輸血風險非感染性課件

1、TRANSFUSION RISKS(NON-INFECTIOUS)Hua Shan, M.D., Ph.DJohns Hopkins Medical InstitutionsBaltimore, Maryland, USATRANSFUSION RISKS(NON-INFECTI輸血風險（非感染性）華山 M.D.，Ph.D約翰 霍伯金斯醫(yī)學院美國，馬里蘭州，巴爾的摩輸血風險（非感染性）華山 M.D.，Ph.D輸血風險非感染性課件危 險 肝炎 同種致敏作用 循環(huán)超負荷 過敏反應 敗血癥危 險 肝炎輸血風險非感染性課件輸血風險非感染性課件Risks of Transfusion: infectio

2、us vs. non-infectiousInfectionsUSA Non-infectiousUSAHIV1/ 1.9 millionDeath:acute hemolytic1:600,000(New York 1990-1991)HCV1/ 1.8 millionHBV1/ 205,000Risks of Transfusion:Infection輸血風險：感染性對比非感染性感染性USA 非感染性USAHIV1/190萬死亡：急性溶血1:600,000(New York 1990-1991)HCV1/180萬HBV1/ 205,000輸血風險：感染性對比非感染性感染性USA 非感染性U

3、SA1:Transfusion ReactionsPotentially severe TR:Hemolytic TRAnaphylactic TRTransfusion-related Acute Lung Injury Circulatory overloadSeptic TRTransfusion-associated Graft-vs-Host Disease Transfusion ReactionsPotential輸血反應(TR)潛在的嚴重輸血反應：溶血輸血反應過敏性輸血反應輸血相關性急性肺損傷 循環(huán)超負荷敗血癥輸血相關性移植物抗宿主病輸血反應(TR)潛在的嚴重輸血反應：Tran

4、sfusion ReactionsCommon and usually mild:Febrile nonhemolytic TRMild allergic TR(Circulatory overload) Acute pain TRTransfusion ReactionsCommon a輸 血 反 應 常見的，通常輕度的輸血反應：非溶血性發(fā)熱輸血反應輕度過敏輸血反應（循環(huán)超負荷）急性疼痛輸 血 反 應 常見的，通常輕度的輸血反應：Hemolytic TRCause:Immunological incompatibility between donor and recipient ABO, R

5、h, other RBC alloantigens Mechanism:Antibody mediated destruction of RBC (Non-immune-mediated hemolysis: Wrong infusion fluid, wrong needle size, or incorrect use of blood warmer, etc)Hemolytic TRCause:溶血性輸血反應原因： 捐獻者和受者之間的免疫不相容性，ABO，Rh和其它紅細胞血型同種抗原機制： 抗體介導的紅細胞破壞非免疫介導的溶血： 輸液錯誤、針的大小錯誤或血液不當預熱等等）溶血性輸血反應原

6、因：Subtypes of Hemolytic TRAcute (AHTR) vs. Delayed (DHTR) TimeHemolysis Antibody Acute: 24hr Extravascular Rh/others(IgG)Subtypes of Hemolytic TRAcute溶血性輸血反應 急性溶血性輸血反應對比遲發(fā)性溶血性輸血反應 時間 溶血 抗體 急性 24hr 血管外 IgG類抗體溶血性輸血反應 急性溶血性輸血反應對比遲發(fā)性溶血性輸血ANTIBODY-MEDIATED HEMOLYSISIgM antibodies are typically naturally

7、occurring, best example is the ABO system IgG antibodies are typically alloantibodies induced by pregnancy or transfusions; best example is the Rh system.ANTIBODY-MEDIATED HEMOLYSIS抗體介導的溶血 IgM抗體是典型的天然存在的血型抗體，最好的例子是ABO血型系統(tǒng) IgG抗體是典型的同種抗體，由懷孕或輸血誘導產(chǎn)生的；最好的例子是Rh血型系統(tǒng)抗體介導的溶血ABO Antigens Critical Role in Tra

