| ObjectiveBlood transfusion as an essential therapy for chronic disease prevention and rescue of critically ill patients,saved countless lives,however,because of the complexity and diversity of blood components and the differences of patient physical,there may be a variety of blood transfusion adverse reactions.Blood transfusion reactions caused a serious threat to the life of patients,inoder to reduce or avoid delayed hemolytic transfusion reactions.The study explored the factors that affected the adverse transfusion reaction.Besides that,investigated the clinical value of irregular antibody screening in preventing adverse transfusion reactions before clinical blood transfusion.MethodA retrospective analysis was used to obtain the adverse transfusion reaction rate after irregular antibody screening before blood transfusion from year 2015 to 2016 in our hospital,which was compared with that without irregular antibody screening before blood transfusion from year 2006 to 2007.Appled ?2 test to analysis the factors of blood transfusion reactions,and retrospective cohort study to explore the relation between the irregular antibody screening and blood transfusion adverse reactions,and explore the effect of irregular antibody screening before blood transfusion on the adverse reactions of clinical blood transfusion.Results(1)31 patients with blood transfusion adverse reactions were recorded from year 2006 to 2007,at the rate of 0.83%,of which allergic reactions accounted for 54.83%;non hemolytic febrile reaction,32.26%;delayed hemolytic reaction,9.67%;and blood transfusion in acute lung injury,3.23%.While 23 patients with blood transfusion adverse reactions were recorded from year 2015 to 2016,at the rate of 0.38%,of which allergic reactions accounted for 78.26%;non hemolytic febrile reaction,21.74%,and no delayed hemolytic reaction and other types of blood transfusion adverse reactions were observed.and that in department of hematology from year 2006 to 2007 was obviously higher than from year 2015 to 2016(x2=3.980,P=0.046);The incidence rate of blood transfusion adverse reactions in patients with suspended red blood cell transfusion or less white red blood cell transfusion from year 2006 to 2007 was both significantly higher than that from year 2015 to 2016(x2=3.859,P=0.049;?2==4.372,P=0.037);Otherwise,there were no statistically significant differences in the incidence rate of blood transfusion adverse reactions between patients with plasma or platelet injection from year 2006 to 2007 and those without from year 2015 to 2016(x2=0.127,p=0.722;x2=0.948,P=0.330).(2)By ?2 test,factors that affected the occurrence of adverse reactions of blood transfusion,such as gender,age and different components of blood had no statistical significance or clinical significance.Only irregular antibody screening(?2=8.780,P=0.003<0.05)and pregnancy history/history of blood transfusion(x2=44.360,P<0.001)had the significant difference with adverse reactions of blood transfusion.By ?2 square test,there was significant difference in the incidence of adverse reactions between the patients with irregular antibody screening and those without before blood transfusion(x2=8.780,P=0.003),The delayed hemolytic reaction rate was significantly higher in patients with irregular antibody screening than those without before blood transfusion(x2=4.917,P=0.027),while there was no significant difference in the incidence of allergic reactions between patients with irregular antibody screening and those without before blood transfusion(?2? 1.700,P=0.192).Pearson chi square test found that the incidence rate of blood transfusion adverse reactions in patients with a prior history of pregnancy or transfusion was significantly higher than that in those without(x2=5.662,P=0.017)(3)In the cohort study further antibody screening,found patients that accepted irregular antibody screening blood transfusion adverse reaction rate is thepatients that not accepted 0.458 times(RR=0.458),so accepted the fact that the irregular antibody test can reduce the adverse reactions of blood transfusion.(4)Among 6084 blood transfusion patients in our hospital from year 2015 to 2016,38 cases of irregular antibody positive was detected and the positive rate was 0.62%(38/6084).38 cases of irregular antibodies mainly involved Rh,MNSs,Duffy and P antibodies,of which anti-E antibody,the most common Rh blood group,was found in 21 cases;anti-D antibody,in 1 case;MNSs,in 8 cases;Duffy system,in 6 cases;and other systems,in 2 cases.38 cases of irregular antibodies were mainly distributed in the department of hematology,obstetrics and gynecology,intensive medicine,gastroenterology,rheumatism and so on.Detection rate of irregular antibody in the department of hematology was significantly higher than that in the ICU(x2=5.385,P=0.020),but there was no significant difference between department of hematology and that of obstetrics and gynecology(?2 ?1.865,P=0.172).Pearson chi square test found that there was a statistically significant difference of gender in antibody positive rate between patients with a prior history of pregnancy or transfusion and those without.Detection rate of irregular antibody in patients with blood transfusion was two times higher than those with blood transfusion less than one time.Furthermore,38 patients with irregular antibody positive were transfused according to clinical selection of blood transfusion,the delayed hemolytic reaction was not observed in patients,and the clinical symptoms were alleviated.ConclusionIrregular pregnancy and repeated transfusion of antibodies were mainly caused by the risk of delayed hemolytic reaction factors,Irregular antibody screening is a protective factor for adverse transfusion reactions,thus the patients before transfusion irregular antibody screening,help to improve the accuracy of matching,to effectively reduce or avoid the non-hemolytic febrile reaction and delayed hemolytic reaction,improve the security of blood transfusion therapy. |
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