【正文】 ,HLAidentical or compatible PLT,Crossmatch with HPA compatible donor,HPA typing of recipient,Crossmatch with HLA/HPA compatible donor,二次以上(yǐsh224。,血小板輸血參考(cānkǎo)指標(biāo)IPF,IPF是Immature platelet fraction(未成熟血小板比例), 可作為評估骨髓(ɡǔ suǐ)造血小板功能恢復(fù)的參考指標(biāo) 化療或干細胞移植后, IPF開始上升代表骨髓造血小板功能逐漸恢復(fù)，約一周內(nèi)血小板會顯著上升。)誘導(dǎo)血小板低下癥 血栓性血小板低下癥 特發(fā)性血小板減少紫癜 肝素誘導(dǎo)血小板低下癥,第五十一頁，共六十頁。 嚴(yán)重出血的ITP患者，輸血仍是最直接有效的，但缺乏評估輸血1小時后的有效的血小板數(shù)的循證 IVIG 1g/kg (5000/mL, 每日追蹤) Glucocorticoids (1g IV, 每日3dose),第四十八頁，共六十頁。)本院急診，疑似TTP的案例。)報告,第四十三頁，共六十頁。,PE of TTP in NTUH,2006.01.~2022計十五名疑似TTP﹝如下一張slide﹞。 唯此兩種血漿療法之相互(xiāngh249。,第三十八頁，共六十頁。oxi224。,The ADAMTS13 assay is based on fluorescence resonance energy transfer (FRET) technology. A synthetic fragment of the von Willebrand Factor protein is used as the Substrate. Cleavage of this peptide between two modified residues releases the fluorescence quenching capabilities. This assay is based on quantifying the cleavage of a small fragment of von Willebrand Factor by the ADAMTS13 protease. The cleavage of this synthetic substrate is detected by reading the fluorescence that results when the substrate is cleaved.,測定(c232。但臨床上可覺察正常金屬蛋白酵素〔metalloprotease,ADAMTS13〕可以分解超大von Willebrand’s體。li225。臨床醫(yī)師建議再次輸血RBC 4U, Plt 1機采血小板.輸血科再次配血相容RBC 4U及1U 機采血小板輸注。)男性45歲酒精性肝炎住院患者。ng xing)。shēn)血小板抗體陽性( flowcytometry, SPRCA, 近日內(nèi)輸過血小板也可能自身血小板抗體陽性) 使用SPRCA法鑒定：血清+藥物及血小板+藥物培溫,第二十三頁，共六十頁。nyīn) 新生兒血小板低下癥 藥物誘導(dǎo)血小板低下癥 血栓性血小板低下癥 特發(fā)性血小板減少紫癜 肝素誘導(dǎo)血小板低下癥,第二十一頁，共六十頁。,新生兒血小板低下(dīxi224。,血小板抗體(k224。部份輸血病人體內(nèi)可以驗出血小板抗體，文獻報告中最多的也是HPA1a抗體(antiplA1 ),第九頁，共六十頁。ng)血小板增加數(shù) 〞 7000, 此方法亦為偵測有無 “ 異體免疫 〞 的間接方式 CCI : ( 輸血后血小板數(shù)輸血前血小板數(shù)) X BSA/ 輸注血小板量。,免疫性血小板低下(dīxi224。nyīn) 新生兒血小板低下癥 藥物誘導(dǎo)血小板低下癥 血栓性血小板低下癥 特發(fā)性血小板減少紫癜 肝素誘導(dǎo)血小板低下癥,第二頁，共六十頁。,Content,血小板低下癥的原因(yu225。,Thrombocytopenia in the ill neonate,Any etiology of thrombocytopenia that occurs in the well child,History, examination, CBC, blood smear evaluation,See Thrombocytopenia in the well neonate,Platelets 100,000~149,000/uL,Platelets 100,000/uL,If platelets 50,000? Cranial ultrasound to R/O intracranial hemorrhage resulting from severe TP of any etology,Follow platelet count,150,000/uL ? no further evaluation,100,000~149,000? continue to fellow,PTT, PT, TT,High Hb,Severe jaundice and low Hb,Prolonged PTT, PT and/or TT +/ microangiopathic hemolytic anemia: Consider Ddimer of FSP, and/or fibrinogen +/ factors II, V and VIII,Polycythemia Cyanotic congenital heart disease,Erythroblastosis fetalis Exchange transfusion p phototherapy,DIC,Etologies Acute infection Asphyxia RDS Meconium aspiration Obstetrical complications Shock Thrombosis Severe hemolytic disease of the newborn Severe hepatic disease,TP usually mild enough not to require transfusion except in DIC due to erythroblastosis fetalis,Treat underlying disease Maintain platelets 50,000 with transfusions Maintain fibrinogen 1.0g/L and PT WNL with FFP +/ cyrorecipitate,Normal PTT, PT, TT,RDS Pulmonary hypertansion Meconium aspiration Mechanical ventilation,Infection Viral Bacterial Fungal,Perinatal asphyxia,No other specific etiology identified,Unknown etiology,Ongoing reevaluation if platelets 50,000,Acutely ill Usually premature Abdominal signs,NEC,Acidosis Emesis Lethargy,+/ Central venous catheter Hematuria Puls