SⅡ were 3.23, 0.29, 197.7 and 574.47, respectively. NLR, MLR, PLR and SⅡ were correlated with tumor differentiation, invasion, diameter and stage. Patients with lower differentiation, deeper invasion, larger diameter and higher stage had higher values of NLR, MLR, PLR and SⅡ (P<0.05). There was no significant difference in NLR, MLR, PLR and SⅡ (P>0.05) with tumor location. Conclusion NLR, MLR, PLR and SⅡ are related to the differentiation, invasion, diameter and stage of gastric cancer, which could be helpful for the diagnosis of lymph node metastasis of gastric cancer, and provide a reference for the choice of surgical methods and the scope of lymph node dissection.
Objective To realize the statistical analysis of data such as fourfold table chi-square test, evaluation and diagnostic test of four-fold table, and paired design of fourfold table chi-square test through Excel, so as to supplement the statistical function of chi-square test of Excel, and apply it to the teaching practice. Methods The statistical program is compiled through Excel VBA program interface to complete fourfold table chi-square and evaluation and diagnostic test, which compared with the case analysis of Health Statistics to vertify the accuracy of results. Results The input parameters include A (positive number in A rest), B (negative number in A test), C (positive number in B test) and D (negative number in B test). According to the above-mentioned conditions, the software automatically outputs the corresponding statistical description parameters: A+C, B+D, A+B, C, D, A+B+C+D, chi-square test, P values, and judgment. The assessment of diagnostic test and paired chi-square input parameters are: A (true positive), B (false positive), C (false negative) and D (true negative) should be numbers, otherwise there is a prompt dialog box. The software output corresponding statistical description parameters automatically according to these conditions: A+C, B+D, A+B, C+D, A+B+C+D, the diagnostic test's sensitivity, specificity, positive predictive value, negative predictive value and accuracy, matching chi-square test, P values and judgment. Conclusion Excel could replace manual process of fourfold tables data, automatically select the corresponding test statistics method, and provide P values and judgment.
