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Access this article online Transfusion reactions in neonates and pediatrics:

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How and why are they different?
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新生儿和儿科的输血反应：如何以及为什么不同？
1
Abhishekh Basavarajegowda, Nishad Plakkal
Abhishekh Basavarajegowda，Nishad Plakkal 1

Abstract:
摘要：
Website:
网址: Neonates and children are physically as well as physiologically different from adults. They are immunologically vulnerable, and the effects
www.ajts.org of transfusion can be longstanding, including with respect to their development. The transfusion reactions in children differ from those in
adults in the type of reactions, incidence, and severity. The incidence is more than that in adults for the common type of reactions noted
DOI: in children. Transfusion reactions are most commonly associated with platelets, followed by plasma and red blood cell transfusions in
土井: children. Febrile, allergic, and hypotensive reactions or volume overload are the common types in children. Standardizing pediatric
10.4103/ajts.ajts_27_22 adverse transfusion reaction definitions and criteria are necessary to improve studies and reports. Several modifications are needed to
10.4 103/ajts.ajts_27_22 be adapted for transfusing blood products in neonates and children to evade the reactions as much as possible and make transfusion safer
in this vulnerable population. This article provides a brief articulation of the transfusion reactions in neonatal and pediatric populations
describing how they are different from adults.
新生儿和儿童在身体上和生理上都与成人不同。他们在免疫上是脆弱的，输血的影响可能是长期的，包括对他们的发展。儿童的输血反应
在反应类型、发生率和严重程度上与成人不同。儿童常见类型反应的发生率高于成人。最常见的输血反应与血小板有关，其次是儿童的血
浆和红细胞输血。发热、过敏和低血压反应或容量超负荷是儿童常见的类型。规范儿科输血不良反应的定义和标准对于改进研究和报告是
必要的。对于新生儿和儿童输注血液制品，需要进行一些修改，以尽可能避免反应，并使这一脆弱人群的输血更加安全。 本文简要介绍
了新生儿和儿科人群的输血反应，描述了其与成人的不同之处。
Keywords:
关键字:
Hypoglycaemia, Hyperkalaemia, neonatal transfusion reactions, paediatric transfusion reactions
低血糖、高钾血症、新生儿输血反应、儿科输血反应

[4]
over transfusions. Excess vulnerability to patient
Introduction identification errors in this age group may be
介绍 because they cannot confirm their details, share the same
date of birth with other infants in the neonatal intensive
[5]
care unit (ICU), or may not yet have a name.

A neonate is defined as an infant under

Recognition and reporting of transfusion errors in
新生儿被定义为以下婴儿
[1]
neonates are hindered because age‑appropriate
4 months of age for t ran sf us io n purposes. adverse transfusion reaction (ATR) definitions and
The upper limit for a “pediatric” patient is defined criteria are unavailable.
variedly as 14 or even 18 years. Transfusion reactions
Departments of 过度输血。 该年龄组的患者极易发生身份识别错误，这
[4]

Transfusion Medicine and reported from India show a lower incidence in the
可能是因为他们无法确认自己的详细信息，与新生儿重症
Neonatology, Jawaharlal Institute of
1

neonatal and pediatric age group, as low as 10%–20% of

Postgraduate Medical Education and
Research, Puducherry,
普杜切里贾瓦哈拉尔
[2,3]
the reported rate in adults. In contrast, there is a 监护室（ICU）中的其他婴儿具有相同的出生日期，或者
disproportionately high number of reports following 可能还没有名字。 由于无法获得与年龄相适应的输血不
[5]

研究生医学教育和研究所输血医学部 pediatric transfusions compared to adults in the West. 良反应（ATR）定义和标准，因此无法识别和报告新生儿

