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【Objective】 To investigate the transfusion effect of 0.5-dose of apheresis platelet in pediatric patients. 【Methods】 A total of 195 children who underwent 0.5-dose platelet transfusion from August 2021 to June 2022 were enrolled, and the platelet count within 24 hours before and after platelet transfusion were recorded. They were grouped by gender, disease type, blood product transfusion history, platelet antibody results, platelet storage time and weight to analyze the effect of platelet transfusion. 【Results】 Among 195 cases, 77.4% (151/195) were effective and 22.6% (44/195) were ineffective after 0.5-dose of platelet transfusion. Platelet transfusion more than three times has significant impact on the effectiveness of platelet transfusion, with platelet transfusion efficiency decreased from 80.8% to 65.9% (P<0.05), and CCI decreased from 11.56±8.94 to 8.52±8.42 (P<0.05). The transfusion effect of the HLA and HPA antibodies positive group was significantly lower than the negative group, with CCI decreased from 11.39±8.87 to 7.82±8.59 (P=0.05). Linear regression analysis showed that the effect of platelet transfusion decreased with the increasing of platelet storage time (P<0.05), and the effect of platelet transfusion decreased in children weighing less than 20 kg compared with those weighing more than 20 kg, with the effective rate decreased from 84.1% to 63.5% (P<0.05). Different gender, disease type and the number of red blood cell transfusions had no significant effect on platelet transfusion. 【Conclusion】 The 0.5-dose platelet transfusion has good therapeutic effect in children below 20 kg. The results of HLA and HPA antibodies and the number of platelet transfusions greatly influence the effect of platelet transfusion in children, and the transfusion effect decreases with the increase of platelet storage time.
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【Objective】 To evaluate the coagulation function of children with Kasabach-Merritt syndrome(KMS)by thromboelastography (TEG) and conventional coagulation tests (CCTs), and to explore the correlation and consistency of the 2 test methods. 【Methods】 A total of 49 children with KMS, submitted to our hospital from January 2016 to December 2020, were enrolled. The TEG, CCTs data and platelet count were analyzed to evaluate the coagulation function, and the superiority of the 2 test methods were compared by Spearman correlation and Kappa consistency analysis. 【Results】 TEG and CCTs showed that the coagulation reaction time(R) was normal, the counts and function of platelet and fibrinogen decreased, and the D-dimer increased. The coagulation complex index (CI) indicated that the whole coagulation function was low. There was no significant difference in coagulation by sex or age in KMS children. The correlation analysis of TEG and CCTs in the coagulation function of KMS children showed that R was correlated with prothrombin time (PT) and activated partial thromboplastin Time(APTT), respectively (P<0.01); Fib had weak correlation with clot formation time (k)(r2=0.33), but strongly correlated with α-angle and MA value(r2=0.7, 0.69), respectively (P<0.01). PLT was moderately correlated with MA(r2=0.49, P<0.05); D-dimer had no correlation with LY30. Comparision resu lts of the consistency of TEG and CCTs showed that FIB and MA had consistency ( kappa=1, P<0.01); None or weak consistency was noticed among other indicators, R with PT/APTT, the kappa was 0.18 and 0.19; Fib with K/α-Angle, the kappa was 0.28 and 0.34; D-dimer with LY30, the kappa was 0.01; PLT with MA, the kappa was 0.35. 【Conclusion】 The main manifestations in low coagulation function in children with KMS were mainly thrombocytopenia, lower fibrinogen, and increased fibrinogen degradation-products, and the coagulation factors were normal. Except for Fib and MA, the consistency of other indexes in the detection of coagulation function in children with KMS by TEG and CCT is weak. Some indexes are significantly correlated but others not. Therefore, the 2 test methods are irreplaceable and should be combined to reduce the risk of embolism and bleeding in children.
