2025 年第 8 期 第 20 卷

血浆置换与去白细胞红细胞悬液输血对自身免疫性溶血性贫血患儿的治疗效果

The therapeutic effect of plasma exchange and blood transfusion with leukocyte-removing red blood cell suspension on children with autoimmune hemolytic anemia

作者：翁艾罕赵兴丹张倩晋艳婷陈明发

英文作者：Weng Aihan Zhao Xingdan Zhang Qian Jin Yanting Chen Mingfa

单位：海南省妇女儿童医学中心输血科，海口570000

英文单位：Department of Blood Transfusion Hainan Women and Children′s Medical Center Haikou 570000 China

关键词：自身免疫性溶血性贫血；去白细胞红细胞悬液输血；血浆置换；凝血功能；纤溶功能；不良反应

英文关键词：Autoimmunehemolyticanemia;Leukocyte-removingredbloodcellsuspension;Plasmaexchange;Bloodcoagulationfunction;Fibrinolyticfunction;Adversereactions

• 摘要：

• 目的 比较血浆置换与去白细胞红细胞悬液输血对自身免疫性溶血性贫血（AIHA）患儿的治疗效果。方法 选取2021年7月至2023年7月海南省妇女儿童医学中心收治的97例AIHA患儿进行前瞻性研究，采用随机数字表法分为对照组（48例）和观察组（49例）。对照组采用血浆置换治疗，观察组采用去白细胞红细胞悬液输血治疗。比较2组患者的临床疗效、血液指标、凝血功能指标、纤溶功能、不良反应发生情况。结果  观察组和对照组治疗总有效率比较差异无统计学意义［98.0%（48/49）比93.8%（45/48）， χ2＝1.087，P＝0.297］。治疗后，2组患者红细胞计数、血红蛋白、凝血酶时间、凝血酶原时间、活化部分凝血活酶时间、纤溶酶原均高于/长于治疗前且观察组均高于/长于对照组，网织红细胞、血清胆红素、纤维蛋白原、D-二聚体和纤溶酶原激活物抑制物1均低于治疗前且观察组均低于对照组，差异均有统计学意义（均P＜0.05）。观察组不良反应总发生率低于对照组［4.1%（2/49）比16.7%（8/48）］，差异有统计学意义(χ2＝4.153，P＝0.042）。结论  血浆置换与去白细胞红细胞悬液输血对AIHA患儿均有良好效果，但后者更有利于改善患儿血液指标、凝血功能和纤溶功能，且安全性较高。

• Objective To compare the therapeutic effect of plasma exchange and blood transfusion with leukocyte-removing red blood cell suspension on children with autoimmune hemolytic anemia (AIHA). Methods A prospective study was conducted on 97 children with AIHA admitted to Hainan Women and Children′s Medical Center from July 2021 to July 2023. According to the random number table method, they were divided into the control group (48 cases) and the observation group (49 cases). The control group was treated with plasma exchange, and the observation group was treated with leukocyte-removing red blood cell suspension. The clinical efficacy, blood indexes, coagulation function indexes, fibrinolysis function, and adverse reactions were compared between the two groups. Results There was no significant difference in the total effective rate between the observation group and the control group ［98.0%(48/49) vs 93.8%(45/48), χ2=1.087, P=0.297］. After treatment, the red blood cell count, hemoglobin, thrombin time, prothrombin time, activated partial thromboplastin time and plasminogen in the two groups were higher/longer than those before treatment, and those in the observation group were higher/longer than those in the control group. The reticulocyte, serum bilirubin, fibrinogen, D-dimer and plasminogen activator inhibitor-1 in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group (all P＜0.05). The total incidence of adverse reactions in the observation group was lower than that in the control group ［4.1%(2/49) vs 16.7%(8/48)］(χ2=4.153, P=0.042). Conclusion Both plasma exchange and leukocyte-removing red blood cell suspension have good effects on children with AIHA, but the latter is more conducive to improving the hemogram, coagulation function and fibrinolysis function of children, and has higher safety.