和新生儿科 However, approximately two‑thirds of these reports are 的输血错误。
India
印度 related to errors, which should be preventable.
Th es e usually include incorrect blood component I mma turity of the immune system, particularly in
Address for transfusions, specific requirements not met, and extremely premature infants, and disorders of cellular
correspondence: Dr.
Nishad Plakkal, Department
avoidable, delayed, or under/ immunity in children increase their susceptibility to
of 4个月大，用于输血。 “儿科”患者的上限被定义 [1]
transfusion‑associated graft‑versus‑host disease
通讯地址：
为14岁甚至18岁。印度报告的输血反应显示，新生儿和儿 (TAGVHD). In contrast, immunologically
Dr.Nishad Plakkal
Neonatology, Jawaharlal Institute of 童年龄组的发生率较低，低至成人报告发生率的10%-20%。 mediated reactions such as febrile or allergic hemolytic
Postgraduate Medical Education 相反，与西方成人相比，儿童输血后的报告数量高得不
[2,3] reactions are rare. Physiological differences lead to
and Research, Puducherry, metabolic complications, which are more specific to this
新生儿，贾瓦哈拉尔研究生医学教 成比例。但是，这些报告中大约有三分之二与错误有关，
育和研究所，普杜切里。 而这些错误应该是可以预防的。这些通常包括不正确的血 population. Blood product
India.
液成分输注、未满足特定要求以及可避免的、延迟的或不 免疫系统的不成熟，特别是在极早产儿中，以及儿童的细
E-mail: plakkal@gmail.
足的/ 胞免疫紊乱增加了他们对输血相关的移植物抗宿主病
印度。
电子邮件：plakkal@Gmail。 （TAGVHD）的易感性。相反，免疫介导的反应，如发热或
com 过敏性溶血反应是罕见的。生理上的差异会导致代谢并发
来吧 This is an open access jo urnal, and articles are distributed under the terms of
the Creative Commons Attribution‑ NonCommercial‑ ShareAlike 4.0 License, which
症，这是这一人群特有的。血液制品
Submitted: 23-02-2022 allows others to remix, tweak, and build upon the work non‑ commercially, as long as
提交日期:23-02-2022 appropriate credit is given and the new creations are licensed under the identical
Accepted: 03-04-2022 terms. How to cite this article: Basavarajegowda A, Plakkal N.
接受日期:03-04-2022 这是一本开放获取期刊，文章是根据知识共享署名-非商业性-类似共享4.0许可 Transfusion reactions in neonates and pediatrics: How
Published: 12-12-2022 协议的条款发布的，该许可协议允许其他人对作品进行非商业性的重新混合、
发布时间:12-12-2022 调整和构建，只要给予适当的信任，并且新的创作是根据相同的条款授权的。
and why are they different? Asian J Transfus Sci
2023;17:97‑ 102.
如何引用本文：Basavarajegowda A，Plakkal N.新生儿
Forreprintscontact:WKHLRPMedknow_reprints@wolterskluwer.com
转载请联系：WKHLRPMedknow_reprints@wolterskluwer.com 和儿科的输血反应：它们如何不同以及为什么不同？亚
洲运输科学杂志2023；17:97‑102.
© 2022 Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow 97
©2022亚洲输血科学杂志|由Wolters Kluwer-MedKnow出版 97
 Basavarajegowda and Plakkal: Transfusion reactions in neonates and pediatrics
Basavarajegowda和Plakkal：新生儿和儿科的输血反应
type, dose, infusion rate, monitoring, triggers, and complex under a radiant warmer or phototherapy lights. Inline potassium
+
administration processes such as warming and infusion through rate adsorption filters or washing have been shown to remove extracellular K
[7]
monitoring devices can lead to a new set of errors and complications. from RBC units, but these may not be feasible on a routine basis.
Specific blood components and indications for transfusion are also 在辐射取暖器或光疗灯下。内联钾吸附过滤器或洗涤已被证明可从RBC单
different in this group of patients. A child’s long‑term development, 位中去除细胞外钾 ，但这些方法在常规基础上可能不可行。 + [7]

particularly neurocognitive development, also needs to be considered while

monitoring long‑term adverse events.
类型、剂量、输注速率、监测、触发和复杂的给药过程（如通过速率监测 Hypothermia
设备进行加温和输注）可能导致一系列新的错误和并发症。在这组患者中， 体温过低
特定的血液成分和输血指征也不同。在监测长期不良事件时，还需要考虑 The higher susceptibility of infants to hypothermia is due to
儿童的长期发育，特别是神经认知发育。 decreased body fat, an immature epidermal barrier, and a higher surface
area‑to‑weight ratio. At increased risk are infants on extracorporeal
Transfusion reactions are generally classified based on pathogenesis into membrane oxygenation (ECMO), those undergoing exchange
immunologically mediated reactions and those that are not. The transfusions or cardiac surgery, and children with trauma. Blood
classification is summarized in Table 1. products brought to room temperature before transfusion also have been
输血反应通常根据发病机制分为免疫介导反应和非免疫介导反应。表1总 shown to decrease an infant’s core body temperature by 0.7°C–2.5°C. [8,9]

结了分类情况。 婴儿对体温过低的易感性较高是由于体脂减少、表皮屏障不成熟和表面积
与体重比较高。使用体外膜肺氧合（ECMO）的婴儿、接受换血或心脏手术
的婴儿以及患有创伤的儿童风险更高。在输血前将血液制品置于室温下也
Metabolic Complications
可使婴儿的核心体温降低0.7°C–2.5°C 。 [8,9]

代谢并发症
Prevention
Hyperkalemia
预防
高钾血症 Usage of blood warmers designed explicitly for blood administration is
+
Plasma K increases during storage of whole blood (WB) and red blood cells [10]
recommended. Counter‑current technology for warming is the most
+
(RBCs) due to leakage of intracellular K associated with inhibition of the effective. [11]