8、nsfusion High antigen density on red cellsReciprocal arrangement whereby patients who are group A have naturally occurring anti-B in their serum. ABO antibodies are high titer IgM antibodies which produce intravascular hemolysisGroup O is universal donor; group AB is universal recipientABO Antigens

9、Critical Role inABO抗原 輸血中的重要角色紅細胞上的高密度抗原有A抗原的病人的血清中天然存在抗-BABO抗體是高滴度的IgM抗體，它們會造成血管內(nèi)溶血O型血是萬能獻血者，AB型是萬能受血者ABO抗原 輸血中的重要角色紅細胞上的高密度抗原Rh BLOOD GROUP1939- Levine and Stetson report case of mother of a stillborn who suffered severe HTR after transfusion of husbands blood.1940- Landsteiner and Wiener immunize

10、d rabbits with rhesus cells and found sera that agglutinated cells from 85% of NYC donors 1941- Levine confirmed association between Rh incompatibility and HDNRh BLOOD GROUP1939- Levine andRh血型1939年 Levine和Stetson報道了一例出現(xiàn)死胎的母親在輸注了丈夫的血液后發(fā)生嚴重溶血性輸血反應1940年 Landsteiner和Wiener用恒河猴的細胞免疫兔子，發(fā)現(xiàn)其血清能與85% 的紐約市獻血者

11、血液發(fā)生凝集 1941年 Levine證實 Rh不相容性和新生兒溶血病之間存在聯(lián)系Rh血型1939年 Levine和Stetson報Rh Antigens Clinical ImportanceImmunogenicity: strongHigh frequency of incompatibilityRhD: 85% positive, 15% negative (USA). D c EMajor problem in US for transfusion recipientsPrior to RhIg, major cause of hemolytic disease of the new

12、bornRh Antigens Clinical ImportanRh抗原 臨床重要性免疫原性：強RhD： 85% 陽性，15%陰性（美國）D c E 成為美國受血者的主要問題在RhIg之前是新生兒溶血病的主要原因Rh抗原 臨床重要性免疫原性：強Other Red Cell AntigensAt least 300 blood groups have been described.Many antibodies are clinically significant, causing hemolysis and transfusion reactions.Other antibodies can

13、 cause serologic incompatibility but do not affect red cell survival clinically insignificantAntibodies causing transfusion reactions vary among populations depending upon antigen frequenciesOther Red Cell AntigensAt leas其他紅細胞抗原已報道至少有300種血型抗原很多抗體具有臨床意義，會造成溶血和輸血反應其他抗體可能造成血清學不相容性，但不會影響紅細胞存活無臨床意義 抗體造成的

14、輸血反應在不同人群中不同，其主要依賴于抗原頻率其他紅細胞抗原已報道至少有300種血型抗原Prevention of Hemolytic TRAt sample collection: Correct patient and sample identificationPre-transfusion TestingABO/RH antigen and antibodyUnexpected antibodiesBefore transfusion: correct patient and unit identificationDuring and after transfusion: close m

15、onitoring of patientsPrevention of Hemolytic TRAt s溶血輸血反應的預防標本的采集： 確認病人和標本正確無誤輸血前實驗室檢查-ABO/Rh抗原和抗體-不規(guī)則抗體輸血前：確認病人和輸血量的正確無誤 輸血中和輸血后：密切觀察病人溶血輸血反應的預防標本的采集： 確認病人和標本正確無誤PRETRANSFUSION TESTINGVerify patient identityDetermine ABO and RhPerform antibody screen (to detect unexpected antibodies)Perform compati

16、bility test-final verificationPRETRANSFUSION TESTINGVerify p輸血前實驗核實病人身份確定ABO和Rh血型進行抗體篩查（檢測不規(guī)則抗體）相容性試驗最后確認輸血前實驗核實病人身份輸血風險非感染性課件輸血風險非感染性課件輸血風險非感染性課件表1 標本貼簽要求和拒絕標準 要求 手寫標簽符合申請表資料 病人全名 病人住院的身份號 絕對拒絕 有證據(jù)顯示貼標簽不是在床邊完成 打印或自動生成的標簽 名字錯誤或沒有 姓錯誤或沒有 沒有病人的住院身份號 身份號超過1個數(shù)字有誤，除非只有2 位數(shù)，數(shù)字順序顛倒 臍帶樣本沒有標明“臍帶”或“嬰兒”或“男孩/女孩

