输血过滤器的临床应用【ppt课件】

输血过滤器的临床应用

陈育新

MilitaryAircraftEngineIntakeAirRoyalNavySeaKingHelicopterfilteredbyPALLFiltration1-2-30LeoYangPallTWNSciencesWelcometoPallCorporationPallisAllAroundYouEnsuringthepurityandclarityofthewine,beerandwateryoudrinkPallisAllAroundYouHelpingtomakevaccinespureandsafeACultureofInnovation1946DrPallinventsporousstainlesssteelandfoundsthecompanythatwillbecomePallCorporation.1958Pall’sFiltersprovideprotectionforhydraulicsystemsonJupiterCbooster.1959Rigimesh®filtermediaisdevelopedbyPallfortheprotectionofBoeing707hydraulicsystems.1969PalldevelopsaspacesuitheatexchangerandlunarmodulefiltrationfortheApollo11mission.1971BloodfiltersbasedonthePallUltipor®filtermediaareintroducedtoprotectcardiacpatientsfrommicroemboli,improvingpostoperativeoutcomes.ACultureofInnovation1979PMM®filtermediaisdevelopedasaclean-upsolutionforThreeMileIslandsite.1988Pallintroducesitsleukoreductionfilterstocombatpost-transfusionfeverandallergicreactions.1989Pall’sScientificandLaboratoryServicesdevelopsfiltrationandmaintenancestandardsforhydraulicssystemsontheEurotunnelboringmachines,ensuringreliableoperationunderchallengingenvironmentalconditions.1990Dr.PallisawardedtheNationalMedalofTechnologybyPresidentGeorgeBushSr.ACultureofInnovation1991ThePallCentriSep®Systemprovidesinnovativeprotectionforthemilitary’sintakesystemsinharshconditionsduringoperation“DesertStorm”.1993TheBB25breathingcircuitfilter,developedbyPalltopreventcontaminationofventilatingequipment.ItbecomescriticallyimportantinfightingthespreadofSARSandAvianFlu.1995PallCorporationintroducestheDV50,thefirstvalidatedvirus-retentioncartridgefilterforthepharmaceuticalindustry.2006Pall’sAcrodose™PLSystemisintroducedtoincreasethesafetyandavailabilityoflife-savingplatelets.TomorrowPallproductswillcontinuetoprotectmissioncriticalsystemsineventheharshestenvironments.FiltersUsedforBloodComponentsAdministrationTypeofFilterRemovalCharacteristicClotScreenPoresizeof170umMicroaggregatePoresizeof2040umLeukocyteremovalRateontheefficiencyofleukocyteremove---notbyporesize

BLOODFILTRATIONTECHNOLOGYMicroaggregateLeucocytereduction redcells platelets salvagedbloodBloodbankfiltersBedside(hospital)filtersTransfusion-Associated

Leukocyte-MediatedMorbidityWalkerJH.AmerJClinPath88:374-8,1987TRANSFUSIONSNearly1in5transfusionsareassociatedwithanadversereactionFrequencyofOccurrenceDose-ResponseforTransfusionandInfectionPatientstransfusedwith1to4unitshaveinfectiouscomplicationsratesapproaching20%.Dose-ResponseRelationshipAllogeneicTransfusionandInfectionAsingletransfusedunithasbeencorrelatedwithsignificantlyincreasedinfectiouscomplicationsapproximating15%.CLINICALEFFECTSOFCONTAMINATINGLEUCOCYTESHLAAlloimmunisationReactions Platelet Graft Refractoriness RejectionViralTransmissionCytomegalovirus(CMV)EBV,HTLVI&II,Varicellazoster ImmuneSuppression Post Cancer Latent Operative Recurrence Viral Infection ReactivationContaminatingLeucocytes1-34-6789-131415-1819-2021,2223,24252627282930313233343536KnowneffectsofLeucocytesAlloimmunization-leadingontoRefractorinessInfectiontransmission-virusesandbacteriaImmuno-modulation-higherincidenceofpostop.InfectionImmuno-suppression-higherANDincreasedincidenceofsolidtumourreformationALLOIMMUNISATIONANDREFRACTORINESSAntigenPresentingCellB-LymphocytePlasmaCellMemoryCellT-Lymphocyte