+ +
membrane Na / K ATPase pump. The plasma of a unit of CPDA‑1 建议使用专为血液给药设计的血液加温器。 用于加热的逆流技术是最有 [10]

WB contains approximately 25 mEq/L of K + at day 35 and RBCs 效的。 [11]

about 75–100 mEq/L, translating to about 8 mEq per unit. This would
not pose a problem with low‑volume transfusions (10–20 mL/kg), as the
+
infant’s daily requirement of K is 1–3 mEq/kg/day. However, Impaired glucose homeostasis
+
large‑volume transfusions or the infant’s kidneys’ inability to excrete K 葡萄糖稳态受损
[6]
may lead to dangerous hyperkalemia. Transfusion at a faster rate or Both hypoglycemia and hyperglycemia are linked to blood
+
through central lines delivering a high K load directly to the heart may transfusion. This is probably also because the infants at risk of
cause arrhythmias, including cardiac arrest. developing hypoglycemia or hyperglycemia are also the ones most likely
血 浆K 在 全血 （ WB） 和红 细胞 （ RBCs） 储存 期间增 加， 这是 由于与膜
+

to receive a transfusion. Neonates have decreased glycogen stores and

Na /K ATP酶泵的抑制相关的细胞内K 的泄漏。在第35天，一个单位的CPDA-
+ + +
mucosal G‑6‑phosphatase. The proposed mechanisms for altered glucose
1 WB的血浆中含有约25 mEq/L的K+，红细胞中含有约75–100 mEq/L的K+， homeostasis in infants are summarized in Table 2.
相当于每单位约8 mEq。这不会对低容量输血（10–20 mL/kg）造成问题， 低血糖和高血糖都与输血有关。这也可能是因为有发生低血糖或高血糖风
因为婴儿每日所需的K 为1–3 mEq/kg/天。然而，大容量输血或婴儿的肾
+
险的婴儿也是最有可能接受输血的婴儿。新生儿的糖原储备和粘膜G-6磷
脏不能排泄钾 可能会导致危险的高钾血症。 以更快的速度输血或通过中
+ [6]
酸酶减少。表2总结了婴儿体内葡萄糖稳态改变的机制。
心静脉导管将高钾 直接输送到心脏可能会导致心律失常，包括心脏骤停。
+

Glucose concentrations are also known to decrease in stored units over

[12]
time. Glucose levels are reported to decrease after transfusion and
Prevention are generally asymptomatic, but mild symptoms can be noted in
预防 infants, especially in children undergoing exchange transfusion. The
Using irradiated blood after 24 h of storage in neonates should be avoided. incidence of hypoglycemia in infants with erythroblastosis fetalis ranged
Care is to be taken to avoid mechanical lysis of cells during infusion. Blood from 2% to 20%. [9]

transfusion tubing can be shielded with aluminum foil while the infant 还已知葡萄糖浓度在储存单位中随时间降低。 据报道，输血后血糖水平 [12]

is 下降，一般无症状，但在婴儿中，特别是在接受换血的儿童中，可出现轻
新生儿应避免使用储存24小时后的辐照血液。注意在输注过程中避免细胞 微症状。胎儿成红细胞增多症患儿低血糖的发生率为2%~20%。
的机械裂解。输血管可以用铝箔保护，而婴儿

Table 1: Classification of transfusion reactions in neonates and children

表1:新生儿和儿童输血反应分类
Immunological Nonimmunological
免疫学的 非免疫的
Febrile nonhemolytic transfusion reactions Allergic reactions Metabolic Hypothermia
发热性非溶血性输血反应过敏反应 Hyperkalemia
Hemolytic transfusion reactions: Acute and delayed Transfusion‑ related 代谢性低温高钾血症
acute lung injury Transfusion‑ associated graft‑ versus‑ host disease Acid–base abnormalities
Transfusion‑associated necrotizing enterocolitis Alloimmunization Hypocalcemia
溶血性输血反应：急性和延迟性输血相关急性肺损伤输血相关移植物抗宿主 酸碱失衡、低钙血症
病输血相关坏死性小肠结肠炎同种免疫 2,3 DPG reduction
Posttransfusion purpura 23 DPG降低
输血后紫癜 Altered glucose homeostasis Infectious
葡萄糖稳态改变感染性
Viral: HBV, HIV, HCV, CMV
病毒：HBV、HIV、HCV、CMV
Sepsis
败血症
Parasites: Malaria and Babesia
寄生虫：疟疾和巴贝斯虫
Others
其他的

98 Asian Journal of Transfusion Science - Volume 17, Issue 1, January-June 2023

亚洲输血科学杂志-第17卷，第1期，2023年1月至6月
 Basavarajegowda
Transfusion‑ associated circulatory overload Iron overload and Plakkal: Transfusion reactions in neonates输血相关的循环超负荷和铁超负荷
and pediatrics
HBV=Hepatitis B virus, HIV=Human immunodeficiency virus, HCV=Hepatitis C virus, CMV=Cytomegalovirus, DPG=2,3‑diphosphoglycerate
Basavarajegowda和Plakkal：新生儿和儿科的输血反应
HBV=乙型肝炎病毒，HIV=人类免疫缺陷病毒，HCV=丙型肝炎病毒，CMV=巨细胞病毒，DPG=2，3-二磷酸甘油酸

