الملخص
【Objective】 To detect endogenous heparin substance in patients with epidemic haemorrhagic fever (EHF) using thromboelastography (TEG) combined with conventional coagulation indices(CCTs), explore the value of TEG combined with CCTs in detecting coagulation function abnormalities in such patients, aiming at providing guidance for clinical treatment. 【Methods】 APTT, TT, TEG plain cup R value and TEG heparinase cup R value were tested in 35 EHF patients of mild/moderate stage, severe stage and recovery stage. Intergroup differences were analysed using Friedman ANOVA. 【Results】 The mean R and heparin cup R values were 7.5 and 6.7 for mild cases of EHF, and TT, R and heparinase cup R values were 16.9, 6.2 and 6.1 for recovering cases, respectively.The normal cup R and heparinase cup R values for mild cases, as well as the TT, R and heparinase cup R values for recovering cases, were normally distributed, and the rest were non-normally distributed. Changes in APTT and TT in EHF patients at different stages were significantly different (P<0.05). The patients′ TEG R-values (coagulation reaction time) also showed statistically significant differences in mild-moderate, severe and recovery periods (P<0.05). Prolonged APTT, TT and R values in the severe phase compared to the mild-moderate phase indicated that the patient′s coagulation function continued to decrease. The difference of R-values minus the heparanase cup R-values in EHF patients was statistically significant in the mild-moderate, severe, and recovery phases (P<0.05). Residual accumulation of endogenous heparin-like substances was higher in the severe phase than in the mild-moderate and recovery phases. 【Conclusion】 Patients with EHF exhibit significant differences in the values of APTT, TT and R at different stages of the disease. The combined detection using TEG and CCTs indicates that the accumulation of endogenous heparin-like substances is one of the most important causes of coagulation disorders in patients with EHF. The combination of TEG and CCTs can detect the accumulation of endogenous heparin-like substances in patients with EHF, which can provide a laboratory basis for clinicians to adopt targeted therapeutic regimen.
الملخص
【Objective】 To evaluate the interference of anti-CD47 monoclonal antibody on transfusion compatibility detection, in order to establish methods for removing interference and evaluate its efficacy. 【Methods】 Blood samples from 8 patients in our clinical trial who were treated with anti-CD47 monoclonal antibody from Tianjing and Xinda were collected. ABO and Rh blood group antigen identification, direct anti-human globulin test, unexpected antibody screening test and cross-matching test were performed by ZZAP, Gamma-clone(an anti-globulin reagent lacking IgG4) and Immucor Capture-R solid phase agglutination kit. 【Results】 ABO blood group identification of 5 subjects were interfered after treatment with anti-CD47 monoclonal antibody. All 8 subjects showed 2+ to 4+ agglutination intensity on direct anti-human globulin test and 3+ to 4+ on unexpected antibody screening. The results of unexpected antibody screening by Gamma-clone and Immucor Capture-R solid phase agglutination kit were all negative, while the cross-matching test were compatible. Patients with anemia caused by CD47 monoclonal antibody treatment were transfused with 2 U suspension red blood cells, and the evaluation showed that the transfusion was effective. 【Conclusion】 The CD47 monoclonal antibody can interfere with transfusion compatibility detection, and the use of antiglobulin reagents lacking IgG4 and Immucor Capture-R solid phase agglutination kit can remove the interference, with good transfusion efficacy in patients.
الملخص
【Objective】 To analyze the efficacy of ABO-matched platelet transfusions and ABO-mismatched platelet transfusions in patients with hematonosis and to explore the effect of circulating immune complexes (CIC) on the efficacy. 【Methods】 A total of 1 510 platelet transfusions involving 757 patients in our hospital from January 2013 to June 2018 were retrospectively analyzed. The patients were divided into ABO-matched group and ABO-mismatched group. The 12-hour percent platelet recovery (PPR) was used to evaluate the effect of platelet transfusion between the groups. TEG was used to evaluate the efficacy of the transfusions, and CIC value was measured before and after platelet transfusion. The effect of A-B/CIC (or AB-O/CIC) on platelet function was tested. 【Results】 1)The results showed that platelet transfusion was effective(PPR>30%) in both ABO-matched group[PPR=(66.5±52.8)%] and ABO-mismatched group[PPR=(47.7%±51.6)%], and there was no increase in the report of hemolytic transfusion reaction of ABO-mismatched group. The efficacy of ABO-matched platelet transfusions was significantly better than that of ABO-mismatched group(P 0.05. 2) In the experiment of simulating platelet transfusion in patients, no difference in MA value of TEG was noticed between ABO-mismatched groups and ABO-matched groups (all P>0.05). 3) There was no difference in CIC value before and after platelet transfusions (P>0.05) in the ABO-matched group, while CIC value decreased significantly in all ABO-mismatched groups (all P < 0.05). 4) The MA values (mm)of AB, A and O blood group platelets mixed with A-B/CIC and AB-O/CIC were 36.1 vs 31.1, 37.8 vs 35.0 and 43.1 vs 45.7, with the MA value (mm) in control group at 49.2 vs 49.5, respectively. 【Conclusion】 Platelet transfusion was effective in both ABO-matched group and ABO-mismatched group, and the efficacy of ABO-matched group was significantly better compared with the ABO-mismatched group. There was no increase in the safety risk of ABO-mismatched platelet transfusion with major mismatches/minor matches. CIC can inhibit the function of platelets and combine more with ABO-matched platelets than with ABO-mismatched platelets, therefore, CCI is an important influencing factor on the efficacy of platelet transfusions.
