来自AABB的临床实践指南:红细胞输血门和储存
Jeffrey L Carson1, Gordon Guyatt2, Nancy M Heddle3
1Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
JAMA
|October 13, 2016
概括
对于大多数住院的成年人来说,限制红细胞输血门是安全的. 无论储存时间如何,建议使用标准发行的红细胞单位,而不是新鲜的单位进行输血.
科学领域:
- 输血医学
- 血液学
- 临床指南
背景情况:
- 全球每年收集的红细胞数量超过1亿个.
- 对于红细胞输血和储存时间的最佳血红蛋白值存在不确定性.
研究的目的:
- 在稳定的住院成年人中推红细胞输血的目标血红蛋白水平.
- 在输血前确定红细胞的最佳存储时间.
主要方法:
- 1948-2016年随机临床试验的系统文献搜索.
- 用于证据总结的建议评估,开发和评估 (GRADE) 方法.
- 对输血值的31个RCT和储存时间的13个RCT的分析.
主要成果:
- 限制性红细胞输血值 (7 - 8 g/ dL血红蛋白) 与自由性值 (9 - 10 g/ dL血红细胞输血值) 相比,没有增加不良临床结果.
- 在较新的红细胞单位 (储存10天以下) 和标准发行的红细胞单位之间没有显著的临床结果差异.
- 建议适用于稳定的住院成年人,不包括急性冠状动脉综合征,严重的血小板减少和慢性输血依赖性贫血.
结论:
- 对于大多数血液动力稳定的住院成年患者来说,限制性红细胞输血门是安全有效的.
- 目前的血液储存实践,即使用标准血液 (在授权约会期内的任何时间点) 应该继续.
- 证据支持最新的红细胞输血指南.
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