Asian Journal of Transfusion Science - Volume 17, Issue 1, January-June 2023 99

亚洲输血科学杂志-第17卷，第1期，2023年1月至6月
 Basavarajegowda and Plakkal: Transfusion reactions in neonates and pediatrics
Basavarajegowda和Plakkal：新生儿和儿科的输血反应
Table 2: Probable mechanisms for altered glucose homeostasis in infants during transfusion
表2:婴儿输血期间葡萄糖稳态改变的可能机制
Hypoglycemia Hyperglycemia
低血糖 高血糖症
In exchange transfusion: Islet cell hyperplasia, inactivation of circulating insulin by Infants requiring surgical procedures under general anesthesia: Stress from induction of anesthesia
increasing levels of reduced glutathione released from hemolysis of red cells, leading to leading to release of epinephrine and norepinephrine
compensatory stimulation of beta cells 需要在全身麻醉下进行外科手术的婴儿：麻醉诱导引起的应激导致肾上腺素和去甲肾上腺素的释放
在换血中：胰岛细胞增生，通过增加红细胞溶血释放的还原型谷胱甘肽水平使循环胰岛素失 Mobilization of endogenous glucose stores
活，导致β细胞的代偿性刺激 内源性葡萄糖储备的动员
Decreased rate of glucose infusion during transfusion Intolerance to exogenous glucose by smaller and premature infants Intrauterine transfusion blunts
输血期间葡萄糖输注率降低 the hyperinsulinemic response by reducing circulating glutathione
较小婴儿和早产儿对外源性葡萄糖不耐受：宫内输血通过减少循环谷胱甘肽来减弱高胰岛素血症反
应

在换血期间，如果怀疑有低钙血症，应使用10%葡萄糖酸钙（2 mL/kg）进行
Prevention 治疗。在接受换血治疗的婴儿中，应监测离子钙水平。
预防
Infants at risk are to be recognised and monitored. Blood products should be Transfusion‑associated circulatory overload
transfused through a second iv line, with maintenance fluids being administered
at a slower rate to avoid fluid overload. The glucose concentration of the fluid 输血相关的循环超负荷
may need to be increased if the infusion rate is reduced. The available definitions of the Centers for Disease Control and
有风险的婴儿应得到识别和监测。血液制品应通过第二条静脉导管输注， Prevention/International Society of Blood
维持液体应以较慢的速度给药，以避免液体超负荷。如果输注速率降低， 疾病控制和预防中心/国际血液学会的可用定义
则可能需要增加流体的葡萄糖浓度。

Reduced 2,3‑diphosphoglycerate
还原2，3-二磷酸甘油酸
During storage, the amount of 2,3‑diphosphoglycerate diminishes
rapidly. This shifts the hemoglobin–oxygen dissociation curve to the left,
thereby reducing the ability of RBCs to release oxygen into tissue. It takes between
3 and 8 h to be regenerated after one unit of RBCs has been transfused. Infants
younger than 4‑month‑old cannot compensate as effectively as older
patients that can compensate for the resulting hypoxia by increasing their
[13]
heart rate.
在储存过程中，2，3-二磷酸甘油酸的含量迅速减少。这使血红蛋白-氧解
离曲线向左移动，从而降低了红细胞向组织释放氧气的能力。输注一个单
位的红细胞后，需要3至8小时才能再生。小于4个月的婴儿不能像老年患
者那样有效地补偿，老年患者可以通过增加心率来补偿由此产生的缺氧。
[13]

Prevention
预防
For neonates undergoing large‑volume transfusions, fresher blood
units are preferred.
对于接受大容量输血的新生儿，首选新鲜血液单位。

Hypocalcemia
低钙血症
The use of sodium citrate as an anticoagulant that binds ionized calcium is
the cause of hypocalcemia in neonates. Small‑volume transfusions are
unlikely to cause it, but the load infused during exchange transfusion can
reach high levels. Most citrate is metabolized in the liver, kidney, and
skeletal muscles. The kidney and liver are not fully functional, and muscle
mass is low in neonates. Hypothermia and acidosis, if present, can also
reduce the clearance of citrate. Transient hypoparathyroidism relates to
the gestational and postnatal age of the neonate. The presence of
hypomagnesemia can also blunt the parathyroid hormone response. Early
neonatal hypocalcemia has also been attributed to the presence of
[13,14]
hypercalcitoninemia and inducing calciuria.
使用柠檬酸钠作为结合离子钙的抗凝剂是新生儿低钙血症的原因。小容量
输血不太可能导致这种情况，但换血过程中输注的负荷可能达到很高的水
平。大多数柠檬酸盐在肝脏、肾脏和骨骼肌中代谢。新生儿的肾脏和肝脏
功能不全，肌肉质量低。体温过低和酸中毒（如果存在）也会降低枸橼酸
盐的清除率。短暂性甲状旁腺功能减退与新生儿的妊娠和出生后年龄有关。
低镁血症的存在也可使甲状旁腺激素反应减弱。早期新生儿低钙血症也可
归因于高降钙素血症的存在并诱发钙尿症。 [13,14]

