Objective To compare detection capabilities between flow cytometry and a conventional serological method to develop a more sensitive and reliable technique for clinical pre-transfusion detection of autoimmune hemolytic anemia patients. Methods We used the plasma samples collected from autoimmune hemolytic anemia patients simulated with human-derived autoantibodies and alloantibodies. Common clinically significant antibodies were selected, and 5 cases of anti-D and 4 anti-E were mixed with the autoantibodies in proportion to prepare autoimmune hemolytic anemia patients' plasma samples. The gel card method and flow cytometry were used to detect the above-mentioned simulated plasma, respectively. Results In 3 titer groups (16, 32 and 64), the sensitivity of flow cytometry was significantly stronger than that of the gel card method, and the detection limit was 4 times that of the gel card method (P<0.05). Conclusion Compared with the traditional serological method, flow cytometry has higher sensitivity for the detection of alloantibodies under the cover of autoantibodies. Application of this method for the pre-transfusion examination of autoimmune hemolytic anemia patients can reduce blood transfusion risks mediated by the same antibody and improve the safety of blood transfusion among them.

Objective The positive rate of immune hemolytic reaction（IHTR）samples in Shanghai Blood Center has been increasing in recent years,gradually popularized with capillary technology,PEG enhancement technology and microcolumn agglutination card technology. These changes may affect the detection rate of IHTRs. Methods IHTR cases detected in the blood group reference laboratory of Shanghai Blood Center from March 2011 to March 2021 were reviewed. The inclusion criteria were the recent history of blood transfusion,the detection of Alloantibody and the detection or confirmation of the input of red blood cells reacting with the antibody. All included cases excluded newborns and patients with autoantibodies to prevent interference from maternal antibodies and mimicking antibodies. The antibody specificity and titer, patient diagnosis,hemoglobin,gender and age distribution,and the time from blood transfusion to detection of hemolytic reaction were caculated for all included cases. Results There were 100 IHTR samples. The diagnosis of patients was mostly tumor and MDS（myelodysplastic syndrome）; Among them,the hemolytic blood transfusion reaction caused by RH system antibody accounts for 78%,and the blood transfusion reaction caused by Kidd system accounts for 11%. Most of the antibody effects are low,and 80% of the titration is less than 4; The patient's DAT positive lasted for more than 8 weeks. Conclusion Hemolytic transfusion reaction can cause severe hemolysis in the recipient,which may seriously endanger the life safety of the patient. Most of the antibodies in IHTR samples are RH system antibodies. RhD,CcEe typing and the homotype transfusion can effectively reduce the occurrence of IHTR. The antibodies causing hemolysis are generally weak,and the incompatible transfused red blood cells are metabolized rapidly in vivo and are not easy to be detected,which makes IHTR easy to be ignored,resulting in repeated input of“matched”red blood cells and endangering the life of patients. In terms of detection technology,it is necessary to improve the detection sensitivity. The capillary technology is of great help to the detection of IHTR.

Objective To study the RhD epitope pattern and molecular mechanism of a volunteer blood donor whose phenotype is partial D. Methods Serological methods were used for weak D test and CE phenotyping for one blood sample which was identified as D-negative initially; and D-screen kit was used to analyze RhD epitopes. All exons of RHD were sequenced by Sanger sequencing method. We developed a method to determine RHD zygosity based on droplet digital PCR and analyzed the sample. Robetta modeling was used to compare the conformations of RhD protein between wild type and the sample. Results It was identified as partial D phenotype serologically,and the CE type was CcEe. The c.492C>G base change of exon 4 of RHD gene was identified by sequencing. The results of ddPCR showed that RHD genotype of the sample was D+/D-. Aspartic acid replaced by glutamic acid may influence the conformation of the third extracellular loop of RhD protein according to Robetta modeling results. Conclusion This is the first domestic report of the variant allele RHD*492G, which results in partial D phenotype with lack of some D epitopes. Compared with RT-PCR,the ddPCR method showed better repeatability and accuracy when used for determining RHD zygosity.

