CC CH PHM MU

GV: V TH KIM HOA

MC TIU
1. Bit r cc loi ch phm mu c bn v thng dng: thnh phn, tnh cht, iu
kin lu tr v tnh n nh
2. Nm c cc ch nh, chng ch nh v cc tai bin c th gp khi truyn cc loi
ch phm mu
1. MU TON PHN
1.1. nh ngha: L mu c thu thp t ngi cho, bo qun trong ti plastic v
cha dung dch chng ng v trng. Mc ch s dng chnh ca mu ton phn l
ngun nguyn liu iu ch cc thnh phn mu.
1.2. Tnh cht:
- Lu tr qu 24 gi: mt yu t VIII v V, mt chc nng tiu cu (TC), gii phng
cc thnh phn ni bo nh Kali v cc protease bch cu (BC), hot ha cc yu t
huyt tng nh kallicrein.
- Mu ton phn khng nn cha cc khng th bt thng c ngha trn lm sng.
1.3. Lu tr v tnh n nh:
- +20C n +60C.
- Thi gian lu tr ty thuc cht chng ng: 35 ngy vi CPD-A1 v 21 ngy vi
ACD hoc CPD.
- Chc nng gii phng O2 t Hb b gim do mt 2,3-diphosphoglycerate (2,3-DPG)
trong qa trnh lu tr. Sau 10 ngy lu tr trong CPD-A1, ton b 2,3-DPG s b mt.
Tuy nhin, n s c ti tng hp li sau khi truyn vo c th ngi nhn: t c
1/2 trong vng 12 gi v tr v mc bnh thng trong vng 24 gi.
1.4. Ch nh:
- Rt hn ch.

- Mt mu cp >25% th tch mu.

- Truyn thay mu.
1.5. Chng ch nh:
- Thiu mu khng gim th tch mu.
- Khng dung np huyt tng.
- Khng dung np do d min dch chng khng nguyn BC.
1.6. Tai bin:
- Qu ti tun hon.
- Cc phn ng truyn mu tn huyt.
- Cc phn ng truyn mu khng tn huyt (ch yu n lnh, st, ni m ay)
- Nhim trng: giang mai, virus vim gan, HIV, KST nh st rt
- D min dch chng HLA v cc khng nguyn HC.
- Ng c citrat tr s sinh v bnh nhn suy gan.
- Mt cn bng sinh ha do truyn khi lng ln nh tng kali.
- Ban xut huyt sau truyn mu.
- Tn thng phi cp lin quan truyn mu (TRALI: Transfusion related acute lung
injury).
- Ly truyn cc tc nhn khc do khng c tm sot hay nhn bit.
2. HNG CU LNG
2.1. nh ngha: L thnh phn mu t c sau khi ly tm tch b huyt tng t
mu ton phn.
2.2. Tnh cht:
- Hct # 65-75%, Hb 45g/l
- BC # 2.5-3 x 109/l
- TC thay i ph thuc phng php ly tm
2.3. Lu tr v tnh n nh: Tng t mu ton phn
2.4. Ch nh:
- Mt mu
2

- Thiu mu
2.5. Chng ch nh:
- Khng dung np huyt tng.
- Khng dung np do d min dch chng khng nguyn BC.
- Thay mu tr s sinh tr khi c b sung huyt tng.
2.6. Tai bin: Tng t mu ton phn.
3. HNG CU RA
3.1. nh ngha: L thnh phn ca mu ton phn sau khi c quay ly tm
tch b huyt tng, v sau ra HC trong dung dch mui ng trng.
3.2. Tnh cht:
- Phn ln huyt tng, BC v TC c loi b.
- Lng huyt tng cn li ph thuc vo phng php iu ch.
- Hct thay i ty theo nhu cu lm sng, nhng nn c Hb 40g/l.
3.3. Lu tr v tnh n nh:
- +20C n +60C
- Thi gian lu tr cng ngn cng tt v 24 gi.
3.4. Ch nh:
- Bnh nhn c khng th protein trong huyt tng, c bit l anti-IgA.
- Bnh nhn c cc phn ng d ng nng khi truyn cc sn phm mu.
3.5. Tai bin:
- Qu ti tun hon.
- Cc phn ng truyn mu tn huyt.
- Nhim trng: giang mai, virus vim gan, HIV, KST nh st rt
- D min dch chng HLA v cc khng nguyn HC.
- Nhim trng huyt do ly nhim vi khun.
- Ly truyn cc tc nhn khc do khng c tm sot hay nhn bit.
4. HNG CU NGHO BCH CU

