Based on the current blood transfusion information management system, specimen management system, full-automatic blood group detection system, intelligent blood storage system, and mobile nursing system, improvement aspects of each system's function is proposed. Enhancing the synergy between different types of equipment, the solutions for the hardware docking, software docking, and real-time data interaction are also proposed in this paper. In this way, the whole process automation of blood transfusion compatibility test and blood management is realized, that is, the whole-process-automation and node closed-loop from specimen reception to report-output, from blood inbound to outbound, and from blood outbound to blood bag recycling,it will push on the construction of intelligent blood transfusion medicine, and provide reference for further promoting the construction of smart hospitals.
The incidence of RhD mismatched allogeneic hematopoietic stem cell transplantation in China is very low. At the same time, the scarcity of RhD-negative blood resources makes it difficult to meet the transfusion needs of this group of patients. In order to provide basis for RhD blood group selection in blood transfusion, especially in emergency,this paper reviews the literature on RhD blood group selection, clinical outcomes and methods to prevention of alloantibody production in RhD mismatched hematopoietic stem cell transplantation.
As a non-profitable organization that provides services for both blood donors and recipients, blood establishment manufacture blood products. The efficiency of blood establishment involves in the indicators including strategic, productivity, effectiveness, quality and capacity. Evaluation indicators suitable for the efficiency of blood establishment include blood donor recruitment and retention, blood collection and process, blood inventory management, supply chain waste, human resources and financial resources. These indicators help allocation of resources, establish blood collection and supply procedures, and improve the standard operating procedures for blood collection and process to provide a reference for optimizing the staffing and operation efficiency of blood establishment.
Objective The data related to the operation efficiency of key positions were compared to understand the work efficiency of key positions in some small and medium-sized blood collection and supply institutions. Methods The data from 20 institutions between 2017 and 2021, such as total numbers of whole blood donated, total numbers of apheresis platelets, tested samples, total blood supply service population, numbers of workers in whole blood collection department, apheresis platelets collection department, component processing department, testing department and blood supply department, were collected. The work efficiency was calculated and compared. The status and differences of work efficiency were analyzed and the number of personnel allocated in each position was obtained. Results The work efficiency of blood collection staffs in 20 institutions ranged from 2.11 to 12.62 units/person/day. The work efficiency of apheresis platelets collection ranged from 1.10 to 9.32 units/person/day. Blood component processed ranged from 8.94 to 36.96 units person/day. Samples tested ranged from 13.67 to 47.53 samples/person. The number of populations served by blood supply staff ranged from 334 615 to 1 694 300 person. Conclusion The work efficiency of key positions in 20 institutions was different. The work efficiency of staff in the whole blood collection position, platelet collection position, component processing position and testing position in most institutions showed an upward trend, while the work efficiency of staffs in the blood supply position showed a downward trend. It suggests that blood collection and supply institutions should improve their work efficiency of positions with work efficiency lower than the median.
Objective To investigate the current inventory management status of red blood cells (RBCs) in prefecture and municipal blood stations in China. Methods Collect the data of the qualified RBCs laid in banks, the average daily stock of RBCs, the blood distribution of RBCs per 1 000 population, and the average shelf life of RBCs between 2017 and 2021 from 26 blood stations in China, and statistical analysis were carried out. Results From 2017 to 2021, the qualified RBCs in 25 blood stations achieved average growth annually with a 5.9% median. The average daily RBCs inventory is between -30%~30% year-on-year among 11 blood stations, and >30% or<-30% year-on-year among 14 blood stations. The average annual growth rate of RBCs supply per 1 000 population among 20 blood stations was increased and the median was 5.09%. The average RBCs shelf life of 26 blood stations were between 7.11~17.66 days, and the overall average was 12.52 days. Between 2017 and 2019, there were expired RBCs produced from 8 blood stations, from 13 blood stations in 2020, and 9 in 2021 Conclusion Recent years, while the overall trend of quantity of RBCs prepared and supply by municipal blood station in China is on the rise, the inventory can maintain relatively fresh and deal with any emergencies situation. However, the fluctuation of daily average inventory and the expired events of red blood cell components suggest that there is still room for improvement in accurate inventory management.