Objective To knock out the SMIM1 gene encoding the Vel blood group antigen in the K562 cell line by lentivirus-mediated CRISPR/Cas9 gene editing. Methods We designed five sgRNA sequences and constructed Cas9-sgRNA co-expression plasmids to initially screen sgRNA sequences with higher cutting efficiency in 293T cells. The sgRNA which had been screened out was packaged with the second-generation lentivirus packaging system and then infected K562 cells. We extracted the genomic DNA for Sanger sequencing and TA cloning detection. Results We established a preliminary screening platform for sgRNA using easy-to-transfect 293T cells, and screened out sgRNA4 sequences with higher cutting efficiency. The CRISPR/Cas9 system successfully exerted gene editing activity at the sgRNA4 recognition site of SMIM1 gene in K562 cells. Conclusion We confirmed the feasibility of using CRISPR/Cas9 technology to knock out the SMIM1 gene in K562 cells, which was a foundation for constructing a cell model with negative Vel antigen phenotype and providing experimental basis for subsequent editing genes of other blood group antigens.

Objective To investigate the effect of a low molecular weight heparin in the treatment of patients with preeclampsia. Methods A retrospective investigation for 290 preeclampsia patients in our hospital was conducted from January to April 2019. These patients were divided into heparin group（190 cases）and control group（100 cases） based on treatment method adopted at the first day postpartum. The differences in general data and blood coagulation parameters between two groups were analyzed. Results Neonatal weight and Apgar score（1 min） in heparin group were lower than those in control group（P<0.05）. In levels of coagulation parameters,only thrombin time,D-dimer and platelet distribution width were different between heparin group and control group before delivery. On postpartum day 1, fibrinogen,platelet count and plateletcrit in heparin group were lower than those in control group,while thrombin time, D-dimer and platelet distribution width were higher（P<0.05）. On postpartum day 3,only D-dimer was different between two groups. Conclusion Low molecular weight heparin used on postpartum day 1 can help patients with preeclampsia to return to normal postpartum coagulation parameters.

Objective To investigate the effect of exchange transfusion（ET）performed for neonatal hyperbilirubinemia. Methods A total of 94 neonates received ET in our hospital between January 2018 and September 2020 were included. Demographic characteristics,blood indexes before and after ET,and adverse reactions in neonates were recorded. Results Ninety-four neonates underwent ET had significantly increased levels of indirect bilirubin, including 28 （29.8%） ABO HDN,14（14.9%） intracranial hemorrhage and cephalohematoma,13（13.8%） neonatal sepsis and other infections,7（7.4%） glucose 6-phosphate dehydrogenase（G-6-PD）deficiency,4（4.3%） Rh hemolysis,3 （3.2%）polycythemia,and 25 （26.6%） hyperbilirubinemia due to other causes. The levels of total bilirubin and indirect bilirubin,direct bilirubin,total protein and albumin,ALT,AST,GGT and ALP,creatinine,urea,CysC,LDH,CK, CK-MB After ET were significantly decreased than those before ET（P<0.05）. WBC count,hematocrit,hemoglobin and platelet count were significantly lower than those before ET（P<0.05）. The levels of pH,HCO3-,BE,Na+ and Cl-, and Ca2+ were significantly lower than those before ET（P<0.05）,but pO2,K+,glucose,lactic acid,PT,INR after ET were higher than those before ET （P<0.05）. No significant differences were found in URIC,pCO2,RBC count and APTT before and after ET（P>0.05）. After ET,there were 33 hypocalcemia,55 thrombocytopenia,83 hyperglycemia,41 metabolic acidosis and 5 cases of hyperkalemia. Conclusion ET is an effective treatment for treat neonatal hyperbilirubinemia due to removal of serum bilirubin,but it can cause significant changes in some blood indexes and adverse reactions after ET. The changes of blood indexes and clinical manifestations should be carefully monitored during ET so as to ensure safety and efficacy of ET.