4.1. nh ngha: L thnh phn mu t c sau khi loi b phn ln BC t ti HC

lng
4.2. Tnh cht:
- BC< 1x106/n v.
- BC trung bnh 0,05 x106
- Hb40g/l.
4.3. Lu tr v tnh n nh:
- Nh mu ton phn v HC lng.
- Nu iu ch bng phng php lc hoc h thng h: <24 gi.
4.4. Ch nh:
- Tng t HC lng.
- Bnh nhn bit hoc nghi ng c khng th BC.
- Ngn nga d min dch i vi khng nguyn BC.
- Thay th mu CMV(-) ngn nga truyn CMV.
4.5. Chng ch nh:
- Cc loi khng dung np huyt tng.
- Truyn thay mu tr s sinh tr khi s dng sn phm iu ch <7 ngy.
4.6. Tai bin: Tng t mu ton phn.
5. HNG CU NG LNH
5.1. nh ngha: L thnh phn iu ch t mu ton phn <7 ngy, c s dng cht
bo qan (glycerol) v d tr -600C n -800C.
5.2. Tnh cht:
- Ngho protein, BC v TC.
- Hb36g/l.
5.3. Lu tr v tnh n nh:
- -600C n -800C nu d tr trong t ng lnh.
- -1400C n -1500C nu d tr trong kh nit lng .
- Thi gian d tr 10 nm nu m bo nhit .
4

- Sau khi gii ng, nn d tr +2 0C n +60C. Thi gian d tr cng ngn cng tt
sau khi ra loi b glycerol v <24 gi khi dng h thng h.
5.4. Ch nh:
- Bnh nhn c cc loi nhm mu him/nhiu khng th d min dch.
- Mt s trng hp truyn mu t thn.
5.5. Tai bin:
- Qu ti tun hon.
- Nhim trng: giang mai, virus vim gan, HIV, KST nh st rt
- D min dch chng cc khng nguyn HC.
- Nhim trng huyt do ly nhim vi khun.
- Ly truyn cc tc nhn khc do khng c tm sot hay nhn bit.
6. TIU CU M C
6.1. nh ngha: L thnh phn TC iu ch t mu ton phn ti bng phng php
ly tm (recovered) hoc iu ch trc tip t mt ngi cho bng my chit tch t bo
t ng (apheresis).
6.2. Tnh cht:
6.2.1. Recovered:
- TC # 45-85 x109 /ti 50-60 ml.
- BC # 0,05-1 x109
- HC # 0,2- 1 x109
6.2.2. Apheresis:
- TC # 200-800 x109
- BC v HC: thay i ty theo phng thc v loi my s dng.
- Gim nguy c d min dch HLA.
- Gim nguy c nhim virus.
6.3. Lu tr v tnh n nh:
- D tr +200C n +240C, trn my lc nh lin tc m bo TC tip xc oxy.
- Ti cha TC phi m bo oxy i vo cho TC.
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- Nng TC < 1,5x 109/ml.

- i sng TC 7 ngy, nhng >5 ngy s c nguy c nhim khun.
6.4. Ch nh:
- Ch nh truyn TC khng ch da trn s lng TC n c.
- Ch nh bt buc: gim TC nng v c chy mu ng k.
- Tt c cc ch nh khc l tng i v ph thuc vo tnh trng lm sng ca BN.
- Sau khi tch b BC, c th truyn TC c CMV (-) ngn nga ly truyn CMV.
6.5. Tai bin:
- Cc phn ng truyn mu khng tn huyt (ch yu n lnh, st, ni m ay).
- Phn ng d min dch c th xy ra, c bit i vi cc khng nguyn HLA v HPA.
- Nhim trng: giang mai, virus vim gan, HIV, KST nh st rt
- Nhim trng huyt do ly nhim vi khun.
- Ban xut huyt sau truyn mu.
- Tn thng phi cp lin quan truyn mu.
- Ly truyn cc tc nhn khc do khng c tm sot hay nhn bit.
7. HUYT TNG TI NG LNH
7.1. nh ngha: L thnh phn mu iu ch t mu ton phn ti hoc t huyt
tng chit tch ti v c ng lnh ngay duy tr y cc yu t ng mu
khng bn.
7.2. Tnh cht:
- Cha cc yu t ng mu n nh, albumin v cc immunoglobulin.
- Cha 70 IU yu t VIIIc/100ml v s lng tng t cc yu t ng mu khng
bn khc.
7.3. Lu tr v tnh n nh:
- 24 thng <-250C.
- 3 thng -180C n -250C.
7.4. Ch nh:

