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【Objective】 To share the experience of autologous platelet-rich plasma(PRP) combined therapy in successful treatment of refractory osteomyelitis with fractures in children. 【Methods】 One case of refractory osteomyelitis with fracture in children failed to respond to traditional treatment for more than 14 months. A total of 20 mL of whole blood was collected from the child, and 6 mL of PRP with 4 to 5 times concentration was prepared by secondary centrifugation. To prepare 2 cm×2 cm platelet concentrate gel (PG), 3 mL of PRP was mixed with a 0.3 mL activator which was then covered with an absorbable dressing. A three-way tube sprayed the remaining 3 mL of PRP and 0.3 mL activator into the surrounding tissues. 【Results】 The X-ray film of the patient followed up for 1 week showed that the fracture line was blurred, and the fracture end had obvious callus formation. The X-ray film reexamination at 4 months showed that the fracture end healed well, the fracture surface healed, and the osteomyelitis healed. 【Conclusion】 Autologous PRP has a good effect in the treatment of refractory osteomyelitis combined with fracture in children, which can provide a new method for clinical treatment.
ABSTRACT
【Objective】 To investigate the changes in cellular immunity (peripheral blood lymphocyte subsets) and humoral immunity (serum immunoglobulin and ferritin) status among children with thalassemia who received repeated transfusions in Yunnan. 【Methods】 Forty-six children with thalassemia who underwent repeated blood transfusions from January 2020 to October 2022 were selected as the observation group. Forty children with thalassemia who did not receive blood transfusion were included in control group 1, and 46 healthy children underwent physical examination were included in control group 2. The differences in lymphocyte subsets, serum immunoglobulin levels and ferritin concentrations were compared among the three groups. 【Results】 For lymphocyte subsets: CD3+, CD4+ and CD4+/CD8+ in the observation group was lower than the control group 1 and 2: 57.60±8.36 vs 64.57±7.56 vs 66.58±5.65, 33.16±5.67 vs 38.62±8.36 vs 38.62±6.41 and 1.49±0.09 vs 2.32±0.15 vs 2.13±0.16, respectively; CD16+ CD56+ in the observation group was lower than the control group 2: 11.21±5.06 vs 16.70±7.92; CD8+ in the observation group was higher than control group 1 and control group 2: 26.63± 1.75 vs 20.60±1.43 vs 18.92±0.84; CD19+ in the observation group was higher than the control group 2: 24.06±6.42 vs 19.67 ±8.42, P<0.05, but no significant difference was noticed between the two control groups(P>0.05). For serum immunoglobulin and ferritin: IgG and ferritin in the observation group were higher than control group 1 and control group 2: 10.59±3.88 vs 7.02±3.88 vs 5.58±1.98 and 2 037.37±1 377.59 vs 72.63±56.71 vs 59.48±33.88. IgA in the observation group was higher than the control group 2: 1.06±0.92 vs 0.39±0.32(P<0.05), but no significant difference was noticed between the two control groups (P>0.05). The difference of IgM and IgE between the three groups was not significant (P > 0. 05). 【Conclusion】 The proportion of lymphocyte subsets in thalassemia children with repeated blood transfusion was imbalanced,and the level of immunoglobulin in humoral immunity was abnormal.