Objective To investigate the clinical application of intrauterine transfusion therapy,and to analyze the influence of intrauterine transfusion（IUT）therapy on short-term pregnancy outcomes. Methods We retrospectively analyzed the cases who were admitted to the Guangdong Women and Children Hospital and received IUT from January 2017 to June 2021. Clinical data were divided into Fetus survival group and non-survival group based on the fetuses' condition. The reasons and frequency for IUT,gestational age at the first IUT and fetal hemoglobin concentration（Hb）,hematocrit （HCT）and peak systolic blood flow velocity of the middle cerebral artery（MCA-PSV） changes were compared between two groups. The data was statistically analyzed by SPSS 13.0 software. Results A total of 34 cases of IUT were included, of which 19 fetuses were alive and 15 were non-survivors. We performed 63 IUTs and the main causes of IUT were unexplained anemia,twin-fetal transfusion syndrome,maternal-fetal blood group incompatibility,and placental hemangioma. The Hb and HCT of the fetuses in the two groups were significantly increased,and the MCA-PSV was significantly lower after IUT（P<0.001）. Logistic regression analysis indicated that the gestational week of the first IUT （OR=1.49,P=0.041） and IUT frequency（OR=6.72,P=0.025） were protective factors for fetal survival. Conclusion IUT has a wide range of applications,which can significantly improve the fetal anemia.

Objective Study on the isoimmunization of RhD negative pregnant women and explore the influencing factors of producing anti-D antibody,and to monitor and prevent hemolytic disease of newborn in perinatal period. Methods ABO blood group and RhD antigen were detected by the standard serological methods,RhD antigen negative confirmation and antibody screening were tested by indirect antiglobulin test. Asia Del（RHD*01EL.01）was detected by PCR-SSP. Results Among 596 pregnant women,70 were confirmed to be RhD negative,of whom 6 produced the anti-D antibody. No anti-D antibody were observed in all first-time pregnant and Del type women．In multi-pregnant women,8.57% produce anti-D allo-immune response. Conclusion Anti-D isoimmunization is affected by many factors and the level of anti-D is regularly monitored during perinatal period of RhD negative pregnant women. Anti-D immunoglobulin treatment is recommended for those pregnant women who do not produce anti-D,and appropriate treatment shoud be adopted to treat or prevent the newborns of pregnant women with anti-D.

Objective To investigate the influence of plasma exchange on prognostic factors of patients with hepatitis B associated chronic acute liver failure（HBV-ACLF）awaiting liver transplantation. Methods A retrospective analysis was performed on patients with HBV-ACLF who received PE while waiting for liver transplantation in Shanghai Changzheng Hospital from June 2018 to June 2021,including the basic information（gender,age,blood type）of the patients,number and dosage of PE,changes of indicators before and after PE,adverse reactions related to PE and the prognosis of the patients. Results Fifty-one cases were included in this research. Multivariate analysis showed that blood ammonia（BA）difference before and after PE was an independent risk factor for 90 days and long-term outcomes in HBV-ACLF patients awaiting liver transplantation treated with PE,and platelet count before PE was also an independent risk factor for long-term outcomes in these patients. ROC curve calculation showed that after PE reduction of BA to 4% of that before PE might result in a better prognosis. Conclusion The change range of BA before and after PE is an effective indicator to predict the efficacy of PE and the prognosis of HBV-ACLF patients,which has guiding significance for the rational allocation and usage of plasma resources.