Objective To investigate the production of red blood cell products in 20 blood stations in China, and therefore provide data support for improving their productivity. Methods The relevant data of red blood cell production in 20 blood stations in China were collected from 2017 to 2021, and the data of whole blood collection, blood collection efficiency, blood scrap rate of red blood cell components, utilization efficiency of red blood cell inventory, and productivity of red blood cell products were statistically analyzed. Results The whole blood collection volume of 20 blood stations increased by an average of 4.38% annually from 2017 to 2021, the blood collection efficiency was 96%, the scrap rate of red blood cell components was 1.51%, utilization efficiency of red blood cell inventory was 97.79%, and the productivity of red blood cell product was 96.92%. Conclusion The productivity of red blood cell products is high, but the influencing factors vary greatly in regions. Blood stations should carefully analyze the reasons and take effective measures to improve their productivity.
Objective To explore the effect of the washing and filtering process of intraoperative cell salvage on coagulation and fetal composition of high-risk cesarean section women, and to prove the safety of intraoperative cell salvage in the application of cesarean section. Methods Fifty high-risk women who underwent cesarean section and IOCS in the obstetrics department of a tertiary hospital were selected as the observation group, and 50 cases during the same period were selected as the control group. Maternal venous blood after delivering, pre-washing blood sample, post-washing blood sample, and filtered blood sample in observation group were collected. Fetus squamous epithelial cells, fetal red blood cells, alpha-fetoprotein and tissue factor were detected. The blood coagulation and fetal components were compared between the two groups before and after the operation. Results There was no significant difference in PT, APTT, Fib, alpha-fetoprotein and tissue factor between the two groups before and after operation (P>0.05). Compared with the blood sample before washing, the fetal red blood cells, alpha-fetoprotein and tissue factor of the blood sample after washing were significantly reduced in observation group (P<0.05). Compared with the blood sample after washing, the fetal epithelial cells, fetal red blood cell counts, alpha-fetoprotein and tissue factor of the filtered blood sample were significantly reduced (P<0.05). Conclusion Intraoperative cell salvage has little effect on maternal coagulation function. It has a good filtering effect on amniotic fluid components, high safety, and suitable for clinical application.
Objective To explore the effect of cardio-pulmonary and renal function on erythrocyte transfusion threshold in patients with chronic anemia, and provide reference basis for clinical pre-transfusion evaluation. Methods The basic information of 979 patients with chronic anemia undergoing blood transfusion in our hospital from 2020 to 2021 was collected, including the patient's sex, age, left ventricular ejection fraction, partial pressure of carbon dioxide, glomerular filtration rate estimation, hemoglobin concentration before blood transfusion and other indicators. Multiple linear regression analysis and propensity score matching were used to study the risk factors affecting the red blood cell infusion threshold. Results The multiple linear regression analysis of 979 patients with blood transfusion showed that the independent risk factors affecting the threshold of red blood cell transfusion were age and partial pressure of carbon dioxide, and the B values were -0.181 and 0.296, respectively, P<0.01. The R2 of the regression model is 0.072, the VIF value is less than 2, and the DW value is 0.533. The independent variables of the model are good, there is no collinearity problem, and the residual conforms to the normal distribution. After score matching of 290 cases of renal failure group, 268 cases were matched successfully. The mean hemoglobin concentration before blood transfusion in the matched renal failure group and the normal renal function group were 57.74 and 68.88, respectively, and the F value was 24.90, P<0.01. Conclusion This study suggests that age, lung function and renal function can affect the red blood cell infusion threshold of patients, and the increase of age and renal failure can reduce the red blood cell infusion threshold; The increase of partial pressure of carbon dioxide will increase the threshold of red blood cell infusion; There was no statistical difference in the effect of left ventricular ejection fraction on red blood cell infusion threshold.