DonorRecipientTransfusionYYYYYYYYYYYYYYYYYYYYAntibodyProduction

*TheproductionofHLAantibodiesisa2signal processrequiringthepresenceofbothClassI andClassIIantigensLocationofHLA *HLAClassI PresentonALLnucleatedcells(whitecells)andplatelets *HLAClassIIPresentONLYonMonocytes,Macrophages,B-Lymphocytes,activatedT-Lymphocytes,dendriticcellsNB:redcellsdonotexpressHLAAlloimmunisationALLOIMMUNISATION%ControlGroupsFilterGroupsANALYSISOFUTILIZATIONANDCOSTOFPLATELETTRANSFUSIONINREFRACTORYHEMATOLOGY/ONCOLOGYPATIENTSNumberofAveragePlateletsAverageAdmissionsTransfused Platelet Costs($)Lilletal.,A.S.H.1997Author

PatientGroup

Alloimmunisation

Refractoriness

BloodProductReductionStandardLeucodepletedStandardLeucodepletedRedCellsPlateletsHLAMatchedT.R.A.P.Study,1997AML45%17%13%3%0%0%-Killicketal.,1997Aplastic50%12%-0%---AnaemicsNovotneyetal.,1995Aplastic-12%-5%---ThrombocytopenicsAdamziketal.,1995Cancer27%0%27%0%-8.3%-AML-----15.7%-Blumbergetal.,1995AML----0%43.2%-*Lymphoma----43.7%50.3%-*Williamsonetal.,1994Cancer37.5%22.4%31%24%---AML63%31%-----Oksanenetal.,1994AML38%17%21%3%14.8%26.5%-*Saarinenetal.,1993Leukaemics30%0%10%0%13.6%28.6%-Bedford-Russelletal.,1993Neonates30.4%0%-----Myllylaetal.,1993Renal67%19%-----Leukaemics--52%0%---AML--18%2.9%---Al-Momenetal.,1992Leukaemics----21.5%--vanProoijenetal.,1991Leukaemics-7.8%-7.8%--82%vanMarwijkKooyetal.,Leukaemics42%7%46%11%---1991OverallMeans:

-42.6%12.3%30.1%6%15.6%24.7%82%*Authorsfoundadditionalcostsavingsintermsoflengthofhospitalstay(23-41%reduction)andtotalcharges(10-41%reduction)intheleucocytedepletedarm造成血小板减少的病人出血之原因，除了血小板数目外，很多其它的临床症状也要考虑，例如败血症，尿毒症，凝血功能异常，以及药物的影响等。不之疾病造成血小板之减少症，对输血小板之反应不尽相同，如败血症，脾肿大，免疫性血小板减少症，则对输血小板之反应不佳。因此，除了血小板的数目外，引起血小板减少之原因及疾病亦应注意，才能掌握血小板输注的正确时效。治疗性血小板输注呢？一般而言，是只对正在出血的血小板减少之病人之治疗方法。这时在输血小板之前及之后，对血中血小板数量的监测与比较是很重要的，因为这样可以评估血小板的存活数量，以及预测未来对输血小板的需求。如果血小板的数量没有爬升，即使是反覆的输血，可能对病人并没有什么好处。通常此时医师必须积极去追查造成顽固性血小板减少的原因。有一些疾病所导致的血小板减少症对输血小板的反应良好，特别是针对骨髓抑制所造成的顽固性血小版减少症。如化学治疗后，放射线治疗后，维持生活素缺乏，或是再生性不良性贫血等。另外有一些疾病所导致的血小板减少症则对输血小板反应不好，如：败血症(sepsis)，脾脏肿大(splenectomy)，以及免疫性血小板减少症，包括自体免疫性血小板减少症(immunethrombocytopenia)，药物引起之血小板减少症，或是淋巴增生性疾病等。相对的，有一些疾病所导致的血小板减少症，输血小板则为其禁忌症。如血栓性血小板减少性紫斑症(thromboticthrombocytopenic

purpura，可能会因输血小板而导致血栓更加恶化。顽固性(refractory)的血小板减少症：顽固性(refractory)的血小板减少症包含了：1.非免疫性(non-immune)的顽固性的血小板减少症2.异体免疫性(alloimmunization)的顽固性的血小板减少症非免疫性的顽固性血小板减少症的原因包含：败血症(sepsis)，弥漫性血管内凝血症(DIC)，以及脾脏肿大(splenomegaly)等。对于非免疫性的顽固性的血小板减少症的处理方法有：1.使用ABO血型相符之血品2.使用新鲜血小板3.在脾脏肿大(splenectomy)的病人则应增加血小板的剂量4.治疗败血症(sepsis)及弥漫性血管内凝血症(DIC)的原因5.考虑使用单一捐赠者HLA相符之血小板等异体免疫性的顽固性血小板减少症根据统计，约有20%至70%反覆输血小板患者会产生异体抗体(allo-antibody)，一般发生在输血小板两个月内。有少数的病人于输血小板前即有异体抗体(allo-antibody)，多半是因为从前曾输血小板或怀孕的缘故。90%的异体抗体(allo-antibody)与HLA-typing有关。血小板只有携带第一型(classI)HLA抗原，血小板本身并不足以对这些抗原引发原发性免疫性免疫反应。但是白血球同时携带第一型(classI)及第二型(classII)HLA抗原，足以引发异体免疫(alloimmunization)反应。一但白血球引发原发性异体免疫反应(primaryalloimmunization)，血小板亦引发次发性异体免疫反应(secondaryalloimmunization)。