17、”難以執(zhí)行 只有首寫字母，罕見的姓氏 手寫標簽在自動標簽上 樣本標簽符合臂章，但與申請表的資料不符可接受 名字錯誤但可以理解，或者兩個名字 姓有細微的拼寫錯誤 病人身份號的一個數(shù)字錯誤或兩個數(shù)字顛倒；罕見名字 抽取血標本的病人的住院病房、床號和日期必須寫在標本的標簽上或是輸血申請單上 不良事件的報告和咨詢表1 標本貼簽要求和拒絕標準輸血風險非感染性課件表2：ABO和/或Rh血型錯誤的頻率 標本 標本分型 錯誤 百分比正確標簽 40,274 14 0.035錯誤標簽（拒絕） 496 7 1.4表2：ABO和/或Rh血型錯誤的頻率Elements of a Compatibility Testin

18、g SystemElements of a Compatibility Testing System Patient identification Sample identification ABO/Rh/Ab screen Records check Unit selection Crossmatching Labeling Recipient identification Patient identification Sample identification ABO/Rh/Ab screen Records check Unit selection Crossmatching Label

19、ing Recipient identification 1/2,900 samples contains blood from the wrong patient1/2,900 samples contains blood from the wrong patient Lumadue JA et al. Transfusion 1997;37:1169-72.Lumadue JA et al. Transfusion 1997;37:1169-72.Elements of a Compatibility Te相容性試驗的組成元素確認病人確認標本 抽錯血標本的幾率是1/2900確認受者相容性試

20、驗的組成元素確認病人輸血風險非感染性課件輸血風險非感染性課件輸血風險非感染性課件輸血風險非感染性課件Acute Hemolytic ReactionsSigns and SymptomsFever and chills81%RigorsAnxiety, feeling of doomFacial flushingAbdominal, back, or flank painNausea and vomiting 12%Dyspnea 7%Hypotension/tachycardia 12%Pain at infusion site 16%Oliguria/anuria 36%Diffuse b

21、leeding (DIC) 8%Acute Hemolytic ReactionsSign急性溶血反應體征和癥狀發(fā)熱發(fā)寒 僵直焦急、感覺不幸臉發(fā)紅腹、背或腰疼頭暈、惡心 呼吸困難 低血壓/心動過速 輸血部位疼痛 尿少/無尿 彌漫性出血(DIC) 81%12%7%12%16%36%8%急性溶血反應體征和癥狀發(fā)熱發(fā)寒 81% 溶血性輸血反應的治療1、停止輸血2、維持靜脈通路3、開始利尿4、輸液5、維持血壓6、監(jiān)測腎功能 7、監(jiān)測凝血狀態(tài) 8、避免輸注抗原陽性血 溶血性輸血反應的治療1、停止輸血輸血風險非感染性課件溶血性輸血反應的調(diào)查 1、停止輸血2、取血樣3、檢查是否有筆誤4、進行直接抗球蛋白試驗

22、 5、觀察血漿的溶血狀況或黃疸6、如果懷疑溶血反應 ，重復相容性實驗溶血性輸血反應的調(diào)查 1、停止輸血Laboratory InvestigationsBlood ProductConfirm ABO, Rh Confirm other antigensBlood Bank LaboratoryDirect antiglobulin testConfirm ABO, A/S, patient IDLook for hemolysisClinical LaboratoryComplete blood countBilirubin, creatinineDIC evaluationLaborato

23、ry InvestigationsBlood實驗室調(diào)查血液制品確認ABO，Rh血型確認其他血型抗原血庫實驗室直接抗球蛋白試驗確認ABO，A/S，病人身份尋找溶血癥臨床實驗室全血計數(shù)膽紅素，肌酐，彌漫性血管內(nèi)凝血評估實驗室調(diào)查血液制品確認ABO，Rh血型血庫實驗室直接抗球蛋白TherapyGeneralRenalPulmonaryDICVenous accessMaintain BP and urine outputMonitorPulmonaryFunctionConsider HeparinVital signsDiureticsOxygenPlateletsICU DopamineVent

