The Preliminary Research On Occurrence Of Blood Transfusion Adverse Reactions Caused By Storage Time Of Red Blood Cell

The storage of red blood cell(RBC)is the prerequisite for safe and effective clinical use.However,it has been confirmed that a series of changes happened on morphology,physical and chemical properties during the storage period,named RBC storage lesion,and the degree of lesions were corelated with the extension of RBC storage time;RBC storage lesion,to some extent,may cause some unexpected impacts to patients.During the last 20 years,RBC storage lesion gradually become one of the hotspots in the field of transfusion medicine.In 2015,the results from 56 clinical retrospective study and eight randomized controlled researches were conflicting,and no research focused on transfusion adverse reactions(TAR).On the basis of our faculty research work,In the first part,We analyzed the general characteristics of clinical TAR happened from a retrospective clinical study,and preliminary analyzed the relationship between the incidence of TAR and the red blood cell storage time.In the second part,we researched transfusion effect of red blood cell storage time for rats infected by e.coli.The first part:clinical researchObjective:In order to analyse the correlated reasons of transfusion adverse reaction(TAR),we tried to command the overall condition of TAR and to analyze the probable correlation of TAR and RBC storage time through the seven years' data of the third people's hospital of Chengdu.Method:Clinical trials:the information of this retrospective clinical trial,including 349 cases blood transfusion reactions,was collected by querying the adverse reaction reports,the adverse reactions tally book,electronic medical records system as well as the patients medical records,etc..such as:The blood product types,dosage,patient number and validity;Patients' gender,age,fertility history department,the types of disease,blood transfusion or pregnancy;Handling and results processed;The dateS of expiration and infusion of 25803 units suspended RBCs were required through electronic medical record system.Results:Since 2010,the overall incidence of the hospital blood transfusion reactions is 2.38 +/-0.86 ‰(n = 349/151605 u);5.64 ‰ for platelets,3.1 7 ‰ for RBC,1.28 ‰ for plasma and 0.94 ‰ for cold precipitation.64%of non hemolytic febrile reaction lies in RBC(172/212);while 38.1%and 28.6%of allergic reaction were caused by plasma(40/105)and platelets(30/105);Amounts of TARs in department of gastroenterology and hematological departments accounted for 32%and 32%,respectively(110/349 and 72/349);93%of TARs in patients with gastrointestinal bleeding were caused by RBC(63/68);71%in patients with liver disease lie in plasma(17/24);57%TARs of patients in the leukemia were occurred by platelets(20/35).The suspended red blood cells account for 45.31%of all blood products used,and 64%of all.TARs.The incidences of TARs of shelf life of 1,2,3 and 4 weeks of suspended RBC were 5.66 ‰,4.49 ‰,3.65 ‰ and 4.49 ‰.The second part:animal researchObjective:we aim to find the correlation between RBC storage time and its effects on the immunosuppressive rats with e.coli infection.Methods:Animal experiments:69 SPF-SD rats,according to whether to use Cyclophosphamide and dexamethasone or transfusion with RBCs stored 9 days or less than 1 day or with normal saline(NS),were randomly divided into four groups:normal + NS;immunosuppression + 9d RBCs;immunosuppression +1d RBCs:immunosuppression +NS and control group.Each of three immunosuppressive groups contained 18 rats,while the control group was 15 only.The rats,subjected bloodletting 20%of total blood volume,were transfused with RBCs stored nine days,or less than one day or with NS,separately,and then were injected with E.coli(0.5ml)through femoral vein.When transfused 24h later,blood of rats were collected from tail vein to determine serum iron and blood bacteria culture,and three rats of every immunosuppressive group were killed to make pathological slices.Result:For the immunosuppressive groups of 9d RBCs,Id RBCs and NS,the mortality were 10/15,11/15 and 9/15,respectively(p>0.05);the mean survival time(h)were 55.6±21.3,38±16.6 and 28.3±15.0,separately(p<0.05);the serum iron ion concentration(?mol/L)were 34.1±9.8,28±10.2 and 26.8±9.0,separately(p>0.05).While the values(OD=600nm)of blood culture were 0.510±0.340,0.790±0.281 and 0.427±0.107,separately(p<0.05).Bacterial counts of intestinal tissue(1000 times/views)were 44 + 9,101-7 and 27 + 8 respectively(P<0.05).Conclusion:1.In all blood components,suspended red blood cells not only accounts the most clinical dosage,but caused the most number of TAR.2.TAR caused by RBC is given priority to with non hemolytic fever,while,other blood composition is given priority to with allergic reaction;3.As the extension of suspension RBC storage time,incidence of TAR associated with RBC appear the trend of reduce gradually and a rising tail at last.4.No significant affect on mortality of immunocompromised rats infected by e.coli when being infused RBC stored for different storage time;5.Compared RBC with long storage duration,fresh RBC promote the reproduction of e.coli,and accelerate the death of the rats.Infected by e.coli.