BasicsofTransfusionTherapy-UniversityofMichigan：基本的输液疗法-密歇根大学.ppt

Special Blood Products Laura Cooling MD, MS Associate Medical Director Transfusion Medicine Over-ordering: Platelets account for 61% of all components wasted Platelets 61% Cryo 18.7% Surgery accounts for 60% of all platelets wasted 51.5% Cardiac 3.82% Transplant 4.54% Other Most Blood collected, stored in Adsol Fraction is collected in CPD and CPDA concern for mannitol in neonates Massive Transfusion in Neonates Extracorporeal Membrane Oxygenation Exchange Transfusion Cardiovascular Surgery Adsol RBC are acceptable for routine, small transfusions in neonates Platelets: Specialty Products Single donor apheresis platelets Crossmatched platelets HLA-matched platelets Pathology consult and evaluation Patients with suspected alloimmune platelet refractoriness Irradiated Blood Products Prevent transfusion-associated GVHD. Engraftment donor lymphocytes Mortality 80-90% Cellular components only (RBC, platelets) Symptoms: Fever Skin eruptions Diarrhea Elevated LFT Pancytopenia DONOR HLA: A1, A1, B8, B8 PATIENT HLA: A1, A2, B7, B8 RELATED OR HLA-MATCHED Donor IncompatibleDonor Incompatible Patient CompatiblePatient Compatible A2, B7 A1, B8 INDICATIONS Intrauterine transfusion/exchange transfusion Premature neonates (1200-1500gm and 4 month age) Congenital immunodeficiencies Bone marrow transplant recipients Hematologic malignancy Solid tumor malignancy requiring high dose, multiagent chemotherapy HLA-matched platelets Directed donations from relatives ORGAN TRANSPLANTS DO NOT REQUIRE IRRADIATION Adverse Effects of IrradiationAdverse Effects of Irradiation Increased rigidity, less deformability Contributes storage lesion (RBC) Increased K+ leak Decrease ATP, pH “accelerated aging” Give irradiated components only to those patients at risk CMV-safeCMV-safe Prevent TA-CMV in at-risk patients Transmitted by lymphocytes cellular components only (RBC, platelets) Prevented by leukodepletion (CMV-safe) Indications: (CMV-safe) Intrauterine transfusion Premature infants/exchange transfusion Bone marrow trans