使用类固醇(steroid)或脾藏切除(splenectomy)对处理具异体免疫抗体患者的效果不好，而使用IVIG亦只有对少数患者有效。减少捐赠者的人数并没有减少异体免疫抗体产生的机会。即便是仅使用单一捐赠者输血小板，亦只有少数研究报告显示有统计上的差异。脾切除：脾切除对自体免疫性血小板减少症及脾功能过盛之病人亦为一很好之治疗方法。根据我们最进之统计资料约有70%脾切除后之自体免疫性血小板减少之病人，不必服药而其小血小板有明显之升高至正常护接近正常之现象。

临床上红血球抗体的发生，与红血球抗原的致免疫性(immunogenecity，或称抗原性)有关。当然，致免疫性之高低，虽然主要是因抗原不同而异，但免疫途径、免疫方法及频率也有所影响，宿主本身的免疫力和身体状况更是影响抗体发生的重大因素。红血球抗原的致免疫性以Rh(D)抗原最强，K抗原其次。其大致的致免疫性如下(以一次输血后会发生抗体的频率表示)Non-hemolyticfebriletransfusionreactions.AlloimmunizationPost-transfusionthrombocytopeniaCytomegalovirustransmissionTransfusioninducedimmunosuppression

(infection,cancerrecurrence)ReductionoftheriskofnvCJDtransmissionLeukocyteDepletionofHomologousBloodProducts(Redcells,platelets,plasma)

BarrierRetentionandPoreSizeSCREENFILTRATIONScreens20-40um(40ummostcommon)Absolutefilters.LargesurfaceareaifmembraneispleatedNormallymadeofpolyesterDEPTHFILTRATIONVariableporesizeremovalefficiencyofparticles/airdependantondensityLowsurfacearea.Modifiedpolyesters-adsorbleukocytes.WHENTOFILTER:THELOGISTICS FilterDonationHold ProcessingStorageTransfusionWarmBloodVariableTemperatureControlledTemperature

Non-HemolyticFebrileTransfusionReactionsResidualleukocytecount(109)1.00.5

0.2-0.1<0.05Patientreactionrate(%)Sirchi:Transfusion30:30-33,1990PreventionofNHFTRofthalassemiapatienttreatedwithmultiplebloodtransfusion

FactorsofPlateletRefractorinessMajorFactorsInfluencingtheCorrectedCountIncrementNon-Immune:1.Splenomegaly2.DisseminateIntravascularCoagulation(DIC)3.Drugs(NumberofAntibacterialsandAmphotercinB)4.Sepsis/Infection5.FeverImmune:1.Platelet-SpecificAntibody2.HLA-Antibody

AlloimmunizationTrialtoReduceAlloimmuizationtoPlateletsTRAPStudyNewEnglJMed:337:1861-1869T.R.A.P.StudyResults

RateofAlloimmuneRefractoriness(%)►Verylowincidenceofrefractoriness.►Allarmsareequallyeffectiveinreducingtheincidenceofalloimmunerefractoriness.►ThereisnoadditionalbenefitofusingfilteredSDplateletscomparedtopooledPC(plateletconcentrates)preventingalloimmune

refractoriness.T.R.A.P.StudyResults

ConclusionsPlateletTransfusionSDPRDPA.Thomas,M.D.,EconomicRoadmapstoUniversal

LeukocyteReduction｀99;PallProgram/AABB.ROLEOFBLOODTRANSFUSIONINCMVTRANSMISSIONANDREACTIVATION:CMVPRIMARYINFECTION

egBloodTransfusionREINFECTION2ndStrainIntroducedinBloodTransfusionREACTIVATION

eg

ImmunosuppressionLeukocyteReductionComparabletoCMVSeronegativeBlood

BowdenRAetal.Transfusion(1995)35:719-722

Aprospective,randomizedtrial

520CMVseronegativemarrowrecipients:ScreenedBlood:N=252FilteredBlood:N=250Betweendays21and100aftertransplant,patientsweremonitoredforthedevelopmentofCMVinfectionandtissue-documentedCMVdisease.LeukocyteReductionComparabletoCMVSeronegativeBloodTransfusionTreatment%P>0.05Seronegative