Objective Analysis of the effect of relevant indexes on blood transfusion of liver transplantation patients. Methods To retrospectively analyze the clinical data of patients undergoing liver transplantation due to various liver diseases in our hospital in 2020,the patients were divided into blood transfusion group（n=153）and non-transfusion group（n=30）according to whether they were transfused with blood products during the operation. According to the diagnostic criteria,these patients were divided into liver cirrhosis group, liver failure group,liver cancer group and other liver diseases group. Intraoperative blood loss,operative time and infusion volume of various blood products （red blood cells,fresh frozen plasma,frozen plasma,cryoprecipitate coagulation factor）of liver transplantation patients were observed. Then,the analysis of preoperative and postoperative coagulation indexes including PT,APTT,INR,FIB in the 153 patients received blood transfusion was performed. Results Compared with the no transfusion group,serum AST,TBIL,Cr,INR and intraoperative blood loss of patients in transfusion group were higher（P<0.05）, but the hemoglobin levels was lower（P<0.05）. There were no significant differences in other indexes（P>0.05）. The intraoperative blood loss and operative time of patients were significantly higher in liver failure group than in the other groups（P<0.05）,as were infusion volume of various blood preparations and the rate of poor prognosis（P<0.05）. Compared with other groups,the preoperative coagulation indexes including PT,APTT,INR,FIB of patients in liver failure group were significantly higher（P<0.05）. Conclusion Perioperative PT and APTT have a guiding role in the blood transfusion of liver transplantation, and the transfusion rate can affect the prognosis and outcome of the patients. It is necessary to make different blood transfusion plans according to basic diseases and blood test indexes before liver transplantation.

Objective To identify specific antibodies（allo-antibody and mimicking antibody）in patients with autoimmune hemolytic anemia（AIHA）by antibody titration procedure. Methods Samples from patients tested positive for direct antiglobulin test from the blood group reference laboratory of Shanghai Blood Center between March and April 2021 were collected. Serum,eluate and diluent eluate for antibody titers were used to identify antibodies. Results Four specific antibodies in serum,3 specific antibodies in eluate,9 specific antibodies in diluent eluate were detected. Conclusion The proportion of specific antibodies detected in diluent eluate in positive DAT patients were higher than that of serum and eluate. The antibody titers play a decisive role in eluate dilution. Testing for antibody titer can increase detection rate of mimicking antibody in AIHA patients. It can reduce the reduction of blood transfusion effect due to mimicking antibody to improve the safety and effectiveness of a transfusion.

Objective To explore the enhancement effect of polyethylene glycol microcolumn gel method （PEG-MGT） in irregular antibody detection. Methods We retrospectively analyzed 70 specimens with weak agglutination by low ionic strength salt solution-microcolumn gel method（LISS-MGT） as well as additional PEG-MGT results from April 2018 to April 2021 and compared the 16-pannel cell reaction pattern and experimental results. Results We identified the specific antibodies in 29 cases by PEG-MGT（41.4%）,including 20 cases of Rh system-related antibodies（69%）,5 cases of Duffy system antibodies （17.2%）,3 cases of Kidd system antibodies （10.3%） and one case of Lewis system antibodies（3.4% ）. There were still 41 cases（58.6%）to be determined the specificity of antibodies. By comparing with the reaction intensity of LISS -MGT and the PEG-MGT results,the experimental results showed that PEG-MGT enhanced the reaction intensity in 16 cases,weakened in 17 cases,and unchanged in 8 cases. The antibodies could be determined by saline medium or MGT incubating at 4℃ in a total of 13 cases,including 9 cases of anti-M antibodies（4 cases of PEG-MGT enhancement,3 cases of weakening,4 cases of constant strength）,2 cases of anti-P1 antibody（both PEG-MGT enhancement）,and anti-Lea antibody （PEG-MGT enhancement） and anti-Leb antibody （PEG-MGT weakening） one case each. Conclusion PEG-MGT method could significantly enhance the antigen-antibody response in Rh system, Duffy system and Kidd system, and it also could be helpful to determine antibodies of MNS system, Lewis system and P1 system.