Objective To analyze killer cell immunoglobulin-like receptor (KIR) gene polymorphism and genotypes characteristics in Shaanxi Han population. Methods The peripheral blood of 474 hematopoietic stem cell voluntary donors in Shaanxi were randomly collected and genotyped by polymerase chain reaction-sequence specific primer (PCR-SSP). The genotypes were designated according the Allele Frequency Net Database (AFND). Results Among Shaanxi Han population, KIR3DP1, 3DL2, 3DL3, 2DL3 and 2DL4 were found in all samples. The gene frequencies of KIR2DS4, 3DL1, 2DL1, 2DP1, 2DS3, 2DL2, 2DS2, 2DS5, 2DS1, 3DS1 and 2DL5 were 67.51%, 96.20%, 98.52%, 99.37% , 15.61%, 20.89%, 25.74%, 29.32%, 37.55%, 37.76% and 40.30% respectively. A total of 44 KIR genotypes were confirmed, among which ID1, 195, 2, 10 and 79 were the most common, with frequencies of 29.96%、13.08%、8.02%、5.91% and 5.48%,respectively. Conclusion The distribution of KIR genes and genotypes in Shaanxi Han population shows common features with Chinese Han population, and have their own distribution characteristics.
Objective Observation on the effectiveness of video stimulation test in prevention of blood donation-related vasovagal reaction (DRVR) caused by anxiety. Methods Blood donors in mobile blood collection vehicle No. 1 and No. 2 between September and October 2022, whose pre-blood donation health examination met GB18467-2001 "Health examination Requirements for Blood donors", Hamilton Anxiety Scale (HAMA) score less than 14 points, Barrier-free communication and cooperation, were selected as the study objects. Blood donors were divided into the experimental group and the control group. Video stimulation test was conducted before blood collection in the experimental group, that is, VR glasses were used to watch the blood collection video for 1 minute and 22 seconds, focusing on the venipuncture, blood outflow and other procedures. After watching, blood donation will be stopped immediately if the donor has any symptoms of physical anxiety, blood pressure and/or heart rate that do not meet the requirements of "Health Examination Requirements for Blood Donors" and HAMA score ≥14 points. Those without the above conditions began blood collection. Blood was collected directly without video stimulation in the control group. The HAMA score, blood pressure and heart rate were compared before and after the video stimulation test between the blood donor interval and the stopping blood donor interval in the experimental group. The reasons for stopping blood donors were analyzed. The incidence of DRVR and the causes of DRVR were compared between the two groups. Results There was no significant difference in HAMA score between the blood donor interval (7.54 ±2.41) and the stopping blood donor interval (7.58±2.84) before the video stimulation test in the experimental group (P>0.05). After the video stimulation test, the HAMA score of the stopping blood donors (12.88±3.51) was higher than that of blood donors (7.61±2.55) (P>0.05). The changes of systolic blood pressure, diastolic blood pressure and heart rate (2.25± 2.37, 1.32±1.64, 1.74±0.26, respectively) in the donor interval before and after the video stimulation test in the experimental group were lower than those in the stopping donor interval (5.41±3.87, 3.64±2.56, 3.87±1.38) (all P>0.05). For the reasons of stopping blood donors in the experimental group, there were 25 cases with any physical anxiety symptoms, accounting for 100.00%, 9 cases with blood pressure and/or heart rate that did not meet the "Health Examination Requirements for Blood Donors", accounting for 36.00%, and 5 cases with HAMA score≥14 points, accounting for 20.00%. The incidence of DRVR in the experimental group (1.11%) was lower than that in the control group (2.50%) (P>0.05). The proportion of DRVR blood donors caused by anxiety in the experimental group (0.22%) was lower than that in the control group (1.19%) (P>0.05). Conclusion The application of video stimulation test can induce anxiety among people who are sensitive to anxiety during the blood collection process. We identify anxiety symptoms and stop blood donation to prevent DRVR caused by anxiety and the incidence of DRVR to effectively protect blood donors'safety.