- Trong ri lon ng mu, c bit trong nhng trng hp thiu nhiu yu t ng

mu.
- C th dng trong iu tr TTP.
7.5. Cn thn khi s dng:
- Khng dng iu chnh gim th tch khi khng c thiu yu t ng mu hoc
dng cung cp immunoglobulin.
- Nn chn huyt tng ph hp nhm mu ABO.
- S dng ngay sau khi gii ng hon ton +370C.
- Khng c lm ng lnh li.
- Khng s dng nu ti ng b rch sau khi gii ng.
7.6. Tai bin:
- c tnh citrate c th xy ra nu truyn nhanh th tch ln.
- Cc phn ng truyn mu khng tn huyt (ch yu n lnh, st, ni m ay).
- Nhim trng: giang mai, virus vim gan, HIV, KST nh st rt
- Nhim trng huyt do ly nhim vi khun.
- Tn thng phi cp lin quan truyn mu.
- Ly truyn cc tc nhn khc do khng c tm sot hay nhn bit.
8. KT TA LNH
8.1. nh ngha: l thnh phn cha cryoglobulin ca huyt tng, c iu ch t
huyt tng ti ng lnh, th tch 30-40ml.
8.2. Tnh cht:
- Cha yu t VIIIc 70 IU/ti, yu t Von Willebrand >100 IU/ti, fibrinogen
40mg/ti, yu t XIII.
8.3. Lu tr v tnh n nh:
- 24 thng <-250C.
- 3 thng -180C n -250C.
8.4. Ch nh:
- Thiu yu t VIII.
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- Thiu nhiu yu t ng mu ging nh DIC.

- Gim fibrinogen (s lng v cht lng).
8.5. Cn thn khi s dng:
- S dng ngay sau khi gii ng hon ton +370C.
- Khng c lm ng lnh li.
- Khng s dng nu ti ng b rch sau khi gii ng.
8.6. Tai bin:
- Cc phn ng truyn mu khng tn huyt (ch yu n lnh, st, ni m ay).
- C th gy pht trin cc cht c ch yu t VIII trong bnh hemophilia.
- Nhim trng: giang mai, virus vim gan, HIV, KST nh st rt
- Nhim trng huyt do ly nhim vi khun.
- Ly truyn cc tc nhn khc do khng c tm sot hay nhn bit.
9. BCH CU HT M C
9.1. nh ngha: L thnh phn BC ht t mt ngi cho, iu ch bng my chit
tch t bo.
9.2. Tnh cht:
- Th tch <500ml.
- BC ht # 10 x 109 /n v.
9.3. Lu tr v tnh n nh:
- Khng nn lu tr, truyn cng sm cng tt sau khi iu ch.
- Lu tr <24 gi +200C n +240C.
9.4. Ch nh: BN gim BC ht nng c tnh trng nhim trng mc d ang iu tr
khng sinh y .
9.5. Tai bin:
- Cc phn ng truyn mu khng tn huyt (ch yu n lnh, st, ni m ay).
- C th gy d min dch vi HLA v cc khng nguyn HC.
- Nhim trng: giang mai, virus vim gan, HIV, KST nh st rt

- Nguy c cao ly nhim virus tim n (CMV, EBV, ) i vi bnh nhn c ch min
dch.
- Nhim trng huyt do ly nhim vi khun.
- Ban xut huyt sau truyn mu.
- Tn thng phi cp lin quan truyn mu.
- Ly truyn cc tc nhn khc do khng c tm sot hay nhn bit.
TI LIU THAM KHO
1. Council of Europe Committee of ministers (2004), Guide to the preparation, use
and quality assurance of blood components. Recommendation No. R(95) 15, 10 th
edition.
2. Dzieczkowski JS (2012), Harrisons principles of internal medicine, 18th
edition.
3. Petrides Marian, Stack Gary, Cooling Laura, Maes LY (2007), Practical guide to
transfusion medicine, 2nd edition, AABB.
4. Westphal RG (1996), Handbook of transfusion medicine, 3 rd edition, American red
cross.