Prevention
预防
Seizure activity during exchange transfusion where hypocalcemia is
suspected should be treated with 10% calcium gluconate (2 ml/kg). Ionized
calcium levels should be monitored in infants undergoing exchange transfusion.
100 Asian Journal of Transfusion Science - Volume 17, Issue 1, January-June 2023
亚洲输血科学杂志-第17卷，第1期，2023年1月至6月
 Basavarajegowda and Plakkal: Transfusion reactions in neonates and pediatrics
Transfusion do not define cutoffs for age‑adapted vital sign values.
Basavarajegowda和Plakkal：新生儿和儿科的输血反应
These definitions also ignore the effect of critical illness that can
influence vital signs. Transfusion‑associated circulatory overload is
[15]
mentioned to be more frequent in children younger than 3 years. The
higher risk is probably because of comparatively fast infusion in the
background of their smaller size.
输血不定义年龄适应生命体征数值的临界值。这些定义也忽略了可能影
响生命体征的重大疾病的影响。输血相关的循环超负荷在3岁以下儿童中
更为常见。 较高的风险可能是因为在其较小尺寸的背景下相对较快的输
[15]

注。

Prevention
预防
Identify patients at‑risk such as premature infants, infants with cardiac
and pulmonary conditions or on mechanical ventilation/vasopressors,
and transfuse them at a rate as reasonably low as possible.
识别有风险的患者，如早产儿、患有心脏和肺部疾病的婴儿或使用机械
通气/血管升压药的婴儿，并以尽可能低的速度对其进行输血。

Transfusion‑transmitted infections
输血传播感染
Given their small size, neonates are often transfused with small‑volume
aliquots and could be exposed to multiple donors. On average, premature
infants weighing <1 kg are exposed to more than five donors during a
single hospital stay if an opened port system is utilized for aliquot production
[16]
instead of multiple aliquot Pedi‑pack systems. There is a high risk of
cytomegalovirus transmission for low‑birth‑weight infants born to
[13]
seronegative mothers.
考虑到新生儿的体型较小，他们通常需要输注小体积的血液，并且可能
会接触到多个供体。平均而言，如果使用开放式端口系统而不是多个等
分Pedi‑Pack系统进行等分生产，则体重<1 kg的早产儿在一次住院期间会
接触五个以上的供体。 血清阴性母亲所生的低出生体重儿极有可能感染 [16]

巨细胞病毒。 [13]

Prevention
预防
One strategy is to reduce multiple donor exposure, which can be achieved
by using sterile collecting devices to use the same units for repeated
transfusion for the infants, Pedi‑packs with prior aliquoting, or a
dedicated donor donates every time the patient wants.
一种策略是减少多个捐献者的暴露，这可以通过使用无菌采集装置来实
现，以使用相同的单位为婴儿重复输血，预先分装的足垫，或每次患者
需要时由专门的捐献者捐献。

Bacterial sepsis
细菌性败血症
It is more frequently associated with the transfusion of platelets than
with any other blood product. The source of infection can be the donor
or contamination of the product post collection, especially during
[17]
manipulation for pediatric use and administration in open systems.
与任何其他血液制品相比，它更常与血小板输注有关。感染源可能是供
体或采集后产品的污染，尤其是在儿科使用和开放系统给药的操作过程
中。 [17]

Prevention
预防
Appropriate usage of platelets and proper and reduced storage duration
are beneficial in reducing these events.
适当使用血小板和适当减少储存时间有利于减少这些事件。

Iron overload
铁过载
Iron overload is observed in chronically transfused children with
thalassemia major, congenital anemias, and sickle cell disease. Each
milliliter of red cells contains
在患有重型地中海贫血、先天性贫血和镰状细胞病的长期输血儿童中观
察到铁过载。每毫升红细胞含有