vsUnscreenedFiltered

BowdenRAetal.Transfusion(1995)35:719-722

Transfusioninducedimmunosuppression

(infection)AdaptedfromJensenetal.Lancet1996;348:841-845.InfectionRate(%)

orReoperationReducesWoundInfection,PneumoniaandReoperationTransfusionRegimen141185DaysinHospitalDollars(thousands)Cost-EffectivenessofLeukoreductionTransfusionRegimenAdaptedfromJensenetal.Transfusion1995;35:719-722.TheRoadtoUniversalLeukocyteReductionAmericanRedCrossBPACPublicStatementsTheAmericanRedCrosswillpresentthefollowingviewsattheFoodandDrugAdministrationBloodProductsAdvisoryCommittee(BPAC)meetingtodayandFriday.TheBPACadvisestheFDAonavarietyofissuesthatpertaintobloodproducts,fromrecommendingapprovalofnewproductstorecommendingchangesofregulations.Itisstrictlyanadvisorycommittee.Thisinformationmayappearsomewhattechnical,however,itinvolvesRedCorsspolicyonfimprovedtestingforinfectiousagentstoimprovethesafetyofAmerica＇sbloodsupply.AABB＇sAssociationBulletin#97-2LimitationsintheInterpretationoftheAboveData:Manyoftheearlystudiescouldnothavebeenanaccurateassessmentofresidualleukocytecountsinthecomponentsadministered.Thefocusatthattimewasonpercentleukocytereduction.Inaddition,manyofthestudiesdidnothaveappropriatecontrolgroups,norweretheyrandomized.Inadditiontotheproblemofprimaryvssecondaryanalyses,thefinalpapernotedabovelacksanintent-to-treaanalysis,andcontainsprotocolandtypographicalerrors.Nevertheless,thislargerandomizedtrialappearstodocumentthatwhenaparticularmanufacturer＇sfilterswereusedatthebedsideundertheconditionsdeterminedbythestudyprotocol,resultswereequivalenttotheuseofseronegativedonorblood.Fromtheavailabledataitcannotbedeterminedwhethersuchresultswouldbeobtainedoutsidethesettingofacontrolledclinicaltrial,withtheuseofothermanufacturers＇componentsorwiththeuseofotherleukocytereductiontechnologies.Recentstudies,infact,havesuggestedthattheperformanceofbedsidefiltrationofredcellconcentratesmaybesuboptimalcomparedtofiltrationunderlaboratoryconditions.StudiesbyLedentandSirchiahaveprovidedin-vitroevidencethatslowfiltrationaroomtemperature(asoccursinabedsidesetting)allowswarmingofredcellconcentratesandsubsequentsuboptimalremovalofdonorleukocytes.Hospitaltransfusionservicesshouldcontinuetoreevaluatethemostappropriateapplicationofleukocytereductiontechnologyinlightofongoingresearch.byKarenShoosLipton,JD.ChiefExecutiveOfficerAABB＇sAssociationBulletin#97-2(Continuous)ExpectationofaLowIncidenceofTT-CMVFollowingTransfusionofLeukocyte-ReducedComponents:Itispossiblethatnormalblooddonorscanhaveatransientandepisodicviremia.Possiblyduetoadecreaseintheregulatorycontroloverthelatentinfection.Thisconceptisunproven,andtheincidenceandkineticsoftheviremiahavenotbeenstudied.Unpublisheddata(Hillyer,CD)ontheuseofPCRhaveconfirmedthatfreeplasmawilltransmitCMVdespitetheuseofcurrentleukocytereductionfilters.Additionally,thedegreeofleukocytereductionnecessarytodecreasetheriskofTT-CMVhadnotbeendetermined.Thus,itispossiblethatsomeleukocyte-reducedcomponentsmaytransmitCMV.Inaddition,clinicianswhorelyexclusivelyontheuseofantibodyrestingtomakethediagnosisofCMVmustrecognizethattheuseofCMV-untestedleukocyte-reducedbloodmayresultinthepassivetransferofdonorantibodiestoCMV,whichcouldcomplicatethediagnosisofCMVinfectionsinpatients.byKarenShoosLipton,JD.ChiefExecutiveOfficerCONCLUSION:ThedataconfirmthatdistinctphenotypicdifferencesexistamongPCspreparedwithdifferentdevicesand/orprocedures.Itissuggestedthatasfornon-genericpharmaceuticals,theclinicalbenefitsofthesevariousPCsshouldbeindividuallyproved.TRANSFUSIONVolume38,July1998Whitecellsubsetsinapheresisandfilteredplateletconcentrates