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Objective:To explore the effect of Vancomycin on immune hemolysis and coagulation in children with non-Hodgkin′s lymphoma (NHL), thus providing the basis for the diagnosis and treatment of hemolytic anemia and coagulation dysfunction caused by Vancomycin, and guiding the rational use of drugs in children with NHL.Methods:From January 2018 to January 2019, 31 children with NHL treated with monotherapy of Vancomycin in Beijing Children′s Hospital, Capital Medical University were collected.Plasma samples within 1 week of Vancomycin medication were collected for detecting the anti-Vancomycin antibody by microcolumn gel method.The laboratory diagnostic and coagulation function indexes of hemolytic anemia before and after Vancomycin medication were analyzed using the paired sample t test. Results:Fourteen out of 31 children with NHL were positive for the anti-Vancomycin antibody, and among them, 10 cases had positive direct antiglobulin test (DAT). In NHL children with positive anti-Vancomycin antibody, their red blood cell count (RBC)[(2.75±0.07)×10 12/L vs.(3.18±0.07)×10 12/L], platelet count (PLT)[64.29±14.87)×10 9/L vs.(91.36±16.84)×10 9/L] and hematocrit (HCT)[(23.02±0.83)% vs.(29.19±1.98)%] were significantly reduced after Vancomycin medication than those before treatment (all P<0.01). On the contrary, total bilirubin (TB) [(51.96±15.52) μmol/L vs.(39.34±13.40) μmol/L], direct bilirubin (DB)[(31.30±13.98) μmol/L vs.(26.38±12.61) μmol/L], indirect bilirubin (IB)[(21.81±2.89) μmol/L vs.(13.75±1.63) μmol/L] and lactate dehydrogenase (LDH)[(208.6±16.85) U/L vs.(60.93±16.00) U/L] in them were significantly enhanced after Vancomycin medication than those before treatment (all P<0.05). Prothrombin time (PT)[(13.94±0.58) s vs.(11.66±0.30) s] and partial thromboplastin time (APTT)[(36.01±2.64) s vs.(28.09±0.98) s] were significantly prolonged in them after vancomycin medication than those before treatment (all P<0.01). A higher international normalized ratio (INR)(1.25±0.05 vs.1.05±0.02) was detected in NHL children with positive anti-Vancomycin antibody after medication ( P<0.000 1). In NHL children with negative anti-Vancomycin antibody, significantly higher PT (12.99±0.35) s vs.(11.82±0.27) s and INR (1.18±0.03 vs.1.07±0.03) were detected after Vancomycin medication (all P<0.000 1), while other indexes were similar before and after treatment. Conclusions:The anti-Vancomycin antibody may cause immune hemolysis and coagulation dysfunction in children with NHL.In order to prevent serious adverse events caused by drug antibodies, comprehensively clinical symptoms should be considered, drug antibodies and laboratory test results should be detected.
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Objective To evaluate the efficacy of antiplatelet agents in patients with Kawasaki dis-ease (KD) by using thrombelastography (TEG). Methods A retrospective study of KD patients admitted in our hospital from May 2016 to December 2016 was conducted. Platelet inhibition rates of Arachidonic acid pathway(AA％ ) and Adenosine diphosphate pathway were assessed using TEG platelet mapping. The effects of aspirin and dipyridamole on platelet inhibition were compared,and the differences of platelet inhibition rates in different aspirin dose and duration of medication were determined. Results There were significant individual differences in the inhibition of platelets by aspirin and dipyridamole. The inhibition rate of aspirin on platelets[M(P25 ,P75 )] was 62. 45％ (35. 58％ ,90. 95％ ),which was higher than that of dipyridamole [23. 75％ (11. 60％ ,48. 38％ )],there was significant difference (P < 0. 01). The incidence of dipyridamole resistance in children with KD ( 56. 75％ ) was higher than that in patients with resistance to aspirin (35. 71％ ),and there was significant difference (P < 0. 01). There was a linear correlation between platelet inhibition rates of two antiplatelet agents in children with KD (r = 0. 351,P < 0. 01). There was no significant difference in the effect of aspirin and dipyridamole on platelet inhibition rate after 4 days of administration. There was no significant difference in the effect of different doses of aspirin on AA％ . Conclusion TEG is an effective way to evaluate the efficacy of antiplatelet therapy in children with KD.