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 Basavarajegowda and Plakkal: Transfusion reactions in neonates and pediatrics
Basavarajegowda和Plakkal：新生儿和儿科的输血反应
roughly about 1 mg of iron. Transfusion‑dependent patients usually
require 200–300 ml/kg/year of blood, whereas an average
nonmenstruating person absorbs and loses only about 0.01 mg
[18]
Fe/kg/day. With no physiologic means of excreting, iron overload is
inevitable in this population.
大约1毫克的铁。依赖输血的患者通常需要200–300 mL/kg/年的血液，而
非月经期患者平均每天仅吸收和损失约0.01 mg Fe/kg。 由于没有生理排
泄方式，铁过载在这一人群中是不可避免的。
This is the most common type of reaction reported in the neonatal and
pediatric age groups. Storage‑generated biological response modifiers
(BRMs) and recipient antihuman leukocyte antigens (HLA) antibodies are
the two well‑described mechanisms for the causation of these reactions. A
higher volume of blood product per kg body
这是新生儿和儿童年龄组中报告的最常见的反应类型。储存产生的生物反应
调节剂（BRMs）和受体抗人类白细胞抗原（HLA）抗体是导致这些反应的两
[18]
种机制。每公斤体重的血液制品量更高

Prevention
预防
Iron chelation should be initiated in children who have received
approximately ten transfusions or a total of about 180 ml/kg of packed
[19]
RBCs or have a serum ferritin level over 1000 ng/ml.
接受约10次输血或总计约180 mL/kg包装红细胞或血清铁蛋白水平超过
1000 ng/mL的儿童应开始铁螯合治疗。 [19]

Immunological Transfusion Reactions

免疫性输血反应
An infant’s immune system is less mature; thereby, its lymphocytes are
unable to present foreign antigens effectively. Hence, immunological
transfusion reactions tend to be less common in this age group.
婴儿的免疫系统不够成熟；因此，其淋巴细胞不能有效地呈递外来抗原。
因此，免疫输血反应在这一年龄组中并不常见。

Hemolytic transfusion reactions

溶血性输血反应
These are rare in neonates. Maternal isohemagglutinins are sometimes
detected in the first 2 months of life. However, infant alloantibodies are
rare before 6 months of age. There is a risk of a relatively large amount of
incompatible blood being transfused in neonates before acute hemolysis is
[20]
recognized.
这在新生儿中是罕见的。有时在出生后2个月内检测到母体的同族血凝素。
然而，婴儿同种抗体在6个月前是罕见的。在未确认急性溶血之前，新生
儿存在输入相对大量不相容血液的风险。 [20]

Prevention
预防
Pediatric antibody tests that include screening for clinically significant
antibodies in the recipient can be done. Components should be screened
for clinically significant blood group antibodies (including high‑titer
[5]
anti‑A and anti‑B), and an indirect antiglobulin test is performed.
可以进行儿科抗体测试，包括筛选接受者中具有临床意义的抗体。应筛查
成分是否存在具有临床意义的血型抗体（包括高效价抗-A和抗-B），并进
行间接抗球蛋白试验。 [5]

Alloimmunization
异源免疫
Alloimmunization to RBCs is particularly frequent in those with sickle
[21]
cell disease receiving transfusions. Incidence of alloimmunization and
platelet refractoriness appears to be lower in children than in comparable
[22]
adult populations. Posttransfusion purpura can develop due to
platelet‑specific alloantibody developing after blood transfusion, most
commonly human platelet antigen‑1a.
红细胞同种免疫在接受输血的镰状细胞病患者中尤为常见。 儿童中同种 [21]

免疫和血小板无效的发生率似乎低于成人。 输血后紫癜的发生可能是由 [22]

于输血后产生的血小板特异性同种抗体，最常见的是人类血小板抗原-1A。

Prevention
预防
Transfusion of phenotype matched and leukoreduced blood, especially for
those needing regular transfusions.
输注表型匹配的去白细胞血液，特别是对于那些需要定期输血的患者。

Febrile and allergic reactions

发热和过敏反应
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 Basavarajegowda and Plakkal: Transfusion reactions in neonates and pediatrics
Basavarajegowda和Plakkal：新生儿和儿科的输血反应 few hours after) RBC transfusion to reduce the risk of NEC, but a
weight, a higher dose of pyrogenic cytokines or allergens in blood product, recent Cochrane review noted the paucity of evidence, and many units
[29]
and undiagnosed IgA deficiency are the causes that put these groups at currently do not withhold feeds. Washed red cells
higher risk for the reaction. The most common product implicated is 传统的做法是在RBC输注期间（或输注后几个小时）暂停补液，以降低NEC
[13,23]
platelets. 的风险，但最近的一项Cochrane审查指出，缺乏证据，许多单位目前没有
体重、血液制品中较高剂量的致热细胞因子或过敏原以及未确诊的IgA缺 暂停补液。 洗涤红细胞
[29]

乏是导致这些人群发生过敏反应风险较高的原因。涉及的最常见产物是
血小板。 [13,23]

Prevention
预防
Leukoreduction, washing, and fresher blood product administration
are a few strategies. Premedication can help in repeated reactions.
白细胞减少、清洗和新鲜血液制品管理是几种策略。术前用药有助于缓
解反复反应。

