WS/T 622-2018Internal medicine transfusion (English PDF)

4.1 Red blood cell components

Therapeutic infusion for acute and chronic anemia caused by erythropoiesis, excessive destruction or loss, and pathological red blood cell components Change and so on. Usually, 1 unit of red blood cell component per infusion can increase hemoglobin 5g/L~10g/L, and/or hematocrit 0.015~0.030.

a) General rules.

1) Hemoglobin >100g/L and/or hematocrit > 0.30, can not be infused;

2) Hemoglobin 60g/L~100g/L and/or hematocrit 0.18~0.30, according to the patient's tissue hypoxia and oxygen consumption, heart Comprehensive assessment of lung compensatory function and other conditions to consider whether infusion is required;

3) Hemoglobin < 60g/L and/or hematocrit < 0.18, can be infused.

b) Special circumstances and instructions.

1) Hemoglobin < 40g/L in patients with autoimmune hemolytic anemia, according to tissue hypoxia and oxygen consumption, cardiopulmonary compensatory function a comprehensive assessment of the situation to consider whether an infusion is required;

2) Hemoglobin < 130g/L in patients with globin synthesis anemia, can be infused;

3) Patients with cardiopulmonary disorders such as myocardial infarction, pulmonary heart disease, congenital heart disease, severe infection, and implementation of cancer radiotherapy and chemotherapy, Infusion indications may be appropriately relaxed;

4) History of allergic reactions to blood transfusion, IgA deficiency, paroxysmal nocturnal hemoglobinuria, advanced liver and kidney disease and hyperkalemia Patients should be infused with washed red blood cells; patients with non-hemolytic fever after transfusion, repeated blood transfusions, etc. should be infused Leukocyte suspension of red blood cells; congenital or acquired (after tumor radiotherapy and chemotherapy) low immunity and hematopoietic stem cell transplantation Patients should be infused with irradiated red blood cells; patients with negative RhD antigen and other rare blood types can be infused with frozen thawed to remove glycerol red Cell

5) After the red blood cell component is infused, it is advisable to observe the improvement of anemia in time, detect the hemoglobin value, etc., and adjust the infusion dose in real time.

4.2 Platelet composition

A therapeutic infusion for hemorrhage caused by reduced platelet count and/or dysfunction or prophylactic loss with a potential bleeding tendency Note. Usually, a platelet count of 10 x 109/L ~ 30 × 109/L can be increased by injecting 1 therapeutic amount of apheresis platelets or 10 units of concentrated platelets per infusion.

a) General rules.

1) platelet count > 50 × 109/L, can not be infused; if there is abnormal platelet function accompanied by significant bleeding, can be infused;

2) Platelet count 10×109/L ~ 50×109/L, accompanied by obvious bleeding, should be infused;

3) The platelet count < 10×109/L should be infused immediately.

b) Special circumstances and instructions.

1) There are other hemostatic abnormalities (such as hereditary or acquired coagulopathy) or high risk factors for bleeding (eg fever, Septicemia, anemia, tumor after radiotherapy and chemotherapy, etc.), when the platelet count < 30 × 109/L, should be infused;

2) A large amount of blood transfusion and/or a large amount of infusion of crystalloid or artificial colloidal fluid after acute hemorrhage leads to dilute thrombocytopenia;

Significant hemorrhage and acute thrombocytopenia caused by extracorporeal circulation, membrane lung, etc., platelet count < 50×109/L and /or when the platelet function is abnormal, it should be infused;

3) The thromboelastogram (TEG) shows a decrease in the MA value with significant bleeding and should be infused;

4) Patients with medical system diseases should achieve the following safety reference values before performing various invasive operation. Otherwise, they should be infused.

Includes. platelet count >20×109/L for mildly invasive procedures; indwelling catheter, meningotomy (lumbar wear), chest Puncture, liver biopsy, transbronchial biopsy, platelet count >50 × 109/L; adult acute leukemia patients with small blood Plate count > 20 × 109/L, most can withstand waist wear without serious bleeding complications; bone marrow puncture and biopsy before operation no need to infuse platelets;

5) Patients who need repeated blood transfusion should choose to infusion of leukocyte apheresis; platelet transfusion is ineffective due to immune factors Patients should be infused with HLA/HPA combined with apheresis; congenital or acquired (eg, after tumor chemotherapy) Patients who can be seriously depressed should be infused with irradiation or leukocyte apheresis; patients with hematopoietic stem cell transplantation should be infused with HLA.

Cooperating type irradiated apheresis platelets;

6) In the absence of HLA/HPA complex apheresis due to immune factors that cause platelet transfusion to be ineffective and may be associated with life-threatening bleeding in the case of platelets, a one-time infusion of platelet component doses without HLA/HPA matching may be appropriately relaxed;

7) Thrombotic thrombocytopenic purpura and heparin-induced thrombocytopenia should be used with caution;

8) After the platelet transfusion, it is advisable to observe the improvement of the patient's bleeding in time, and increase the correction index (CCI) by the platelet count and /or the platelet recovery rate (PPR) and/or thromboelastogram (TEG) test, etc., adjust the infusion dose in real time.

4.3 Single granulocyte

It is indicated for therapeutic infusion of granulocytopenia or abnormal granulocyte function. Usually the infusion dose is 1~3 units per time.

a) General rules.