24、ilatorFFPPulmonaryArtery cathDialysisTherapyGeneralRenalPulmonaryDI治 療總的腎的肺的彌漫性血管內(nèi)凝血靜脈途徑維持血壓和排尿監(jiān)測肺功能考慮肝素重要信號利尿劑氧血小板重癥監(jiān)護多巴胺呼吸器新鮮冰凍血漿肺動脈導管 透析治 療總的腎的肺的彌漫性靜脈途徑維持血壓和排尿監(jiān)測肺AHTRSUMMARYABO Incompatible blood is the most common causeIntravascular hemolysis can lead to fever, shock, renal failure, DIC. Clerica

25、l errors and wrong blood in tube are the major cause: (51% of 355 reported deaths in 100 million units 1976-1985)AHTRSUMMARYABO Incompatible b急性溶血性輸血反應小結(jié)ABO不相容是溶血最常見的原因血管內(nèi)溶血會導致發(fā)熱、休克、腎衰、彌漫性血管內(nèi)凝血書寫錯誤和血標本錯誤是主要原因：（1976-1985年間，1億單位輸血量355例死亡報導中51%是由此造成）急性溶血性輸血反應小結(jié)ABO不相容是溶血最常見的原因輸血風險非感染性課件輸血風險非感染性課件Hemoglo

26、bin Level Change During DHTRHemoglobin Level Change DuringHemoglobin Level Change During DHTRHemoglobin Level Change During*Many patients may be asymptomatic*Many patients may be asymptom血管外溶血性輸血反應 癥狀：虛弱不舒服頭疼體征紅細胞壓積降低黃疸（高膽紅素血癥）發(fā)熱直抗試驗陽性*很多病人可能沒有癥狀血管外溶血性輸血反應 癥狀：DHTR- Criteria Pre-transfusion:Negative

27、pretransfusion antibody screenNegative crossmatchPost-transfusion:Crossmatch with post-transfusion serum becomes positiveAlloantibody detectedClinical and laboratory evidence of hemolysis Past history of pregnancy or transfusionsDHTR- Criteria Pre-transfus延遲性溶血性輸血反應診斷標準輸血前：輸血前抗體篩查陰性交叉配血試驗陰性輸血后：用輸血后的

28、血清進行交叉配血試驗呈陽性檢測到同種抗體 臨床和實驗室證明溶血 既往有懷孕或輸血史延遲性溶血性輸血反應診斷標準輸血前：DHTR- Laboratory FindingsUnexplained anemiaPositive direct antiglobulin test (DAT)Antibody in posttransfusion RBC eluate: Non-ABO RBC alloantibodiesDHTR- Laboratory FindingsUnexp延遲性溶血性輸血反應實驗室發(fā)現(xiàn)無法解釋的貧血直抗陽性輸血后紅細胞洗出液存在抗體： 非-ABO紅細胞同種抗體延遲性溶血性輸血反應

29、實驗室發(fā)現(xiàn)無法解釋的貧血Antibodies Implicated in DHTRJohns Hopkins seriesAnti-E 47%Anti-Jka 23% ( clinically important)Anti K 15% Antibodies Implicated in DHTR延遲性溶血性輸血反應中的抗體霍普金斯醫(yī)院資料抗-E 47%抗-Jka 23%（臨床意義）抗-K 15% 延遲性溶血性輸血反應中的抗體霍普金斯醫(yī)院資料抗-E DHTR TimelineTIME (DAYS)EVENTCAUSE0Negative testsAntibody not detectable1RB

30、Cs given3-10Clinical hemolysisAccelerated RBC destruction10-21Positive DAT and A/S detectedAntibody titer increases and sensitizes cells21DAT negativeSensitized donor cells clearedDHTR TimelineTIME (DAYS)EVENTC延遲性溶血性輸血反應時間表天事件原因0 試驗陰性抗體不可被檢測1RBCs given3-10臨床溶血紅細胞破壞加速 10-21直抗陽性，監(jiān)測到A/S抗體滴度增加，細胞致敏21直抗陰