Objective Design of a real-time PCR method for rapid screening of rare Di(b-) blood types inspired by 3 clinical cases. Methods Blood type and unexpected antibodies were identified by serological methods. The coding region of SLC4A1 gene was amplified by PCR and sequenced to analyze the DNA sequence. Real-time TaqMan-MGB PCR was used for rapid identification of DI*A/DI*B from clinical cases and control samples. Results The unexpected antibody identification of 3 clinical cases was uniformly positive with RBCs, suggesting the presence of unexpected antibodies against high-frequency antigens. DNA sequencing confirmed that the 3 cases were TT at 2561bp in exon 19 of the SLC4A1 gene, which is rare Di(b-) blood type. Real-time fluorescent PCR primers and probes designed for rapid screening of matching blood can accurately identify the SLC4A1 genotype of samples. Conclusion The real-time fluorescent TaqMan-MGB PCR method we designed can quickly, accurately and efficiently identify DI*A and DI*B genes, and can be used to rapidly screen Di(b-) blood to meet the clinical blood needs.
Objective To compare the impact on stem cell quality between using modified cord blood separation method (modified method) and using traditional cord blood separation method (traditional method). Methods We developed a modified method, in which different centrifugation parameters were used according to the samples' volume. We collected QC vials' thawing data, which were processed within one year before and after the modification. Test results were compared between these two methods. Results In modified method group, volume after separation decreased from (25.68±2.03) mL to (22.53±4.24) mL (P<0.05). Red blood cells (RBC) removal rate rose from (75.87±11.84)% to (82.94±8.68)% (P<0.001). No statistic difference was observed in total nucleated cells (TNC) recovery, CD34+ cell recovery and CD34+ cell viability after thawing. In colony formation test, colony forming unit-granulocyte monocyte (CFU-GM) recovery were (60.00±32.52)% and (46.97±28.12)% in modified method group and traditional method group, respectively. The difference was statistically significant (P<0.05). Conclusion sThe modified cord blood separation method improved RBC removal rate and freezing product volume. After freezing, the stem cell showed higher potency in CFU-GM formation.
Objective To systematically evaluate the efficacy and safety of Ixazomib in the treatment of multiple myeloma (MM). Methods Web of science, PubMed, Embase, The Cochrane Library, ClinicalTrials.gov were searched. Data was extracted between their inception and June 2022 and all the documents were manually retrieved. After literature selection, evaluation quality and data extraction according to inclusion and exclusion criteria, meta-analysis was performed using RevMan5.4 software. Results Seven RCTs involving a total of 3 094 patients were included. Meta-analysis showed that Ixazomib reduced the risk of disease progression in MM patients (HR=0.75, 95%CI：0.68~0.83, P<0.00001) and reduced the risk of disease progression in high-risk cytogenetic patients (HR=0.73,95%CI：0.57~0.94, P=0.01), but did not significantly reduce the risk of death (HR=0.94, 95%CI：0.82~1.08, P=0.37). Ixazomib had an increased risk of any grade ≥ 3 adverse events (RR=1.18, 95%CI：1.11~1.25, P<0.000 01). The main increased adverse events were thrombocytopenia, diarrhea, rash and peripheral neuropathy. Conclusion Ixazomib has significant progression-free survival (PFS) benefit in patients with MM, and can significantly reduce the risk of disease progression in high-risk cytogenetic patients. With limited toxicity and convenient oral therapy, it is an important treatment choice for patients with multiple myeloma.