الملخص
【Objective】 To explore the characteristics of the D antigen epitope of individuals with RhD variants and the genetic molecular mechanism of gene mutations in Guangzhou. 【Methods】 A total of 59 samples of RhD variants were collected from blood donors and hospitals in Guangzhou from January to August 2019. Serological characteristics of D epitopes were further analyzed using two kinds of monoclonal anti-D reagents and D epitope detection kits, and RHCE phenotypic typing was performed. QuickGene DNA extraction kit was used to extract the genomic DNA of the samples, and PCR-RFLP method was used to analyze the RHD gene zygote type. The RHD gene sequence was detected by multiple ligation-dependent probe amplification(MLPA) genotyping, and the RHD exon(1~10) Sanger sequencing was performed on the samples still in doubt after the above detection. DNAStar/SeqMan analysis software was used for comprehensive analysis. 【Results】 In this group of individuals with RhD variants in Guangzhou, 27.12%(16/59) were detected from blood donors [accounting for 0.007%(16/232 793) of blood donors in Guangzhou during the same period], and difficult samples of patients sent by hospitals for determination accounted for 72.88%(43/59). RHD genotype detection: 40.68%(24/59) were RHD*weak partial 15, 25.42%(15/59) were RHD* DⅥ.3 and 33.90%(20/59) were rare RHD variants [76.92%(10/13) were RhD variants with 2 different alleles]. Serological D-screen revealed a relatively fixed pattern of RHD*DⅥ.3 in anti-D antibody(clone: P3*212 23B10), while the others was negative. The phenotypic distribution of RhD variant CE was Ccee 38.98%(23/59), ccEe 35.59%(21/59), CcEe 25.42%(15/59). 【Conclusion】 Weak partial D15 and DⅥ.3 were the most common RhD variants in Guangzhou Han population, and DⅥ can be preliminarily identified by serological methods such as D-Screen anti-D reagent, while the remaining RhD variants can only be identified by molecular biological methods, and >95% of the RhD variants were C+ or E+ phenotypes.
الملخص
【Objective】 To explore the prognosis of critically ill patients with coagulation dysfunction using thrombelastogram(TEG) and coagulation four items combined with APACHEⅡ score. 【Methods】 From March 2017 to March 2020, 287 critically ill patients with coagulation dysfunction in our hospital were selected as the study group, and 303 patients with normal coagulation function during the same period were set as the control. The study group was divided into low-risk group(group A), intermediate-risk group(group B) and high-risk group (group C) based on the APACHEⅡ score, and into survival group and death group according to the prognosis. The difference of TEG, coagulation four items, and APACHEⅡ scores between the two groups were analyzed. The correlation and difference between TEG, coagulation four items and APACHE II score in the study group were analyzed. The ROC curve was drawn to analyze the prognostic predictive value of research indicators. 【Results】 Blood coagulation function related indicators in the study group fluctuated significantly: in comparison to the control, the CI value, MA value, and α angle were smaller, while the K time and R time were longer; among the coagulation four items, PT, APTT and TT were higher; Fg level was lower, and the APACHE Ⅱ score was higher(P0.05). There were significant differences between the TEG and coagulation function related index levels in patients with different prognosis. Compared with the survivals, the CI value, MA value and α angle of the dead group were smaller, while the K time and R time were longer; and among the coagulation four items, PT, APTT, and TT were higher, the Fg level was lower, and the APACHEⅡ score was higher (PP4\\P5>APACHE Ⅱ score>P1>P2. 【Conclusion】 TEG, coagulation four items, and APACHE Ⅱ score can be used to assess the severity of patients with severe coagulation dysfunction. and the combined application of the 3 indicators are of high value in predicting the prognosis of such patients, and can provide reference for clinical formulation or adjustment of intervention programs to correct coagulation dysfunction.
الملخص
Objective To investigate the therapeutic effect of Yishen Tianjing Zhuyun Prescription(a Chinese herbal recipe consisting of Xianqi Yizhen Capsules and Xianzi Yizhen Capsules, having the actions of strengthening kidney-essence and promoting gestation) together with active lymphocyte immunotherapy for habitual abortion (HA)patients. Methods A total of 139 HA outpatients with negative blocking antibodies(BA)were randomly divided into treatment group(70 cases) and control group(69 cases). The control group was treated only with active lymphocyte immunotherapy, while the treatment group was treated with Yishen Tianjing Zhuyun Prescription and active lymphocyte immunotherapy . Results (1) After treatment, the BA-positive rate was 82.86% in the treatment group and was 60.87% in control group, and there existed significant difference between the two groups (P < 0.05 ). (2) The total anti-abortion effective rate was 87.14% in the treatment group and was 66.67% in control group, the difference being significant between the two groups(P<0.05 ). Conclusion Yishen Tianjing Zhuyun Prescription combined with active lymphocyte immunotherapy is more effective than active lymphocyte immunotherapy alone for the treatment of HA patients with negative BA.