儿科输血HuaShan,MD,PhDProfessor,StanfordMedicalSchoolAdjunctProfessor,JohnsHopkinsMedicalSchool内容•新生儿特殊生理Specialconsiderationsforneonates•儿童的输血反应Transfusionreactionsinchildren•新生儿同种免疫性血小板减少性紫癜Neonatalalloimmunethrombocytopenia(NAIT)•问题/答案Questions/answers新生儿Neonates•早产儿输血可能性最高Pretermneonatesaremostfrequentlytransfusedpatients•早产儿贫血的高危因素Highrisksforanemia•血红蛋白明显下降MarkeddecreaseofHgb•其它临床并发症Othermedicalcomplications•临床需要频繁抽血检验Needforfrequentblooddraw•骨髓造血能力弱Lowmarrowproduction新生儿的输血时机？Whentotransfusionaneonate?•新生儿的输血基于临床病情而非仅根据1项指标Decisiontotransfusionshouldbebasedonclinicalconditioninsteadjustonenumber•美国输血协会儿童输血：医师手册AABBPediatricTransfusion:aphysician’shandbook•红细胞RBC•血小板PlateletsAABBPediatricTransfusion:aphysician’shandbook美国输血协会儿童输血：医师手册AABBPediatricTransfusion:aphysician’shandbook表29.小于4月足月婴儿红细胞输注指征1.Hb<7g/dL伴网织红细胞计数减低及贫血症状2.Hb<10g/dL婴儿·面罩吸氧<35%·经鼻插管吸氧·持续气道正压CPAP/间断指令通气IMV机械通气平均气道压<6cmH2O·明显呼吸暂停或心动过缓§·明显心动过速或呼吸过频†·体重增加不足‡3.Hb<12g/dL婴儿·面罩吸氧>35%·持续气道正压CPAP/间断指令通气IMV机械通气平均气道压≧6cm-8cmH2O4.Hb<15g/dL婴儿·体外膜肺·先天性青紫型心脏病§接受治疗剂量的甲基黄嘌呤同时，12小时内发作6次或24小时内发作2次，需要面罩通气.†心率>180次/分超过24小时，呼吸>80次/分超过24小时.‡给予≧100卡路里/公斤体重/日，连续观察4天，婴儿每日体重增加<10克.新生儿贫血的预防PreventingAnemiainNeonates•延迟脐带钳夹（3分钟）Delaycordclamping(3minutes)•减少静脉采血Minimizephlebotomylosses•用脐带血进行初次实验室检验UsingfetalcordbloodforinitiallabtestforVLBWbabies•用促红素制剂Administrationoferythropoiesis-stimulatingagents新生儿红细胞制剂的选择SelectingRBCUnitsforNeonatesABO血型•新生儿血液有母亲ABO抗体NeonatesbloodhavematernalABOantibodies•红细胞制剂需与新生儿和母亲的ABO相容RBCunitsneedtobecompatiblewithbabyandmother’sbloodtype•输O型红细胞GivetypeORBC•如果新生儿血液母亲ABO抗体阴性，输新生儿ABO型红细胞Ifbaby’sbloodisnegativeformaternalantibodies,usebaby’sABOtype抗体筛查Antibodyscreen•需对母亲进行抗体筛查Needtobedonetodetectantibodiesfrommother•采取母亲血液Canusemother’sblood•如果抗体筛查阴性，4个月内无需重复筛查Noneedtorepeatuntil4-monthold(ifnegative)•如果抗体筛查阳性，4个月内重复筛查可随访抗体清除状况Usefultorepeat(ifpositive)tofollowclearance新生儿红细胞输注时特别注意之处RBCforNeonates:SpecialConsiderations•输注速度：10-15ml/公斤，>1-2小时Rate:10-15cc/kgover1-2hours•注意其它溶质：腺嘌呤和甘露醇Concernsforadditivesolutions:Adenineandmannitol•优选CPD或CPDA-1制剂PreferCPDorCPDA-1units•限制输注洗涤红细胞制剂LimitvolumeorwashadditivesolutionstoredRBC•避免节约而给1位新生儿重复输注同一供者的红细胞制剂Limitdonorexposurebysaveaunitforrepeateduseforthesameneonate•辐射红细胞制剂Irradiation•去白细胞Leukoreduction•关注血钾尤其在大量输血情况下PotassiumconcernsespeciallyforlargevolumetransfusionsAABBPediatricTransfusion:aphysician’shandbook表31.新生儿血小板输注指征1.婴儿病情稳定，血小板计数<20000/μL2.婴儿病情不情稳定，但未应用体外膜肺，无出血，血小板计数30000/μL—50000/μL3.婴儿有活动性出血，或需进行侵袭性操作，血小板计数≦50000/μL4.婴儿虽无出血，但应用体外膜肺ECMO血小板计数<100000/μLECMO=体外膜肺...
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