Objective To study the effect of freeze-drying preservation method and activation time on platelet rich plasma (PRP) growth factor (GFs) content. Methods 20 PRPs were collected from healthy blood donors, of which platelet concentration was (1 031±150.1) × 109/L. Each PRP sample is divided into 5 groups, (1) fresh PRP (PRP), (2) frozen PRP activated by calcium gluconate (F-Ca PRP), (3) PRP activated by calcium gluconate followed by freezing (Ca-F PRP), (4) PRP freeze-dried first, then activated by calcium gluconate (FD-Ca PRP), (5) PRP activated by calcium gluconate followed by freeze drying (Ca-FD PRP). The concents of transforming growth factor-β1 (TGF-β1), vascular endothelial growth factor (VEGF), and platelet-derived growth factor-BB (PDGF-BB) were quantified by ELISA. Results TGF-β1 and PDGF-BB concentrations in FD-Ca PRP were not statistically different from PRP, while the VEGF was elevated and statistically different compared with the PRP. TGF-β1 and VEGF concentrations in the other three groups were not statistically different from PRP, while the differences in PDGF-BB were statistically significant. Conclusion The freezing and freeze-drying on PRP did not affect the concentrations of the three main growth factors from PRP, and compared with freezing on PRP, freeze-drying was less required with storage conditions. It suggested that wider possibilities of freeze-dried PRP for clinical applications.

Objective To detect HPA genotypes of blood samples from apheresis platelet donors in Hefei, Anhui Province,and calculate their distribution frequency in this region. Methods Multiplex PCR was used to characterize HPA1-6,10,15 and 21 genotypes of blood samples from 1181 apheresis platelet donors aged 18-55. Blood samples from 22 apheresis platelet donors aged 18-55 were tested for HPA genotyping using SBT direct sequencing. Results HPA-2, HPA-3 and HPA-15 were the most polymorphic in the Anhui population, and the frequencies of HPA alleles were as follows∶1a∶0.994 1,1b∶0.005 9,2a∶0.946 2,2b∶ 0.053 8,3a∶ 0.574 1,3b∶ 0.425 9,4a∶0.998 7,4b∶0.001 3,5a∶0.981 8,5b∶0.018 2,6a∶0.985 2,6b∶ 0.014 8,10a∶1.0,10b∶0.0,15a∶0.539 4、15b∶0.460 6,21a∶0.992 8、21b∶0.007 2. Conclusion The results of HPA genotyping are similar to those of SBT direct sequencing. The polymorphisms of HPA genotypes in Hefei,Anhui Province basically consist with those in other regions reported in the literature,but the distribution frequency of genotypes is specific to this region.

Objective To investigate whether vascular endothelial cadherin can predict vascular endothelial injury and its relationship with the occurrence and severity of hemolysis in ABO hemolytic disease of newborn. Methods 50 cases of ABO hemolytic disease of newborn（ABO-HDN Group）and 47 healthy newborns with matching maternal and infant blood types（Control Group）were selected in our hospital from April 2020 to November 2020. The hemoglobin （Hb）, reticulocyte percentage（Ret%）,indirect bilirubin（IBIL）and lactate dehydrogenase（LDH）were measured at the same time, and the concentration of vascular endothelial cadherin（VE-Cad）was quantitatively measured. Results There was no significant difference in birth weight,gestational age and the age by day on detection between the two groups（P> 0.05） ,but there was significant difference in Hb,Ret%,IBIL,LDH and VE-Cad between the two groups（P<0.05）, the VE-Cad level was positively correlated with Ret%,IBIL and LDH,but negatively correlated with Hb（P<0.05）. Multiple regression analysis showed that VE-Cad level was independently correlated with Hb,Ret%,IBIL and LDH （P<0.05）. Conclusion The increased level of VE-Cad in ABO hemolytic disease of newborn can be used to reflect the endothelial injury of children and help to assess the risk of severe vascular dysfunction.

