Transfusion
1. ¼öÇ÷½Ã Áõ°¡Á¤µµ
platelet 50-70 ml : 5õ-1¸¸/uL Áõ°¡
cryoprecipitate : factor VIII 80U Áõ°¡
FFP(200-250 ml) : coagulation factor 2% Áõ°¡
packed RBCs(180-200 ml) : Hb 1g/dL Áõ°¡
2. delayed hemolytic transfusion : anti-JK¶§¹®
3. ±¹³» ³óÃàÀûÇ÷±¸ ÃÖ´ë º¸°üÇã¿ë±â°£: 35ÀÏ, CPDA-1
4. cryoprecipitate(factor 1, 8, 13, vWF)ÀÌ À¯¿ëÇÑ Áúȯ
Hemophilia A, von Willebrand disease, DIC, afibrinogenemia
5. FFP transfusion Ix: coagulopathy, °áÇÌµÈ plasma protein°ø±Þ, TTPÄ¡·á
6. Ç÷¼ÒÆÇ ¼öÇ÷ȯÀÚ¿¡¼ low platelet CCI¸¦ º¸ÀÌ´Â °æ¿ì
refractoriness : anti-HLA Ab, anti-Plt Ab
±× ¿Ü: ¹ß¿, ÃâÇ÷, ºñÁ¾´ë, DIC, drug
cf. ºÒÀÀ¼º ¿¹¹æ¹æ¹ý: HLA- & ABO matched donor, single donor, leukocyte reduced
component
7. CCI(corrected count increment)
= (¼öÇ÷ÈÄ - ¼öÇ÷Àü Ç÷¼ÒÆÇ ¼ö)/¼öÇ÷ÇÑ Ç÷¼ÒÆÇ ¼ö(¡¿1011) ¡¿ BSA
¼öÇ÷ 1½Ã°£ÈÄ 10¡¿109/mL, 18-24½Ã°£ÈÄ 7.5 ¡¿ 109/mL°¡ Á¤»óÀÓ
8. ¼öÇ÷½Ã 2500 cGyÀÇ gamma irradiationÀÇ ÀûÀÀÁõ
BMT recipient, congenital immunodeficiency syndrome,
immunosuppressive tx¹ÞÀº malignancyȯÀÚ(neutropenic pt)
1kg¹Ì¸¸ÀÇ ¿µ¾Æ
intrauterine transfusionÀ» ¹ÞÀº ½Å»ý¾Æ
homozygous HLA_haplotypeÀ» °øÀ¯ÇÑ °¡Á·, ģô³» ¼öÇ÷
9. RBC contaminationÀÇ mc cause: Y. enterocolytica, P. aeruginosa
Ç÷¼ÒÆÇ ¿À¿°À¸·Î ÀÎÇÑ ÆÐÇ÷ÁõÀÌ RBC ¿À¿°À¸·Î ÀÎÇÑ ÆÐÇ÷Áõº¸´Ù ÀÓ»ó¾ç»óÀÌ ´õ ´Ù¾çÇÏ´Ù.
10. ¼öÇ÷ÀÇ ºÎÀÛ¿ë
delayed hemolytic transfusion reaction(DHTR) - ÀúÀý·Î ÁÁ¾ÆÁø´Ù.
acute lung injury: donor´Â ´ëü·Î multiparous woman, ÈÄÀ¯Áõ¾øÀÌ È¸º¹µÈ´Ù.
fluid overload, hypothermia, electrolyte toxicity(hyperkalemia, hypocalcemia, acidosis)
11. febrile nonhemolytic transfusion reaction
¹éÇ÷±¸¿¡ ´ëÇÑ Ç×ü°¡ ¿øÀÎÀ̸ç Àü¿¡ ¸¹Àº ¼öÇ÷À» ¹ÞÀº ȯÀÚ¿¡¼ ¹ß»ýÇÑ´Ù.
leukocyte filter¸¦ ÀÌ¿ëÇÔÀ¸·Î½á ÀÌ·¯ÇÑ ¹ÝÀÀÀ» ´ëºÎºÐ ¿¹¹æÇÒ¼ö ÀÖ´Ù.
12. ¼öÇ÷µµÁß ¿ÀÌ ³ª´Â °æ¿ì
hemolytic transfusion reaction
febrile non-hemolytic transfusion reaction
acute lung injury
anaphylaxis
septic transfusion
13. leukocyte filter¸¦ »ç¿ëÇÒ ¶§ ¿¹¹æÇÒ¼ö ÀÖ´Â ¼öÇ÷ºÎÀÛ¿ë 3°¡Áö
febrile non-hemolytic transfusion reaction
HLA alloimmunization
transfusion induced infection(CMV)