T‑antigen activation‑induced hemolysis T‑antigen activation

is reported in about 0.6% of all infants in ICU and in 9%–27% of
[24]
the infants with necrotizing enterocolitis (NEC). The red cell membrane
glycoproteins carry O‑linked oligosaccharides that are disialylated
tetrasaccharides. Bacterial neuraminidases released by anaerobic and
aerobic organisms remove these sialic acid residues, exposing a
T‑antigen which is usually hidden (T cryptantigen). This T‑antigen
binds with anti‑T immunoglobulin present in most adult plasma,
[13,20]
and hemolysis can happen.
T抗原激活诱导的溶血在ICU中的所有婴儿中约有0.6%报告了T抗原激活，
在坏死性小肠结肠炎（NEC）的婴儿中有9%-27%报告了T抗原激活。 红细 [24]

胞膜糖蛋白携带O连接的寡糖，即二唾液酸化的四糖。厌氧菌和需氧菌释
放的细菌神经氨酸酶去除这些唾液酸残基，暴露出通常隐藏的T抗原（T
隐窝抗原）。这种T抗原与大多数成人血浆中存在的抗T免疫球蛋白结合，
可能发生溶血。 [13,20]

Prevention
预防
Infants with sepsis or NEC who need plasma‑containing components
should be minor crossmatched. Avoid transfusion of plasma or use low
anti‑T titres plasma. RBC products may be washed before transfusion.
患有败血症或NEC且需要含血浆成分的婴儿应进行微量交叉配型。避免输
入血浆或使用低抗T滴度血浆。输血前可清洗RBC产品。

Transfusion‑associated necrotizing enterocolitis The

association between RBC transfusions and NEC in neonates is
controversial, and severe anemia itself may predispose to the
development of NEC. A recent meta‑analysis of randomized controlled
trials even suggested a protective effect of a recent RBC transfusion on the
development of NEC, while another meta‑analysis of observational data
[25,26]
did not find any association. In theory, intestinal injury either from
feeding, intestinal ischemia, or bacterial colonization in susceptible
infants combined with exposure to biologically active mediators such as
free hemoglobin, increased cytokines, and broken red cell fragments
within the transfused blood may trigger an immunologic response
within the intestinal mucosa. Altered angiogenesis within the intestine
due to platelet‑activating factor acetylhydrolase and reperfusion
associated with transfusion has also been described as possible
mechanisms for gut injury. Prematurity, low birth weight, and
hypoxic‑ischemic events are known to be risk factors for the
[27,28]
development of transfusion‑associated necrotizing enterocolitis.
输血相关性坏死性小肠结肠炎红细胞输注与新生儿NEC之间的关系尚有争
议，严重贫血本身可能易导致NEC的发生。最近的一项随机对照试验的荟
萃分析甚至表明，最近的红细胞输注对NEC的发展具有保护作用，而另一
项观察数据的荟萃分析没有发现任何关联。 理论上，喂养、肠缺血或 [25,26]

易感婴儿细菌定植引起的肠道损伤，加上接触生物活性介质，如游离血
红蛋白、细胞因子增加和输注血液中破碎的红细胞碎片，可能会引发肠
粘膜内的免疫反应。由于血小板活化因子乙酰水解酶和与输血相关的再
灌注导致的肠道内血管生成改变也被描述为肠道损伤的可能机制。 已知
早产、低出生体重和缺氧缺血性事件是输血相关性坏死性小肠结肠炎发
生的危险因素。 [27,28]

Prevention
预防
The traditional practice has been to withhold feeds during (or for a

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 Basavarajegowda and Plakkal: Transfusion reactions in neonates and pediatrics
Basavarajegowda和Plakkal：新生儿和儿科的输血反应 预防
may be provided to neonates with NEC to reduce Prestorage leukoreduction and pathogen reduction have some preventive
complement‑dependent antibodies that can cause hemolysis of
benefits as leukocytes, and their soluble
neoantigen‑labeled RBCs.
储存前白细胞减少和病原体减少具有一定的预防作用，因为白细胞及其可溶
可提供给患有NEC的新生儿，以减少可导致新抗原标记的红细胞溶血的补
性
体依赖性抗体。

Transfusion‑related acute lung injury

输血相关急性肺损伤
This condition is more challenging to differentiate from other pulmonary
pathologies. The current definition is not suitable for the pediatric and
neonatal population. There are two peaks noticed concerning its
occurrence, one in infants <1 year and the other in those more than 14
[30]
years. Two events cause transfusion‑related acute lung injury: the
generation of biologically active compounds related to stress that activates
the pulmonary vascular endothelium and primes the neutrophils, and
the infusion of biological response modifiers and antibodies in stored
blood components. Infants may be vulnerable because a respiratory
injury has already happened in many hospitalized ones.
这种情况与其他肺部疾病的鉴别更具挑战性。目前的定义不适用于儿科和
新生儿人群。关于它的发生有两个高峰，一个在1岁以下的婴儿中，另一
个在14岁以上的婴儿中。 两个事件导致输血相关的急性肺损伤：产生与
[30]