Objective We calculated the stress hyperglycemia ratio (SHR) using pre-thrombolysis random blood glucose (RBG) and fasting blood glucose (FBG) to glycosylated hemoglobin on the first morning after admission to assess the association of SHR with early neurological improvement (ENI) in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA). Methods The clinical data of 85 AIS patients treated with intravenous thrombolysis with r-tPA were analyzed. SHR1 was defined as [RBG (mmol/L)]/[HbA1c(%)], and SHR2 as [FBG (mmol/L)]/[HbA1c(%)]. The relationship between SHR and ENI was analyzed. Results Univariate analysis showed that the median SHR2 of the ENI group was 0.87, lower than that of the non-ENI group, which was 1.03 (Z=-3.012,P<0.05). There was no significant difference in SHR1 between the two groups. In patients without diabetes, the AUC of ENI was 0.674, the optimal diagnostic threshold was 0.9, the sensitivity was 85%, and the specificity was 57.1%. Conclusion SHR promises to be a predictor of ENI after thrombolysis.
Objective A prediction model for dyslipidemia was established based on laboratory data of patients with moderate coronavirus disease 2019 (COVID-19). Methods Clinical data and the results of the first laboratory examination of 74 patients with moderate COVID-19 at admission were collected. Patients were divided into normal and abnormal groups based on lipid levels. Univariate Logistic regression and colinear diagnosis were used to determine the risk factors of dyslipidemia, and backward stepwise regression was used to establish a line graph model. Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis were used to evaluate the model discrimination, goodness of fit, and clinical usefulness. Results The patients with dyslipidemia at admission returned to normal levels of blood lipid at discharge. Logistic regression analysis showed that uric acid (OR=1.024) and alkaline phosphatase (OR=1.417) were combined to predict dyslipidemia (P<0.05). The ROC curve showed that the model had a high degree of differentiation (area under the curve was 0.987). The calibration curve showed that the model had a good fitting degree (P=0.989). The decision curve showed that the mode had a good clinical usefulness. Conclusion The combined model of uric acid and alkaline phosphatase established in this study can better predict dyslipidemia in patients with moderate COVID-19. This study is in the preliminary exploratory stage, and the clinical usefulness of the model needs further validation with large sample data, which can be used as a reference for related studies.
Objective To investigate the diagnostic value of thromboelastogram parameters (TEG) combined with clinical indexes for acute ischemic stroke (AIS). Methods A total of 190 patients were enrolled in this study, including 120 acute ischemic stroke patients in the observation group and 70 other patients as the controls. Complete blood count, coagulation function, D-dimer, fasting blood glucose (GLU) and blood lipid parameters were analyzed. Lasso regression and logistic regression were used to screen variables for AIS diagnostic model presented by nomogram. Receiver operating characteristic (ROC) curve and area under curve (AUC), decision curve and calibration curve were applied respectively to evaluate the discrimination, accuracy and application value of the model. Results Six variables, i.e., MA, GLU, CHOL, smoke, history of acute ischemic and systolic pressure were selected to establish the AIS diagnostic model and draw the nomogram. The AUC of the diagnostic model was 0.909（95%CI:0.860 5, 0.945 3）.Calibration curve showed its good reliability of forecast and goodness of fit（Homer-Lemeshow, P=0.104）. Decision curve confirmed its pronounced application value when the probability threshold ranged between 0.6 and 1.0. Conclusion The MA of TEG and such clinical indexes as GLU, CHOL, and history of acute ischemic and systolic pressure could establish a diagnostic model of AIS, providing laboratory basis for the prevention and early diagnosis of AIS.
With the continuous innovation and scientific and technological advances and the deepening of scientific research, the content of transfusion medicine is being constantly updated. This article provides a brief overview of the research progress in transfusion medicine from 2021 to 2022, including blood products uses, cross-disciplinary research and application of cutting-edge technologies, and research related to clinical transfusion and treatment, to provide a reference for discipline construction and development of transfusion medicine in China.