31、性捐獻者致敏細胞被清除延遲性溶血性輸血反應時間表天事件原因0 試驗陰性抗體不可被檢DHTR PreventionImproved patient care by developing mechanism to identify patients, counsel them about future transfusions, provide early warnings to health care providers.Prevention with careful transfusion history, registries of alloimmunized patientsDHTR Pr

32、eventionImproved patien延遲性溶血性輸血反應的預防通過對病人身份鑒定、 和他們商討未來的的輸血，對健康看護者提供早期警告來改進對病人的照顧對同種免疫的病人備案，仔細詢問既往輸血史 預防延遲性溶血性輸血反應延遲性溶血性輸血反應的預防通過對病人身份鑒定、 和他們商討未Typical sequence of chest X-rays changes:Left: Normal CXR prior to transfusionMiddle:2 hrs posttransfusion, showing bilateral pulmonary infiltrates c/w pulmo

33、nary edemaRight:48 hours posttransfusion, showing clearing of pulmonary infiltratesChest X-ray in a post-transfusion patientTypical sequence of chest X-ra一名病人輸血后的胸片典型的胸片改變左圖輸血前正常胸片中圖輸血后2小時顯示肺兩側(cè)有浸潤，肺水腫右圖輸血后48小時顯示肺浸潤清除一名病人輸血后的胸片典型的胸片改變Transfusion Related Acute Lung Injury (TRALI)Acute Lung Injury (ALI

34、)Acute onset of hypoxiaBilateral infiltrates on chest X-rayFever, mild hypotensionHappens within 6 hours of transfusionPlasma containing product (FFP, Plt, RBC)Rule out other reasons for ALISepsis, pneumonia, DIC, aspiration etcTRALI can cause patient deathThe #1 cause for transfusion related dealth

35、 in USA in 2001-2003Transfusion Related Acute Lung輸血相關性急性肺損傷急性肺損傷組織缺氧急性發(fā)作透雙側(cè)浸潤發(fā)熱、輕度低血壓輸血后6小時內(nèi)發(fā)生 血漿含有血制品（新鮮冰凍血漿、血小板、紅細胞）排除其他急性肺損傷原因敗血癥、肺炎、彌漫性血管內(nèi)凝血、吸入等輸血相關急性肺損傷可使病人死亡是2001-2003年美國輸血相關死亡的首位原因。輸血相關性急性肺損傷急性肺損傷TRALI-Differential DiagnosisAnaphylactic Transfusion ReactionCirculatory OverloadBacterial conta

36、minationTRALI-Differential DiagnosisAnTRALI的鑒別診斷過敏性輸血反應循環(huán)量超負荷細菌污染TRALI的鑒別診斷過敏性輸血反應TRALI-Mechanism Immunological reactionAntibodies to white cellsanti-HLA or granulocyte specific Usually in donorsLess often in recipientsTRALI-Mechanism Immunological TRALI發(fā)生機制免疫學反應白細胞的抗體抗- HLA或粒細胞特異性抗體通常在獻血者中在受血者中不常見T

37、RALI發(fā)生機制免疫學反應TRALI-Prevention Prevention:Exclude multiparous donors from plasma donoation (UK)Minimize the use of high-plasm-volume products from leukocyte-alloimmunized donors (US)TRALI-Prevention Prevention:TRALI預防預防：不用經(jīng)產(chǎn)婦血漿（英國）最小限度地使用白細胞同種免疫的捐獻者的高血漿量的血制品TRALI預防預防：TRALI-Treatment Respiratory suppo

38、rt:Oxygen supplementationIntubation / mechanical ventilationMost patients improve clinically within 48-96 hrs if treated promptlyTRALI-Treatment Respiratory suTRALI治療呼吸支持：補充氧插管法/機械換氣大部分病人如果治療迅速在 48-96小時內(nèi)臨床緩解TRALI治療呼吸支持：TRALI Summary Pulmonary leukoagglutination syndromeReaction to donor antibodies a

