输血的要求和影响,在患有thalassaemia major.患者. 库利护理计划 库利护理计划
1Centro Trasfusionale e de Immunologia dei Trapianti, Ospedale Policlinico, Milano, Italy.
Lancet (London, England)
|February 2, 1991
概括
血症的治疗已经进化,切除术和输血延迟的情况较少. 在非脊髓切除的患者中,血液需求更高,并且随着输血延迟而增加免疫接种风险.
科学领域:
- 血液学 血液学 血液学
- 儿科医学 儿科医学
- 公共卫生 公共卫生
背景情况:
- 在过去的二十年里,血症治疗发生了显著的变化.
- 国际质量评估计划Cooleycare提供了关于治疗的数据.
- 了解当前的治疗趋势及其影响对于管理血症至关重要.
研究的目的:
- 基于1985年的数据,分析沙拉血病患者的治疗需求和治疗结果.
- 评估脊髓切除率,脊髓切除时的年龄和第一次输血时的年龄的趋势.
- 评估治疗对患者身高,血液需求和免疫接种的影响.
主要方法:
- 分析了3468名意大利和希腊患者的数据,这些患者已注册在Cooleycare计划中.
- 检查脊髓切除术率和超过20岁的年龄的趋势.
- 血液需求与脊髓切除术状态,输血间隔和血红蛋白水平的相关性.
主要成果:
- 随着时间的推移,观察到脊髓切除术率下降和脊髓切除术时年龄增加.
- 一部分患有较轻的沙拉塞米亚形式的患者出现了延迟的第一次输血 (>4年).
- 接受现代治疗的儿童在11岁之前表现出近乎正常的身材,然后往往会变矮.
- 非脊髓切除的患者比脊髓切除的患者需要35%更多的血液.
- 输血间隔 (2-4周) 对血液需求没有显著影响.
- 血液需求随着血红蛋白度的增加而增加,可能非线性.
- 输血的延迟开始与红细胞合免疫的更高患病率相关.
- 输血反应发生在1%的输血中 (主要是白细胞枯竭),影响了17%的患者.
结论:
- 血症的治疗策略发生了变化,影响了患者的治疗和治疗结果.
- 及早开始输血是预防与免疫的关键.
- 增长模式和血液需求需要持续监测和量身定制的治疗方法.
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