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【Objective】 To study the yielding rate and distribution of unexpected antibodies in blood transfusion children with thalassemia in Yunnan province, and to explore the blood transfusion strategies. 【Methods】 From January 2016 to December 2021, 298 children with thalassemia, who received blood transfusion treatment in Kunming, Xishuangbanna, Wenshan, Dehong, Yuxi and Baoshan hospitals across Yunnan Province, were selected. The unexpected antibodies of blood plasma were screened by microcolumn gel card. The samples with positive antibodies were identified for alloantibody specificity. 【Results】 Unexpected antibodies were yielded in 67 out of 298(22.48%) transfused children with thalassemia. The positive rates of unexpected antibodies in boys and girls were 16.55%(24/145) and 28.10%(43/153), respectively. The positive rates of unexpected antibodies in Han, Dai, Zhuang, Yi, Bulang, Jinuo and Miao people were 14.06%(18/128), 30.80%(32/104), 35.71%(10/28), 36.36%(8/22), 50.00%(4/8), 60.00%(3/5)and 66.67%(2/3), respectively, with statistically significant differences between each other. The positive rate of unexpected antibodies in ethnic minorities was higher than that in Han. The positive rates of unexpected antibodies in children who received the first transfusion at birth-one year old, 1~3 years old, 3~6 years old and above 6 years old were 12.50%(3/24), 10.14%(7/69), 24.54%(40/163)and 40.48%(17/42), respectively. The positive rates of unexpected antibodies in children with first transfusion after 3 years old were significantly higher than those before 3 years old. The positive rates of unexpected antibodies in children with one transfusion, 1~3, 3~10, 10~20 and more than 20 transfusions were 4.76%(1/21), 12.07%(7/58), 23.71%(23/97), 28.16%(29/103)and 36.84%(7/19), respectively, with statistically significant differences between each other. The number of blood transfusions was positively correlated with the unexpected antibody yielding. The yielding rate of unexpected antibodies in children with α thalassemia, βthalassemia, δ+ βthalassemia and untyped thalassemia was 7.50%(3/40), 17.62%(34/193), 53.70%(29/54)and 9.09%(1/11), respectively(P<0.05). The yielding rate of unexpected antibodies in transfused children with δ+ βthalassemia was the highest. And 57 unexpected antibodies of Rh blood group system were yielded, 6 anti-M antibodies, 2 anti-N antibodies and 2 undetermined. 【Conclusion】 The positive rate of unexpected antibodies in transfused children with thalassemia in Yunnan province is high. Routine antibody screening should be carried out for transfusion children with thalassemia, and blood units, compatible with ABO, Rh and MNS typing results, should be selected to ensure the safety and effectiveness of clinical blood use.
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【Objective】 To analyze the effect of intravenous immunoglobulin(IVIG)-produced IgG antibody on the crossmatch incompatibility of neonates. 【Methods】 Blood type grouping, antibody screening, crossmatch, direct anti-globulin test, elution test, indirect antiglobulin test, and IVIG titer determination were conducted by microcolumn gel method. 【Results】 IgG anti-A were detected out in the elution test and free antibody test of 6 infants, and the titer of IgG anti-A contained in IVIG was 256, which led to the crossmatch incompatibility between infants and donors with the same type. 【Conclusion】 The hemolysis and crossmatch incompatibility in newborns, born to ABO-compatible mothers, may occur due to the IVIG-induced IgG antibodies. The O-type washed red blood cells should be selected for transfusion.
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Objective To analyze the causes of blood transfusion adverse reactions in children,and to explore the measures to reduce the adverse reactions of blood transfusion in children.Methods Collect 30 518 cases of transfusion reaction data which is during 2009 to 2014 in Kunming Children's hospital for analyzing.Results 166 cases of transfusion reaction occurred and the occurrence rate is 0.54％ in 30 518 cases,allergic transfusion reaction accounted for 89.16％ (148/166),non-hemolytic febrile reaction 10.24 ％ (17/166),hemoglobinuria accounted for 0.60 ％ (1/166);In children the transfusion reaction rate of hemapheresis platelet is 1.92％(72/3 743),plasma is 0.43％(56/13 132),suspension red blood cells is 0.28％(38/13 480);the signs and symptoms of children's blood transfusion reaction:simplex urticaria and rash 74.10％(123/166),simplex fever 10.24％ (17/166),rash associated with fever 5.42％ (9/166),eyelid or oral edema (mild angioneurotic oedema) 9.04％ (15/166),,Bronchospasm (mild) 0.60％ (1/166),simple hemoglobinuria 0.60％ (1/166).Conclusion Children with blood transfusion adverse reactions to allergies,mainly for local or systemic rash;Platelet is the most-common blood component that causes transfusion reaction with children.