Objective To investigate the RHD genetic background of 48 D variant specimens. Methods Specimens were collected from blood donors and patients sent to Suzhou Blood Center and Xuzhou Blood Center for RHD blood group confirmation from July 2020 to July 2021. All samples showing negative or equivocal agglutination were tested by IAT with three commercially available anti-D reagents,with D variant defined once it reacted positively with an anti-D. The genomic DNA of the D variant specimen was extracted,and the RHD genotype of the specimen was preliminarily identified by PCR-SSP. For doubtful or unidentifiable results,further genetic sequencing of RHD exons 1-10 was performed. Results A total of 48 cases were identified with the D variant.The PCR-SSP method directly determined the allelic composition in 35 cases, including RHD*15,RHD*06.03.01,RHD*15/RHD*01EL.01 and RHD*01EL.01,of which weak D type and DⅥ type are the most prevalent,with 17 cases（34.69%）and 9 cases（18.37%）respectively. The allelic composition of the remaining 13 cases was determined after RHD sequencing,including 5 cases of weak D（RHD*01W.72,RHD*01W.54, RHD*01W.10 and RHD*11/RHD*01EL.01）,4 cases of partial D（RHD*05.01,RHD*05.04,RHD*05.05 and RHD*16.02）,as well as 1 case of RHD*01. There were also 3 weak D specimens with single nucleotide mutations,2 cases with RHD*779G and 1 case with 509T>G. The 509T>G mutation was found to be like partial D after being tested with multiple monoclonal antibodies. The common type of RHD*15 was ccEe,accounting for 70.59% of the allelic composition; the common type of RHD*06.03.01 was Ccee,accounting for 77.78% of the allelic composition. Conclusion RHD*15 is the most common D variant in the two areas,whose common type is ccEe,and the D variant has rich genetic polymorphisms for this locus.

Objective To explore a FOCUS-PDCA cycle approach to improve reporting of adverse reactions to blood transfusion. Methods The FOCUS-PDCA cycle approach was applied to continuously improve the reporting process of adverse reactions associated with transfusion in 2019 versus transfusion cases from 2015 to 2018 in the control group. Results Through the establishment of a novel system for reporting adverse transfusion reactions, the target value was set at 100%. The implementation rate of adverse reactions gradually increased to 98% by FOCUS-PDCA cycle approach. The incidence of adverse reactions increased to 0.74%, with statistically significant differences compared to the previous year (χ2=81.64,P<0.05). Conclusion The application of the FOCUS -PDCA cycle approach significantly improved the execution rate of adverse transfusion reactions reported. It plays an important role in clinical blood transfusion quality management and is worthy of promotion.

Objective We aim to clarify the changes of lymphocyte subsets in peripheral blood of elderly patients with gastric cancer before and after postoperative adjuvant chemotherapy, and to analyze the value of human epidermal growth factor receptor 2 (HER2) in the prognosis evaluation of elderly patients with gastric cancer. Methods The clinical data of 67 patients with gastric cancer who received postoperative adjuvant chemotherapy in the First Affiliated Hospital of University of Science and Technology of China from January 2017 to December 2019 were retrospectively collectedto analyze the number changes of white blood cells and lymphocyte subsets before and after chemotherapy in different age groups of HER2+ and HER2- gastric cancer patients. Results The frequency of HER2+ gastric cancer patients aged ≥60 was 45.2%, which was significantly higher than that in patients <60 years (12.0%), and the difference was significant (P=0.003). Further analysis showed that the absolute numbers of CD3+T, CD3+CD4+T and CD3+CD8+T cells in patients with gastric cancer aged≥60 years after the first chemotherapy were significantly lower than those before chemotherapy (P<0.05), and the absolute numbers of CD3+CD8+T cells in HER2+patients were significantly lower than those in HER2- patients after chemotherapy. At the same time, CD3-CD56+NK cells and CD4+CD25+Treg cells showed no significant changes before and after chemotherapy. In HER2-patients, however, chemotherapy did not affect the number of lymphocytes. Conclusion The proportion of HER2+ elderly patients (≥60 years) with gastric cancer was significantly increased. Compared with HER2- patients, adjuvant chemotherapy significantly inhibited the number of lymphocytes in HER2+patients, thus affecting the immune status of HER2+ patients. Therefore, it is speculated that precise immunotherapy or combination with low-dose chemotherapy is more suitable for elderly patients with HER2+ gastric cancer than traditional chemotherapy.

