【正文】 ll s f o r h e m a t o p o iet ic r e c o n s t it u t ion Cy tap h e res is P o s t t r a n s f u s ion p u r p u r a T P E R e f s u m ’s d is e a s e ( p h y t a n ic a c id) T P E S ic k le c e ll s c y n d r o m e Re d c e ll e x c h a n g e T h ro m b o c y to s i s , s y m p to m a ti c Cy to red u c ti o n T h ro m b o ti c th ro m b o c y to p e n ic p u rp u ra T P E 第一級適應(yīng)癥 輸血反應(yīng) Transfusion Reactions Immune effects ? Acute ? Immediate hemolytic transfusion reaction ? Febrile nonhemolytic transfusion reaction ? Allergic reaction ? Anaphylaxis and anaphylactoid reactions ? TRALI ? Delayed – Delayed hemolytic transfusion reaction – Alloimmunization – Posttransfusion purpura – Transfusion associated –GVHD (graftversushostdisease) – Immunosuppression Transfusion Reactions(cont) Non immune effects ? Immediate – Bacterial contamination – circulatory overload – Physical RBC damage ? Delayed – Iron overload TRANSFUSION RELATED GvHD ? Leukocyte filtration does not offer protection ? Mortality: 7590% ? Blood from relatives must be irradiated ? No effective treatment. ? Almost fatal. Guideline form blood transfusion services of the United Kingdom Prevention of transfusionrelated GvHD ? BMT/PB stem cell transplants should receive irradiated blood ponents. Allo at least 6 months (some centers remend indefinitely), auto: at least 3 months. ? HLAmatched platelets should be irradiated. ? Patients received purines analogues, Hodgkin’s disease and congenital immune deficiency. ? All intrauterine transfusions ? All granulocyte concentrates. Guideline form blood transfusion services of the United Kingdom 輸血案件 (19992020) 輸血風(fēng)險 事件類別 件數(shù) ABO 抗體 A RBCs→O pt B/AB RBCs →O pt A/AB RBCs →B pt B RBCs →A pt O plasma →A/AB B plasma →AB 80 26 12 6 6 1 小計 131 不規(guī)則抗體 AntiK AntiEKP1 AntiJka+Jkb+JK3 AntiJKb AntiFya 5 1 1 1 1 小計 9 19761985 FDA統(tǒng)計輸血死亡案例 —與抗體有關(guān)者 本地輸血醫(yī)療糾紛 ABO血型 discrepancy不敢發(fā)血 ? 51歲女姓病人，於淩晨零點(diǎn)十五分前往某區(qū)域醫(yī)院急診，主訴在外自行服用傷風(fēng)藥劑後全身無力，畏寒，口乾，想吐。 ? 國人約每 8000中有一人是亞孟買血型 ? 在血源遺傳探討時會有不符合 ABO遺傳的規(guī)則。 表 12 Blood group transferase Locus 基因 Transferase 註 FUT1 (H) H h a1,2Lfucosyltransferase 無 作用於血球之 2型鏈 FUT2 (SE) Se se a1,2Lfucosyltransferase 無 作用於分泌物之 1型鏈 ABO A B O a1,3NacetylDgalactosaminyltransferase a1,3Dgalactosyltransferase 無 FU