基于采供血全流程要素分析的红细胞输注不良反应证据探索

黎欢; 彭涛; 张利; 胡燕; 谢佳; 何洪伟

doi:10.13201/j.issn.1004-2806.2025.06.008

基于采供血全流程要素分析的红细胞输注不良反应证据探索

- 中国人民解放军西部战区总医院输血科(成都，610083)

详细信息

通讯作者: 彭涛，E-mail：tao_1226@126.com

中图分类号: R457.1

收稿日期: 2024-09-09

刊出日期: 2025-06-01

Analyzing the influencing factors and type characteristics of transfusion adverse reactions occurring in patients after red blood cell transfusion

- Department of Blood Transfusion, General Hospital of the Western Theater Command, PLA, Chengdu, 610083, China

More Information

Corresponding author: PENG Tao, E-mail: tao_1226@126.com

Received Date: 09 September 2024

Publish Date: 01 June 2025

摘要

摘要: 目的以采供血全流程要素分析为基础，探索仅输注红细胞患者发生输血不良反应的证据。方法选取医院2022年1月—2023年12月仅输注红细胞的150例患者为研究对象。收集患者基本资料、献血者信息、临床相关资料。根据患者是否发生输血相关不良反应分为无不良反应组90例(A组)，有不良反应的非溶血性发热反应组33例(B组)，有不良反应的过敏反应组27例(C组)。对三组进行输血不良反应单因素分析，对单因素分析中有显著差异的变量(P＜0.01)进行多因素logistic回归分析。结果单因素分析中三组患者在输血次数、献血者年龄、发血到输注时间、输血前白细胞、中性粒细胞百分比(Neut%)、中性粒细胞、淋巴细胞计数百分比、嗜酸性粒细胞百分比、嗜碱性粒细胞百分比(Baso%)、C-反应蛋白(CRP)、降钙素原上的差异有统计学意义(P＜0.05)。多因素分析：①输血次数(OR=1.245，95%CI 1.054~1.471)、发血到输注时间(OR=1.058，95%CI 1.027~1.089)、CRP(OR=1.010，95%CI 1.000~1.020)是非溶血性发热的危险因素。②输血次数(OR=1.246，95%CI 1.041~1.491)、献血者年龄(OR=1.101，95%CI 1.031~1.176)，Neut%(OR=1.325，95%CI 1.032~1.701)、发血到输注时间(OR=1.061，95%CI 1.030~1.094)是过敏的危险因素。③Baso%(OR=0.021，95%CI 0.001~0.705，P＜0.05)是过敏的保护因素。结论引发患者输注红细胞相关不良反应的因素多，且贯穿采供血流程始终。有多次输血史、炎性指标CRP、Neut%增高的患者，输血医学科应积极与临床沟通，并筛选献血者年龄、严格控制发血到输注时间，拟定并实施高危患者输血预案，以保障红细胞输注安全有效。
- 红细胞 /
- 输血不良反应 /
- 非溶血性发热反应 /
- 过敏反应 /
- 输血安全
Abstract: Objective Based on the analysis of the whole process of blood collection and supply, the evidence of adverse transfusion reactions in patients with red blood cell transfusion only was explored.Methods From January 2022 to December 2023 in our hospital, 150 patients with red blood cell transfusion only were selected as the study objects. Patients' basic data, blood donors' information and clinical data were collected. According to whether the patients had transfusion-related adverse reactions, they were divided into no adverse reaction group(90 cases), non-hemolytic fever reaction group(33 cases) and anaphylaxis reaction group(27 cases). Univariate analysis of adverse blood transfusion reactions was performed in the three groups, and multivariate logistic regression analysis was performed for variables with a significance level below 0.10 in the univariate analysis and a statistically significant difference.Results Univariate analysis: There were statistically significant differences between the three groups in the number of transfusions, donor age, blood delivery to infusion time, pre-transfusion WBC, Neut%, Lymph%, EOS%, Baso%, Neut, CRP and PCT(P < 0.05). Multi-factor analysis: ①The number of transfusions(OR=1.245, 95%CI 1.054-1.471), the time from blood delivery to infusion(OR=1.058, 95%CI 1.027-1.089), CRP(OR=1.010, 95%CI 1.000-1.020), were risk factors for non-hemolytic fever. ②Number of transfusion(OR=1.246, 95%CI 1.041-1.491), donor age(OR=1.101, 95%CI 1.031-1.176), Neut%(OR=1.325, 95%CI 1.032-1.701), time from blood delivery to infusion(OR=1.061, 95%CI 1.030-1.094) P < 0.05, which was the risk factor of allergy. ③Baso%(OR=0.021, 95%CI 0.001-0.705, P < 0.05) was a protective factor for allergy.Conclusion There are many factors that cause adverse reactions related to red blood cell transfusion in patients, and they run through the whole blood collection and supply process. For patients with multiple blood transfusion history, inflammation index CRP, Neut% increased, blood transfusion medicine departments should actively communicate with the clinic, screen the age of donors, strictly control the time from blood delivery to transfusion, and formulate and implement transfusion plans for high-risk patients to ensure the safety and effectiveness of red blood cell transfusion.
- red blood cells /
- transfusion adverse reactions /
- non-hemolytic febrile reactions /
- allergic reactions /
- transfusion safety

