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μάθημα9ο μετάγγιση
μάθημα9ο μετάγγιση
(pRBCs)
-
. .
-
2011
, :
1.
2.
3.
4.
5.
:
1.
2.
3.
4.
:
10
RBCs
:
1. (18.2%)
2. (13.8%)
3. (8.8%)
;
:
;
1.
2.
:
1. 2
2.
:
1.
2.
3.
4. (TRALI)
HIV
1.
2.
3.
/
TRALI HLA HPA
TA-GvHD
ACE
1/1.000.000
1/30.000-1/250.000
C 1/30.000-1/150.000
HIV 1/200.000-1/2.000.000
HTLV I/II 1/250.000-1/2.000.000
B19 1/10.000
1/500.000
1/12.000
Creutzfeldt-Jacob
1/250.000-1/1.000.000
1/1.000
1/5.000
TRALI
- SHOT
(Serious Hazards of Transfusion)
1996/7 1997/8 1998/9 1999/2000 2000/01
27 24 31 28 40
11 11 10 5 3
TA-GvHD 4 4 4 0 1
TRALI 11 16 16 19 15
8 3 9 6 6
7 0 0
169 196 255 293 315
()
()
Hb
,
2
O2
2,
2/ 2
20%-25%, 50%
(50%)
Hb 3.5-4 gr/dl,
Hb 6-7 gr/dl
1. ,
2/ 2, Hb,
2.
,
;
1. 16
RBCs,
1.404
1.4%
2.
1. ,
,
2.
,
Hb 8 gr/dl
30, 90
1. , 418
Hb < 7 gr/dl
Hb 7-9 gr/dl, 420
Hb < 10 gr/dl
Hb 10-12 gr/dl
2.
30 2 , ,
7
gr/dl
10 gr/dl
;
1.
2. 257
(p >0.30)
3.
4.
1.
-
2.
,
,
2
;
30
, Hb
2
2.
:
1. ,
2.
3.
Hb
.
1. RBCs
2.
RBCs Hb 6-8 gr/dl
3. RBCs
Hb 8 gr/dl,
Hb 10 gr/dl
4.
Hb 11 gr/dl
Hb > 10g/dl
Hb 7- 10g/dl
Hb <7 g/dl
15% :
-
15-30% :
,
-
30- 40% :
,
>40% :
(Fe,
B12, )
Hb
Hb =8 g/dl
1.
Hb 9-
11g/dl
2.
Hb<7 g/dl
3.
1.
2.
3.
4.
5. Hb>8g/dl
6. >75x 109/l ( >100 x 109/l
, )
7. PT APTT<1.5
8. >1g/l
9.
1.
(.. , )
2.
(.. , )
3. (.. , )
1.
2. -
3.
-
4.
FFP
1. ( ,
, )
,
,
> 10 x 109 /l
20 x 109 /l
2. ( []):
> 38 C
10 / 5 x 109 /l
3. :
> 20 x
109 /l.
4.
( , )
10 5 x 109 /l
5. :
,
,
.
:
, ,
, ,
, ,
,
50 x 109 /l
(.. , )
100 x 109 /l
1. ,
(.. ibuprofen),
ADP, .
2.
,
3. Ht > 30%
rhEPO
4. DDAVP
,
:
2 50
x 109 /l
< 50 x 109 /l
, 100 x 109 /l
():
()
, > 50 x
109 /l.
,
:
(
Glanzmann )
,
()
, ,
,
IV IV
1. (),
2.
(HIT-)
1.
2. -
3. -
4. -
5.
,
- -
1. Rh (-) Rh (-)
2. Rh (+)
anti-D
1.
(HBV,HCV,HIV)
,
(1:3000 )
1:25000
2. HLA
HLA I
3.
4. TA-GVHD
5. TRALI
Fresh Frozen Plasma
(Fresh Frozen Plasma)
1. FFP 1
<-300 C 6
2. 1
FV FVIII
3.
2 .
1. FFP
2. FFP
,
12-15 ml/kg
3. FFP
PT
aPTT
FFP
1.
2.
3.
4.
5.
FFP
1. --
II, VII, IX
X, ,
C S, 4-6
2.
,
FFP 1 Lt
FFP
1.
shock, , ,
V, VIII, ,
,
2. ,
, FFP
3.
FFP
FFP
1. PT/aPTT
1.5 , (PT
>18 sec aPTT >55-60 sec) FFP
2.
(
<50 x 109/l)
FFP
1.
2.
,
,
3. FFP
,
,
4.
,
II, VII, IX, X 40%
FFP
FFP > 1 L
PT 1.6-1.8 ,
,
(PCCs)
,
,
FFP
1.
2.
3. , ,
,
FFP
4.
FFP
1. ,
2.
- -
3.
4. RHESUS,
(10 )
FFP
1.
1-3%
< 1:100.000
2.
3.
, ,
TRALI (Transfusion-Related Acute Lung Injury)
FFP
1.
2.
3. ,
4. (HAV,HBV,HCV,HIV1+2,Parvo B19)
2.
,
(85ml/kg , 100
ml/kg )
(CMV)
,
(TAGVHD)
(, ).