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Current and Evolving Issues in Transfusion Therapy

Current and Evolving Issues in Transfusion Therapy. R2 김일석. Hemolytic Transfusion Reactions. Serology. Erythrocyte Ag system ABO Ag : sugar chain ,glycosyltransferase naturally occuring Ab : exposure of other source of Ag after first few Month of life

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Current and Evolving Issues in Transfusion Therapy

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  1. Current and Evolving Issues in Transfusion Therapy R2 김일석

  2. Hemolytic Transfusion Reactions

  3. Serology • Erythrocyte Ag system ABO Ag : sugar chain ,glycosyltransferase naturally occuring Ab : exposure of other source of Ag after first few Month of life Rh Ag : D,C,E,c,e, nonglycosylated polypeptides lack of D Ag : not form Ab without blood expose Non-ABO-Rh Ag : -common Ag system(MSN,Kell,duffy,kidd) -uncommon (Lutheran,Diego,Y1,Xg)

  4. Ag of human leukocyte Ag(HLA) system -genes on the major histocompatibility Cx -cell surface bound glycoprotein on platelet, most nucleated cell -exception in mature erythrocytes -recognition of self & nonself -immune-mediated platelet refractoriness, febrile non-HTRs transfusion associated acute lung injury posttransfusion graft-versus-host disease

  5. Routine testing procedure for erythrocyte Ags • ABO type : direct agglutination of erythrocytes forward typing(pt’s RBC- anti A,anti B reagents) reverse typing(pt’s sera-reagent A1, B cells) • Ab screen : indirect Ab or Coomb’s test unexpected Ab against common non ABO Ag • Cross-match • Timetable

  6. Acute HTRs • Ig M Ab to ABO Ag • Hemolysis via complement fixation , formation of immune complex • Tx : maintain organ perfusion -low dose dopamine -intravenous crystalloids, diuretics -cougulation factor,plt(DIC)

  7. Delayed HTRs • Most Rx to non ABO Ag-IgG mediated, • Not detected by by pretransfusion test- anamnestic Ab response • Not fix complement-not catastrophic • Most immediate immune mediated HTRs -clerical or misidentification errors • Ca containing solution with RBC-clots • Nonimmune HTRs : overwarm, pr infusion pump, small bore neddle-mechanical stress

  8. Acute,nonhemolytic transfusion reactions • Febrile reaction : preformed cytokine within the stored unit, host Ab to donor lymphocyte, bacteial contamination of stored unit -decreased by prestorage leukoreduced blood, bacterial growth more common at room temp. • Allergic reaction : complement, plasma protein, IgA deficiency • Respiratory distress : fluid overload, allergic Rx, TRALI(anti HLA or antileukocyte Ab) • Metabolic : coagulopathy, hypothermia, hyperkalemia

  9. Delayed nonhemolytic transfusion reactions • Ag of HLA system:rejection of transplanted tissue &long term survival after solid organ BM transplantation • Immune mediated plt refractoriness, febrile non HTRs, TRALI, transfusion associated graft-versus-host disease • Iron overload-accumulation in vital organ

  10. Transmission of bloodborne pathogens • Lipid enveloped virus : HIV, human T-lymphocyte virusⅦ, hepatitis B, C • Donor screening & test: p24 Ag for HIV, polymerase chain Rx-based test for hepatitis C viral RNA-DNA during window period • Syphilis, E-B virus, • Parasitic disease- malaria,toxoplasmosis

  11. Evolving issues and interface between the operation room and laboratory medicine

  12. Blood ordering schedules and new testing procedures • Maximum surgical blood ordering schedules : recommended number of unit for given procedure • Crossmatch-to-transfusion ratio : >2 : blood ordering exceed reasonable blood requirements • Type & screen : potentially require blood but unlikely to receive blood

  13. Specialized procedures and emerging techniques • Solvent-detergent tx of pooled plasma products- inactivate lipid encapsulated virus(hep.B,C,HIV) • Polymerase chain Rx based test- non lipid encapsulated (hep.A, parvovirus B19) • Specialized blood or blood components : CMV (-),leukioreduced blood-immunocomprom. universal leukodepletion-febrile non HTRs washed RBC or plt-anaphylactic Rx,IgA deficien. irradiated blood-graft versus host disease

  14. Collaboratory clinical ventures between anesthesiology and medicine services • Preop.autologous donation : reduce TRs, blood borne pathogen • Normovolemic hemodilusion : less RBCs lost when low Hct(20~25%) • Cell salvage system : collect,process,return RBCs from surgical blood loss – adequate processing & washing • Blood & blood component administration : turnaround times of lab.based test, Hct, PT, aPTT, fibrinogen

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