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表 1 输血不良反应单因素分析例(%)，X±S，M(P₂₅，P₇₅)

变量	输血不良反应			F/H/χ²	P
变量	无不良反应(n=90)	FNHTR(n=33)	过敏反应(n=27)	F/H/χ²	P
性别				2.419	0.298
女	46(51.11)	16(48.48)	18(66.67)
男	44(48.89)	17(51.52)	9(33.33)
年龄/岁	60.90±15.47	58.55±17.86	53.74±20.94	1.845	0.162
血型				9.834F	0.111
A	23(25.56)	13(39.39)	4(14.81)
B	22(24.44)	8(24.24)	9(33.33)
AB	4(4.44)	0	4(14.81)
O	41(45.56)	12(36.36)	10(37.04)
输血次数/次	0(0，1.00)	2.00(0，5.00)	1.00(0，5.00)	18.181	＜0.001
红细胞库存天数/d	14.00(8.75，20.00)	12.00(9.00，17.00)	13.00(9.00，23.00)	0.533	0.766
献血者性别				4.263	0.109
女	9(10.00)	4(12.12)	7(25.93)
男	81(90.00)	29(87.88)	20(74.07)
献血者年龄/岁	25.00(23.00，28.00)	29.00(24.50，32.00)	35.00(27.00，41.00)	20.900	＜0.001
发血到输注时/min	17.00(14.00，28.00)	48.00(27.00，86.50)	30.00(14.00，60.00)	35.735	＜0.001
输血前是否使用抗组胺药物				0.488	0.784
否	47(52.22)	15(45.45)	13(48.15)
是	43(47.78)	18(54.55)	14(51.85)
WBC/(×10⁹/L)	6.00(4.18，8.76)	8.79(4.23，10.77)	8.65(5.74，11.33)	9.217	0.010
Neut%	72.00(60.23，82.90)	81.00(74.91，87.90)	83.11(80.10，89.10)	21.393	＜0.001
Lymph%	15.55(10.18，25.70)	8.90(6.10，15.71)	10.30(6.90，13.30)	17.647	＜0.001
EOS%	1.10(0.38，2.19)	0.10(0.05，0.90)	0.20(0，1.10)	21.258	＜0.001
Baso%	0.30(0.10，0.60)	0.20(0.10，0.30)	0.10(0.10，0.20)	16.738	＜0.001
Neut/(×10⁹/L)	4.25(2.43，7.39)	7.02(3.40，8.75)	7.16(4.49，9.34)	14.109	0.001
Lymph/(×10⁹/L)	0.96(0.71，1.31)	0.78(0.40，1.28)	0.84(0.54，1.14)	5.009	0.082
CRP/(mg/L)	2.28(0.05，27.94)	106.47(24.82，169.19)	21.50(6.32，69.41)	38.447	＜0.001
PCT/(ng/mL)	0.05(0.05，1.56)	0.83(0.35，2.34)	1.30(0.23，3.46)	22.033	＜0.001

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表 2 输血不良反应多因素logistic回归模型结果

变量	FNHTR			过敏
变量	OR	95%CI	P	OR	95%CI	P
输血次数/次	1.245	1.054~1.471	0.010	1.246	1.041~1.246	0.017
献血者年龄/岁	1.021	0.952~1.096	0.562	1.101	1.031~1.101	0.004
发血到输注时间/min	1.058	1.027~1.089	＜0.001	1.061	1.030~1.061	＜0.001
WBC/(×10⁹/L)	3.616	0.429~30.452	0.237	4.544	0.516~4.544	0.172
Neut%	1.111	0.927~1.332	0.254	1.325	1.032~1.325	0.027
Lymph%	1.026	0.832~1.266	0.808	1.276	0.958~1.276	0.096
EOS%	0.780	0.446~1.363	0.383	1.306	0.918~1.306	0.138
Baso%	0.275	0.024~3.128	0.298	0.021	0.001~0.021	0.031
Neut/(×10⁹/L)	0.235	0.024~2.299	0.213	0.198	0.020~0.198	0.166
Lymph/(×10⁹/L)	0.475	0.041~5.502	0.552	0.338	0.026~0.338	0.406
CRP/(mg/L)	1.010	1.000~1.020	0.049	0.992	0.980~0.992	0.183
PCT/(ng/mL)	0.874	0.697~1.096	0.244	1.028	0.879~1.028	0.729

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