39、gainst recipient white cellsRespiratory distress, hypoxia, pulmonary edema, 5 to 8 % mortalityIntubation, 100% O2, defer donors Reactions more likely with larger quantities of plasma from multiparous donorsTRALI Summary Pulmonary leukoaTRALI小結(jié)肺白細胞凝集綜合癥受者白細胞對捐獻者抗體的反應呼吸困難、組織缺氧、肺水腫 、5-8%死亡率插管法、100% O2、

40、捐獻者延期獻血反應大多是由于輸注大量經(jīng)產(chǎn)婦獻血者的血漿造成TRALI小結(jié)肺白細胞凝集綜合癥Transfusion Associated Circulatory Overload (TACO)Congestive heart failure cause by transfusionDiminished cardiac reservePre-transfusion fluid overloadIV infusion, chronic anemia etcEspecially in old or very young patientsRapid infusion or massive transfu

41、sionSymptoms caused by acute pulmonary edema:Dyspnea, tachycardia, orthopenea, BP increase, cyanosis, pulmonery/pedal edemaTransfusion Associated Circula輸血相關性循環(huán)超負荷輸血造成的充血性心衰 心力儲備降低輸血前輸液過量靜脈注射、慢性貧血等 特別是老年人和小年齡病人快速或大量輸血急性肺水腫造成的癥狀：呼吸困難、心動過速、端坐呼吸、血壓增高、紫紺、肺/ 下肢水腫輸血相關性循環(huán)超負荷輸血造成的充血性心衰TACO-Differential diag

42、nosisTRALI Hypotension Pulmonary wedge pressure normal or low Chest x-ray Anaphylaxis Rapid onset (seconds to minutes) Erythmatous confluent rashSevere hypotensionNo pulmonary edemaBacterial contamination Fever HypotensionTACO-Differential diagnosisTRA循環(huán)超負荷鑒別診斷急性輸血相關性肺損傷 低血壓 肺楔壓正?；蚱?胸透過敏反應快速發(fā)作紅斑綜合性

43、皮疹嚴重的低血壓無肺水腫細菌污染發(fā)熱 低血壓循環(huán)超負荷鑒別診斷急性輸血相關性肺損傷TACO-PreventionIdentify susceptible patients:Old, young, history of heart disease, fluid overload, chronic anemia etcSlow infusion: 1 ml/kg body weight/hour Concentrate componentsSplit a component Close monitoring of symptomsTACO-PreventionIdentify suscep循環(huán)超負

44、荷預防確定易感者：年老、小病人、有心臟病史、輸液過量、慢性貧血等輸血速度減慢每公斤體重每小時輸1ml血 濃縮成份分離血液成份密切監(jiān)測癥狀 循環(huán)超負荷預防確定易感者：SEPTIC REACTIONSMicrobial contaminationFever (hours), shock, hypotensionGram stain, bacterial culturePlatelets (room temp storage) Red cell reactions less common but often due to Yersinia infectionSEPTIC REACTIONSMicro

45、bial cont敗 血 癥微生物污染發(fā)熱、休克、低血壓革蘭氏染色、細菌培養(yǎng)血小板（室溫保存）紅細胞反應少見，但經(jīng)常是由于耶爾森氏菌感染敗 血 癥微生物污染Transfusion-Associated GVHDClassic GVHD symptoms: diarrhea, skin rash, hepatitisBone marrow failure -aplastic anemia common with TA-GVHDDeath (infection) 2 to 3 weeks post transfusionTransfusion-Associated GVHDCla輸血相關的移植物抗

46、宿主病經(jīng)典的癥狀：痢疾、皮疹、肝炎骨髓衰竭再生障礙性貧血常見于是輸血相關的移植物抗宿主病輸血后2-3周死亡（死于感染）輸血相關的移植物抗宿主病經(jīng)典的癥狀：痢疾、皮疹、肝炎PATIENTS AT RISK for TA-GVHDIn-utero transfusionsYoung childrenPatients with congenital immunedeficiencyPatients with acquired immunosuppressionCancerImmunesuppressive therapy Recipients of related donor bloodPATIEN