应激相关的生物活性化合物，激活肺血管内皮并启动中性粒细胞，以及在
储存的血液成分中输注生物反应调节剂和抗体。婴儿可能是脆弱的，因为
许多住院的婴儿已经发生了呼吸损伤。

Prevention
预防
Avoid using plasma products from multiparous women donors.
Rational use of plasma products is to be practised.
避免使用经产女性献血者的血浆制品。应合理使用血浆制品。

Transfusion‑associated graft‑versus‑host disease The

population at risk are immunocompromised patients, extreme
preterm infants, infants who receive intrauterine transfusions, those
with neonatal alloimmune thrombocytopenia, and those on ECMO.
Many initial cases were reported in severe combined immunodeficiency
or Wiskott–Aldrich syndromes, newborns with erythroblastosis fetalis,
sepsis, or ARDS. The inability of these recipients to mount an immune
response against donor T‑lymphocytes is fundamental to the
[20]
pathogenesis of TAGVHD.
输血相关的移植物抗宿主病高危人群包括免疫功能低下患者、极早产儿、
接受宫内输血的婴儿、新生儿同种免疫性血小板减少症患者和使用ECMO的
患者。许多初始病例报告为严重联合免疫缺陷或Wiskott–Aldrich综合征、
新生儿胎儿成红细胞增多症、败血症或ARDS。这些受体不能对供体T淋巴
细胞产生免疫应答是TAGVHD发病机制的基础。 [20]

Prevention
预防
Avoid blood from blood relatives. If absolutely necessary to be
used then irradiate those blood products. Pathogen inactivation has
also been known to reduce the risk.
避免血液来自血亲。如果绝对需要使用，则照射这些血液制品。已知病原
体灭活也可降低风险。

Transfusion‑related immunomodulation
输血相关免疫调节
The development of immunity in premature infants is not complete,
and they generally have complicated clinical conditions. Hence,
t ran sf us ion‑ relat ed immunomodulation is difficult to define in
premature patients than in adults. Effects like increased risk of
short‑term mortality (up to 3 months), increased risk of postoperative
bacterial infections, and recurrence of resected malignancies have been
[31,32]
described. More studies are required to elucidate this issue.
早产儿的免疫发育不完全，一般临床情况复杂。因此，与成人患者相比，
早产儿患者的输血相关免疫调节更难界定。短期死亡率（长达3个月）风险
增加、术后细菌感染风险增加和切除恶性肿瘤复发等影响已被描述。需要
更多的研究来阐明这个问题。 [31,32]

Prevention
104 Asian Journal of Transfusion Science - Volume 17, Issue 1, January-June 2023
亚洲输血科学杂志-第17卷，第1期，2023年1月至6月
 Basavarajegowda and Plakkal: Transfusion reactions in neonates and pediatrics
Basavarajegowda和Plakkal：新生儿和儿科的输血反应 9. Jackson JC. Adverse events associated with exchange transfusion
in healthy and ill newborns.
mediators mediate these effects. Washing also helps by removing Pediatrics 1997;99:E7.
杰克逊JC健康和患病新生儿与换血相关的不良事件。《儿科学》1997；99:E7。
soluble HLA molecules, autoantibodies, and factor concentrate.
介体调节这些效应。清洗也有助于去除可溶性HLA分子、自身抗体和因子 10. Jorgenson M. Administration of blood components. In: Cohn CS, Delaney M, Johnson S, Katz
L, editors. Technical Manual. Bethesda, Maryland: AABB Press; 2020. p. 537‑51.
浓缩物。 Jorgenson M.血液成分的管理。见：科恩CS，德莱尼M，约翰逊S，卡茨L，编辑。技术手册。
马里兰州贝塞斯达：AABB出版社；2020.P。537‑51.

Conclusion 11. Uhl L, Pacini D, Kruskall MS. A comparative study of blood

Uhl L，Pacini D，Kruskall MS.血液的比较研究
结论
Due to the numerous difficulties in classifying and studying transfusion
reactions in children, standardizing pediatric ATR definitions and criteria
is necessary to improve studies and reports. Several modifications are
needed to be adapted for transfusing blood products in neonates and
children to evade the reactions as much as possible and make transfusion
safer in this vulnerable population.
由于对儿童输血反应进行分类和研究存在诸多困难，因此有必要对儿科
ATR的定义和标准进行标准化，以改进研究和报告。对于新生儿和儿童输
注血液制品，需要进行一些修改，以尽可能避免反应，并使这一脆弱人
群的输血更加安全。

Financial support and sponsorship

财政支持和赞助
Nil.
无。

Conflicts of interest
利益冲突
There are no conflicts of interest.
不存在利益冲突。

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