1) Bone marrow granulocyte hyperplasia is extremely reduced by granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF) for more than 5 days, neutrophils continue to be <=0.5×109/L, accompanied by severe bacterial or fungal infections.

Infusion

2) Infusion can be performed when neutrophil function is abnormally abnormal and accompanied by severe bacterial or fungal infection.

b) Special circumstances and instructions.

1) In order to reduce the occurrence of ineffective infusion, as well as congenital or acquired (such as. after tumor radiotherapy and chemotherapy), the immune function is seriously low, Hematopoietic stem cell transplantation and other patients should choose HLA-matched apheresis;

2) All infusion patients should choose to irradiate a single granulocyte when conditions permit;

3) After a single granulocyte infusion, it is advisable to observe the patient's infection remission in time and adjust the infusion dose in real time.

4.4 Fresh frozen plasma/virus inactivated fresh frozen plasma

It is suitable for the treatment of various unstable coagulation factors and/or stable coagulation factors and/or antithrombin III caused by various reasons.

Infusion. Usually the infusion dose is 10mL/kg ~ 15mL/kg.

a) General rules.

1) PT or APTT > reference value range upper limit 1.5 times ~ 2 times, accompanied by bleeding, should be infused;

2) INR value >1.5~2.0 (liver disease INR value >1.3), accompanied by bleeding, should be infused.

b) Special circumstances and instructions.

1) When it is necessary to quickly correct warfarin anticoagulant effects (eg, emergency surgery, etc.), excessive use of warfarin or craniotomy during use Infusion can be performed when there is severe bleeding in the internal part. Usually the infusion dose is 7mL/kg ~ 10mL/kg;

2) The thromboelastogram (TEG) shows an increase in the R value, accompanied by bleeding, which can be infused;

3) In addition to thrombotic thrombocytopenic purpura (TTP), patients with other diseases may be infused when performing plasma exchange;

4) When infusion of virus to inactivate fresh frozen plasma, the dose may be appropriately relaxed;

5) Fresh frozen plasma/virus inactivated fresh frozen plasma after infusion should be observed in time to improve the patient's bleeding, through PT and /or the APTT and/or INR and/or thromboelastogram (TEG) test, etc., adjust the infusion dose in real time.

4.5 Frozen plasma/virus inactivated frozen plasma

A variety of therapeutic infusions for stable clotting factor deficiency for a variety of reasons. Usually the infusion dose is 10mL/kg~15mL/kg.

a) General rules.

1) PT or APTT > reference value range upper limit 1.5 times ~ 2 times, accompanied by bleeding, should be infused;

2) INR value >1.5~2.0 (liver disease INR value >1.3), accompanied by bleeding, should be infused.

b) Special circumstances and instructions.

1) Patients with thrombotic thrombocytopenic purpura (TTP) may be infused and/or applied to plasmapheresis;

2) The thromboelastogram (TEG) shows an increase in R value with bleeding, except for FVIII or FV deficiency, which can be infused;

3) When infusion of virus to inactivate frozen plasma, the dose may be appropriately relaxed;

4) After infusion of frozen plasma/virus inactivated frozen plasma, it is advisable to observe the improvement of bleeding in patients, through PT and/or APTT and/or INR and/or thromboelastogram (TEG) detection, etc., adjust the infusion dose in real time.

4.6 Cryoprecipitate factor

Suitable for therapeutic infusion of Factor VIII and/or XIII and/or vWF and/or fibrinogen deficiency. Usually the infusion dose is

10 IU/kg ~ 15 IU/kg.

a) General rules.

1) Congenital or acquired hypofibrinogenemia (fibrinogen level < 1.0g/L) with significant bleeding in drug-induced when fibrinogen is not available, it can be infused;

2) plasma FVIII activity is low with obvious bleeding, can be infused when the drug-derived FVIII concentrate preparation is not available;

3) Vascular hemophilia is associated with significant bleeding and can be infused when the drug-derived FVIII concentrate formulation is not available.

b) Special circumstances and instructions.

1) In patients with bleeding or DIC, if the clotting factor XIII is suspected to be deficient or low, it can be infused;

2) The thromboelastogram (TEG) shows that the K value is prolonged, the angle alpha is reduced, and there is significant bleeding, which can be infused;

3) Infusion of uremia with coagulation dysfunction, thrombolytic therapy overdose, etc.;

4) Infusion of cryoprecipitate factor should be observed in time to improve the patient's bleeding, through PT and/or APTT and/or INR and/or the thrombus elastic force map (TEG) test, etc., adjust the infusion dose in real time.

references

[1] Blood Donation Law of the People's Republic of China (Presidency of the People's Republic of China No. 93) [2] "Administrative Measures for Clinical Blood Use in Medical Institutions" (Order No. 85 of the Ministry of Health) [3] "Technical Specifications for Clinical Blood Transfusion" (Wei Yi Fa [2000] No. 184) [4] Department of Health, Ministry of Health of the People's Republic of China. National clinical inspection procedures [M]. Beijing. People's Medical Publishing House, 2015.

[5] "Administrative Measures for Clinical Laboratories of Medical Institutions" (Wei Yi Fa [2006] No. 73) [6] American association of blood bands(AABB).Standards for Blood Banks and Transfusion Services, 31st Edition [M]. Bethesda.AABB.2018.