合理使用血液和血液成分

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1、1会计学合理使用血液和血液成分合理使用血液和血液成分第1页/共129页第2页/共129页第3页/共129页AGENTPre-NATPost-NATHCV1:103,0001:334,043HBV 1:63,000NAHTLV1:641,000NAHIV1:676,000 1:1,100,000第4页/共129页病种核酸检测前 核酸检测后HCV1:103,0001:334,043HBV 1:63,000NA（无数据）HTLV1:641,000NA（无数据）HIV1:676,000 1:1,100,000第5页/共129页第6页/共129页n应鼓励替代同种异体输血的方法第7页/共129页第8页/共

2、129页第9页/共129页R E D C E L L SP L A T E L E T SC R Y OF F PC O A G F A C T O R SP L A S M A F O RF R A C T IO N A T IO NP L A T E L E T -R IC H P L A S M AW H O L E B L O O D第10页/共129页R ED C ELLSPLAT ELET SC R Y OFFPC O AG FAC T O R SPLASM A FO RFR AC T IO N AT IO NPLAT ELET -R IC H PLASM AW H O LE BL

3、O O D全血红细胞富血小板血浆血小板新鲜冰冻血浆血浆（成份分离）凝血因子冷沉淀第11页/共129页第12页/共129页第13页/共129页第14页/共129页 减少容量 去除白细胞 去除血浆 增加贮藏期第15页/共129页COMPONENTFEATURESINDICATIONSWhole BloodHigh volume;Good flowMajor bleeding;Exchange TxRBC ConcentratesHigher Hct; Lower volumeRBC Deficit; Chronic anemiaLeukodepletion 10exp6 WBC Reduce WB

4、C effectsWashed RBCRemove plasmaAllergic reactionFrozen RBCLong-term storageRare units;Auto. blood第16页/共129页成分成分特性特性适应症适应症全血高容量，流动性好 大出血;换血疗法浓缩红细胞高红细胞压积，低容量红细胞减少;慢性贫血去白红细胞90,000 platelets/ ulNone 50,000 platelets/ ulBleeding time prolongsNo significant problems10,000-50,000/ ulPetechiae, easy bruisi

5、ng90,000 血小板/ 微升 无 50,000 血小板/ 微升 出血时间延长无明显临床表现10,000-50,000血小板/ 微升 瘀斑，容易碰伤4.Units of FFP transfusedINR post INR preLack of Effect of FFP (324 units) on the INR among 121 patients with mild abnormalities of coagulation: INR= 1.1 to 1.6Abdel-Wahab O, Healy B, Dzik W. Transfusion 2006; 第66页/共129页0-0.5

6、0.51.01.512344.新鲜冰冻血浆输注单位输血后国际标准化比率输血前国际标准化比率121例轻度凝血功能异常患者新鲜冰冻血浆（324单位）输注无效的国际标准化比率INR= 1.1 to 1.6INR= 1.1 to 1.6Abdel-Wahab O, Healy B, Dzik W. Transfusion 2006; 第67页/共129页第68页/共129页细胞沉淀物第69页/共129页第70页/共129页凝血因子第71页/共129页第72页/共129页第73页/共129页第74页/共129页第75页/共129页第76页/共129页第77页/共129页第78页/共129页第79页/共1

7、29页第80页/共129页第81页/共129页第82页/共129页第83页/共129页第84页/共129页标本信息标签第85页/共129页第86页/共129页教育与认证严格执行标本信息标签制度以减少血库标本信息发生错误的机率第87页/共129页第88页/共129页出现血型记录偏差的概率出现血型记录偏差的概率错误标签（错误标签（拒绝）拒绝）正确标正确标签签偏差偏差第89页/共129页Elements of a Compatibility Testing Elements of a Compatibility Testing System Patient identification Sample

8、 identification ABO/Rh/Ab screen Records check Unit selection Crossmatching Labeling Recipient identification Patient identification Sample identification ABO/Rh/Ab screen Records check Unit selection Crossmatching Labeling Recipient identification 1/2,900 samples contains blood from the wrong patie

9、nt1/2,900 samples contains blood from Lumadue JA et al. Transfusion 1997;37:1169-72.Lumadue JA et al. Transfusion 1997;37:1169-72.第90页/共129页 相容性检测的组成相容性检测的组成元素元素 ABO/Rh/Ab screen Records check Unit selection Crossmatching Labeling 病人信息确认病人信息确认标本信息确认标本信息确认 ABO/Rh/Ab screen Records check Unit selectio

10、n Crossmatching Labeling 受者的身份确认受者的身份确认1/2,900 samples contains blood from the wrong patient1/2,900 samples contains blood from the wrong patient Lumadue JA et al. Transfusion 1997;37:1169-72.Lumadue JA et al. Transfusion 1997;37:1169-72.每2900个标本中有一个留样错误第91页/共129页第92页/共129页第93页/共129页n第94页/共129页第95页/

11、共129页第96页/共129页第97页/共129页第98页/共129页第99页/共129页第100页/共129页第101页/共129页第102页/共129页第103页/共129页第104页/共129页第105页/共129页第106页/共129页第107页/共129页第108页/共129页第109页/共129页第110页/共129页第111页/共129页第112页/共129页第113页/共129页第114页/共129页第115页/共129页第116页/共129页第117页/共129页第118页/共129页第119页/共129页1lerx7%CHTL%a0adSA44a*6h02(t1wmi%!y

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