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新生儿红细胞输注

Author
Robin Ohls, MD
Section Editors
Donald H Mahoney, Jr, MD
Joseph A Garcia-Prats, MD
Deputy Editor
Melanie S Kim, MD
Translators
贲晓明, 主任医师，教授

引言

红细胞(red blood cell, RBC)输注能够立即增加组织的氧输送，是治疗急性贫血的一种快速有效的方法。红细胞输注可减少早产儿贫血等慢性贫血相关并发症发病率，能够挽救严重失血新生儿的生命。

然而，输血作为一种暂时的治疗措施，仍然存在一些缺点，包括进一步抑制红细胞生成，以及与以下风险相关：感染[1]、移植物抗宿主病、输血相关急性肺损伤(transfusion related acute lung injury, TRALI)、输血相关循环超负荷(transfusion associated circulatory overload, TACO)和抗凝药或保存剂的毒性作用。据报道，红细胞输注与死亡、坏死性小肠结肠炎、脑室内出血(intraventricular hemorrhage, IVH)的范围扩大或呼吸支持暂时性增加的风险增加有关；然而，目前没有高质量的证据可以证明红细胞输注与上述任一不良事件之间存在因果关系[2-4]。由于可能发生这些潜在并发症，在安排非紧急输血之前需要仔细评估新生儿血液向组织输送氧气的能力，并且在输血后记录下获益。 (参见“输血相关的移植物抗宿主病”和“免疫性输血反应”和“新生儿坏死性小肠结肠炎的病理学和发病机制”，关于‘贫血和红细胞输注’一节)

需要红细胞输注治疗的贫血新生儿与已经适应了低血细胞比容(hematocrit, HCT)的新生儿常常难以区分，后者最好采用保守治疗以避免输血相关风险。

本专题将总结新生儿红细胞输注的适应证及正确血液制品的选择。早产儿贫血及婴儿和儿童红细胞输注的适应证将单独讨论。 (参见“早产儿贫血”和“婴儿和儿童红细胞输注：适应证”)

适应证

概述 — 当红细胞量不能充分满足组织的氧需求时，贫血就会发生。

               

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-12.
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