47、TS AT RISK for TA-GVHDIn存在有輸血相關的移植物抗宿主病風險的病人 子宮內(nèi)的輸血 年幼兒童 有先天免疫缺陷的病人 有獲得性免疫抑制、癌癥、接受免疫抑制治療的病人 親緣性輸血的受血者存在有輸血相關的移植物抗宿主病風險的病人 子宮內(nèi)的輸Prevention of TA-GVHD: IRRADIATED BLOODIrradiation at the correct dose destroys lymphocytes ability to reproduce, therefore eliminate risk of TA-GVHDLuokoreduction is NOT su

48、fficient, because a very small number of live lymphocytes can still cause TA-GVHDPrevention of TA-GVHD: IRRADITA-GVHD預防 血液輻照適當劑量的輻照損壞白細胞的再生能力，因此可減少輸血相關移植物抗宿主病的風險去白是不夠的，因為非常少量的活的白細胞仍舊可以造成輸血相關移植物抗宿主病TA-GVHD預防 血液輻照適當劑量的輻照損壞白細胞的再生FEBRILE, NON-HEMOLYTIC REACTIONSTemperature elevation 1 CWBC antibodies in

49、 patient serum reacting with donor WBC or plateletsCytokines generated by stored WBCMust be distinguished from hemolytic and septic reactionsFEBRILE, NON-HEMOLYTIC REACTIO非溶血的發(fā)熱反應 溫度升高1C 病人血清中的白細胞抗體與捐獻者的白 細胞或血小板反應 儲存的白細胞產(chǎn)生細胞因子 必須與溶血反應和敗血癥區(qū)別非溶血的發(fā)熱反應 溫度升高1CFEBRILE, NON-HEMOLYTIC REACTIONSPreventable b

50、y use of leukoreduced blood componentsMay be applied for selected patients with previous reactions or universally to prevent reactions in all patientsPre-medication: TylenolWashing components may also help to remove cytokines or white cells from blood componentsFEBRILE, NON-HEMOLYTIC REACTIO非溶血性發(fā)熱反應

51、通過使用去白血液制品可以預防去白血制品可用于以前有反應的病人或者普遍用于 預防輸血反應輸前用藥：羥苯基乙酰胺血液成份洗滌也可有助于去除細胞因子或白細胞非溶血性發(fā)熱反應通過使用去白血液制品可以預防輸血風險非感染性課件病理免疫介導的組胺的釋放處理抗組胺劑類固醇（嚴重）腎上腺素（嚴重）洗滌紅細胞（抗-IgA）過 敏 反 應病理過 敏 反 應ALLERGIC REACTIONSHypersensitivity (IgE) response to donor plasma proteins; hives, flushing, tachycardia are most common signs and s

52、ymptomsBronchospasm or anaphylaxis can occur, often with IgA deficiencyBenadryl, corticosteroids, concentrated or washed productsMost common cause of transfusion reaction, particularly with products containing plasmaALLERGIC REACTIONS過敏反應對捐獻者的血漿蛋白超敏反應（IgE），麻疹、臉紅、心動過速都是常見的體征和癥狀 會發(fā)生支氣管痙攣或過敏反應，常常IgA缺乏二

53、苯醇胺、皮質(zhì)類固醇，濃縮或洗滌血液產(chǎn)品是最普遍的輸血反應的原因，特別是含血漿的血制品過敏反應Massive TransfusionDefinition:Receiving 10 units of blood (replacing one blood volume) in 24 hours:Replacing 50% of the circulating blood volume in 10U血液：在3小時內(nèi)置換了50%循環(huán)血量通常發(fā)生在：外傷、主動脈瘤破裂、嚴重的出血（胃腸道、外科手術中等）大 量 輸 血定義Massive Transfusion-ComplicationsHypothermiaHemostatic abnormalities Dilutional coagulopathyDICMetab