Objective To study the effects of venetoclax or CAG combined with azacitidine on patients with recurrent refractory acute myeloid leukemia（AML）. Methods The clinical data of 65 patients with recurrent refractory AML in the hospital between July 2019 and December 2020 were retrospectively analyzed,and the patients were divided into venetoclax group （n=30,venetoclax + azacitidine） and CAG group（n=35,CAG + azacitidine） according to different treatment regimens. The efficacy was compared between the two groups after 4 weeks of treatment,prognosis indicator （WT1）,quality of life [Karnofsky Performance Status （KPS）],levels of tumor necrosis factor-α（TNF-α） and interferon γ（IFN-γ） and incidence rates of adverse reactions were compared between the two groups after 4 weeks, 12 weeks and 24 weeks of treatment. The follow-up results of the two groups were compared. Results After 4 weeks of treatment,the ORR of venetoclax group was higher than that of CAG group（P<0.05）. After 4,12 and 24 weeks of treatment,the WT1 expression level in both groups was decreased,and the expression level of venetoclax group was lower than that of CAG group. The levels of TNF-α and IFN-γ were increased in the two groups, and the levels were higher in venetoclax group than those in CAG group（P<0.05）. The incidence rates of Ⅲ~Ⅳ degree bone marrow suppression, nausea and vomiting and abnormal liver-kidney function were lower in venetoclax group than those in CAG group while the incidence rates of diarrhea and musculoskeletal pain were higher than those in CAG group （P<0.05）. After 24 weeks of treatment,KPS score in venetoclax group was higher than that in CAG group （P<0.05）. The median follow-up time was 7 months （1~15 months）. By the end point of follow-up,the overall survival （OS） rate of venetoclax group was 53.33% （16/30）and that of CAG group was 42.86% （15/35）,and there was no statistical significance in OS rate between the two groups（P>0.05）. The leukemia-free survival （LFS） rate of 33.33% in venetoclax group was significantly higher than 11.43% in CAG group（P<0.05）. Conclusion Venetoclax + azacitidine has a better efficacy than CAG + azacitidine in the treatment of recurrent refractory AML,and the former one can improve the body's inflammation and has better prognosis, higher quality of life and lower incidence rates of bone marrow suppression, nausea and vomiting and abnormal liver-kidney function, but has higher incidence rates of diarrhea and musculoskeletal pain.

Objective To explore a new mode of online continuing education for transfusion medicine and to play the promoting role of continuing education in the sustainable development of the discipline. Methods China Blood Transfusion Lecture Hall for live teaching was created on the online network platform. A large number of basic and clinical research progress related to transfusion medicine was delivered to the front-line staff in the form of special lectures. Anonymous online questionnaire survey was carried out through Wenjuanstar software system to acquire the composition of lecture audience and the evaluation of course setting and lecture effect. Results In the past four years,166 sessions and 249 hours of online lectures have been given,and more than 63 000 people have watched the live lectures of China Blood Transfusion Lecture Hall. A total of 1 266 valid questionnaires were collected. The satisfaction scores of lecture content arrangement（S1）≥90,80≤S1<90 and 70≤S1<80 accounted for 61.45%,30.88% and 5.85%,respectively. The satisfaction scores of teacher competence（S2）≥90,80≤S2<90 and 70≤S2<80 accounted for 68.01%,25.91% and 5.06%,respectively; The effects of the lectures included improving the ability to deal with problems in clinical practice（89.02%）,enhancing the level of basic theory（84.36%）,improving the overall understanding of the subject of transfusion medicine（83.89%）, expanding the field of vision（81.04%）,improving the collaboration with the clinic（64.14%）and training the clinical thinking ability（63.35%）. Conclusion sThe online continuing education model of China Blood Transfusion Lecture Hall can effectively overcome the limitations of time and space,provide a convenient and systematic channel for transfusion practitioners to update their knowledge,and improve their basic knowledge,theories and skills in various degrees.