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OBJECTIVE To compare two different procedures of blood donation in volunteer donors,which lead to different discard rates of blood,different donation reaction rates and the satisfaction of the donor agency,so as to seek the better procedure bringing less discard of blood and more convenience for the military donor agency and blood center. METHODS In group A,3 667 donors blood was collected before the tests and retests for transfusion transmitted diseases(TTD) were done.While in group B,4 185 donors were taken blood samples for pre-donation test.The blood collection was performed 4 hours later. RESULTS In group A,3 652 units of blood were collected,of which 69 units were discarded on account of positive results in test and retest.Meanwhile,in group B 3 718 units of blood were collected from the donors who passed the pre-donation test for TTD.As a result,34 units of blood were discarded because of the positive results in retest.The discard rates of blood were 1.89% and 0.91% while the donation reaction rates were 2.22% and 3.98%,respectively.in two procedures.The discard rates of blood in group A were higher than those in group B.But the donation reaction rate in group B was higher than that in group A. CONCLUSIONS The discard rate of blood in the procedure collecting before test is higher than that in the procedure testing before collection.But the donation reaction rate is low and the waiting period for donation is short in the former procedure,which is suitable for low TTD infections population of military agencies.
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Objective To compare the specificity, sensitivity, titers, and rapidity of four methods including papain technique, anti-globulin technique, polybrene test, and micro-column gel test for determination of IgG red blood cell antibodies. Methods Twelve kinds of IgG red blood cell antibodies such as anti-D, anti-E, anti-C, anti-c, anti-e, anti-Jk a, anti-Jk b, anti-Fy a, anti-Fy b, anti-k, anti-S, and anti-s were checked by the four methods. Results Seven kinds of IgG red blood cell antibodies including anti-D, anti-E, anti-C, anti-c, anti-e, anti-Jk a, and anti-Jk b were detected using papain technique (7/12). All of the 12 kinds of IgG antibodies were detected by anti-globulin technique (12/12). Eleven kinds of IgG red blood cell antibodies except anti-k were examined with polybrene test (11/12) and all the antibodies were also determinated by micro-column gel test (12/12). The titers of the antibodies determination suggested that papain technique was less sensitive than other three methods, while the micro-column gel test was more sensitive than other three methods in examination of all the antibodies. The lasting time of four techniques were: papain technique 45 min, anti-human globulin technique 60 min, polybrene test 5 min, and micro-column gel test 30 min. Conclusion Papain technique has some limitation in determination of IgG antibodies and anti-globulin technique is complicated because of long period incubation and multiple wash of red blood cells. Polybrene test is the most simple and convenient technique for determination of IgG antibodies. Micro-column gel test is the most sensitive method in determination of IgG antibodies.
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Objective To analyze the curative effect of blood transfusion on 100 patients undergoing liver transplantation,to efficiently enhance hemostasis and coagulation function of the patients,to lower the incidence of the operative complications,and to put forward the guideline of blood transfusion to the patients undergoing liver transplantation.Methods The volumes of red blood cells concentrates(RCCs),fresh frozen plasma(FFP),cryopreserved platelets,and cryoprecipitate transfused to the patients undergoing liver transplantation were measured before,during and after the operation respectively.The volumes of blood components transfused to the 50 patients in the former stage and 50 patients in the later stage of liver transplantation in our hospital were also measured respectively.Results The mean volume of the blood components transfused to each patient was 3 334ml.The ratios of the transfused blood volumes to 100 patients were 4.3%,53.4% and 42.3% before,during and after operation respectively.The rate of blood components transfusion was 100% and the ratio of transfused blood volumes to the patients between RCCs and FFP was 1.45:1.The mean volumes of the transfused blood and the operative complications of 50 patients in the former stage of liver transplantation of our hospital were significantly higher than those of the 50 patients in the later stage.Conclusion It is very vital in the scientific,safe and reasonable blood transfusion for the success of liver transplantation,which significantly lowers the incidence of operative complications,such as massive haemorrhage during and after operation,and thrombosis at inosculation of liver artery and portal vein.
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Objective To explore the factors affecting the collection of allogenic peripheral blood stem cells in donors. Methods Using COBE-spectra blood cell separator to collect peripheral blood stem cells in 21 allogenic donors. The impact of the factors including the number of white blood cell(WBC) and nucleated cell(NC), and mono-nucleated cell(MNC) ratio on the collecting rate of peripheral blood stem cells was analyzed before and after collection. The output of CD 34 +stem cells stimulated by different doses of G-CSF was also analyzed. Results When the mean count of peripheral WBC and MMC in donors was (41?7.7)?10 9/L and 12?2.9% respectively, the count of collected NC was 2.7?0.8?10 8/L, and the number of the collected CD 34 + stem cells was also higher. Statistical analysis showed that the number of NC was significantly related to the collecting rate of CD 34 stem cells(P