在患者血液管理时代,优化急诊科浓缩 O 型红细胞的使用。

Louisiane Courcelles, Marie Pouplard, Orla Braun, Corentin Streel, Véronique Deneys
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引用次数: 0

摘要

背景:急诊输血时可能需要使用 O 型阴性红细胞浓缩液,而无需进行输血前检测。在圣卢克大学诊所,急诊科习惯于使用两种分散型 O 型阴性红细胞浓缩液。本研究旨在分析在实施旨在优化库存的新策略前后,急诊科 O 型阴性红细胞浓缩液的消耗情况。该策略将一个单位的 O 型阳性红细胞浓缩液和一个单位的 O 型阴性红细胞浓缩液合并分配,分散在急诊科,只为 45 岁以下女性和 20 岁以下男性输注阴性红细胞浓缩液:对2008年至2022年间急诊科所有未经输血前检测立即接受输血的患者的输血和医疗记录进行了回顾性研究:结果:2008 年至 2022 年间,共有 193 名患者在急诊情况下未经输血前检测接受了 O 型红细胞浓缩液。在住院的头 24 小时内,共输注了 354 个 O 型阴性单位。2008 年至 2020 年间,O 型阴性袋数的平均比率为 1.98 单位/患者。实施新策略后,2021 年的比率为 1.46 单位/病人,2022 年急剧下降至 0.79 单位/病人:结论:在紧急情况下,只为 45 岁以下的女性和 20 岁以下的男性分配 O 型阴性红细胞单位,可以节省 85% 的 O 型阴性浓缩红细胞输血(303/354),同时平衡免疫风险。限制急诊科 O 型阴性红细胞浓缩液的脱位单位数量似乎可以降低 O 型阴性红细胞的消耗量。通过这一策略,节省下来的单位本可以输给更需要的患者(如镰状细胞患者或长期输血的患者)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Optimizing O red blood cell concentrate usage in the emergency department in the era of patient blood management.

Background: Emergency transfusion may require the availability of O-negative red blood cell concentrates without pre-transfusion testing. At the Cliniques Universitaires Saint-Luc, the emergency department was used to having access to two decentralized O-negative red blood cell concentrates. This study aims to analyze the consumption of O-negative red blood cell concentrates in emergency situations both before and after the implementation of a novel strategy aiming at optimizing stocks. This strategy provides a combined allocation of one unit of O-positive red blood cell concentrate and one unit of O-negative red blood cell concentrate decentralized in the emergency department and reserve the transfusion of the negative unit only to under 45-year-old women and under 20-year-old men.

Materials and methods: A retrospective study was conducted of the transfusion and medical records of all patients who received immediate transfusions in the emergency department without pre-transfusion testing between 2008 and 2022.

Results: A total of 193 patients received O red blood cell concentrates without pre-transfusion testing in emergency situations between 2008 and 2022. During the first 24 h of hospitalization, 354 O-negative units were transfused. Mean ratios of number of O-negative bags between 2008 and 2020 was 1.98 unit/patient. After implementation of the new strategy, the ratio in 2021 was 1.46 unit/patient and drastically decreased in 2022 to 0.79 unit/patient.

Conclusion: In situations of emergency, allocating O-negative units only for women younger than 45 years and men younger than 20 years could have saved 85% of O-negative red blood cell concentrates transfused (303/354) yet balancing the immunological risk. Limiting the number of delocalized units of O-negative red blood cell concentrates in the emergency department seems to lower O-negative consumption. With this strategy, the units spared could have been transfused to patients with greater needs (e.g., sickle cell patients or chronically transfused patients).

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