S.O.Sowemimo-Coker,A.Kim,E.Tribble,H.J.Brandwein,andB.WenzTRANSFUSIONVolume38,July1998Whitecellsubsetsinapheresisandfilteredplateletconcentrates

(Continuous)TRANSFUSIONVolume38,July1998Whitecellsubsetsinapheresisandfilteredplateletconcentrates

(Continuous)FunctionsofLeukocyteSubsetsMonocytes:MajorAntigenPresentingCells(whichareabletoinitiateimmunereactionsleadingtoalloimmunization).Granulocytes:Phagocyticcellswhichengulfanddestroyforeignmatter.Mainlyresponsibleforfebriletransfusionreactions.Evidencesuggeststhatcytomegalovirus(CMV)maybespecifictogranulocytes,although

monocytesmayalsoharborCMV.Lymphocytes:Carryoutavarietyofimmunefunctions.Mainreservoirforcellassociatedretroviruses.BLymphocytes:CommittedBlymphocytesproduceandsecreteantibodies(IgG,IgM).Majorantigenpresentingcellsresponsibleforalloimmunization.FunctionsofLeukocyteSubsets

(Continuous)T4-Lymphocytes:TcellshavingCD4phenotypeplaykey“helper＂

roleinregulatingtheimmuneresponsebyvirtueoftheirabilitytodirect“B＂cellstodifferentiateandproduceantibodies,directactivationofCD8positivecytotoxic

effectorcells,activatemacrophagesandNaturalKillerCells(NK),andalsodirectthegenerationofCD8-positivesuppressorcells.T8-Lymphocytes:TcellshavingCD8phenotypescandevelopintoT-suppressorcells(thatalsoplayanimportantroleinmodulatingtheproductionofantibodiesbyBlymphocytes)andalsoT-Cytotoxiccellswhichareimportantinthedefenseagainstviruses.NaturalKillerCells:LymphoidcellsthataredistinctfromTandBlymphocytesandareimportantintransplantationrejectionandeliminationofmalignanttumors.主旨

NH(F)TR发生的概率并无法因Prestorage之白血球过滤处理而具有任何统计上意义之降低，目前一系列新的证据显示，使用乏白血球处理后之血小板，能使NH(F)TR发生比率再降低之关键并非以Prestorage方式去白血球可以降低之Cytokine，而在血小板本身产生之ChemokineRANTES系列。说明请参考后附之＂Transfusion1999;39:1179-1184＂期刊所发表之论文。在该篇论文中详细记录、统计、分析了1992~1996年间，德国血液及肿瘤科因化疗或脊髓功能不健全而造成血小板缺乏症而需输血小板患者之所有输血反应之记录，其二组对照比较之情况（均用PALLFilter），如表一：Febrileandallergictransfusionreactionsafter

thetransfusionofwhitecell-poorplateletpreparations

H.Kluter,S.Bubel,H.Kirchner,andD.WilhelmCONCLUSION:PrestorageWBCfiltrationdidnotreducetheincidenceofthesereactions,andinflammatorycytokineswereofminorrelevance.Theproinflammatoryplatelet-derivedchemokine

RANTES,whichaccumulateseveninWBC-reducedplateletconcentrates,wasassociatedwithallergictransfusionreactions.Platelet-derivedmediatorsmaybeakeytounderstandingNHTRs.TRANSFUSIONVolume39,November/December1999Febrileandallergictransfusionreactionsafter

thetransfusionofwhitecell-poorplateletpreparations

(Continuous)

Nonhemolytictransfusionreactions(NHTRs)arecommonsideeffectsafterthetransfusionofbloodcomponents.Mostofthereactionsaremild,butsomearelife-threatening,becauseofsevereanaphylacticshock.Whereasinthepastwhitecell(WBC)antibodieswereofforemostrelevance,theirimpactfadedwiththeintroductionofWBC-reductiondevices.Recently,contaminatinginflammatorycytokinesinplateletconcentrates(PCs),suchasinterleukin(IL)-1,IL-6,IL-8,ortumornecrosisfactorα(TNFα),havebeenconsideredinstrumentalintheoriginofthesereactions.ThesemediatorscanaccumulateinhighconcentrationsinstoredPCs,buttheirlevelsareverydependentontheWBCcontamination.WBC-reducedPCscontainfewifanyinflammatorycytokines,andprestoragefiltrationofPCscancircumventtheaccumulationofthesemediatorsduringstorage.ThereisalsoaremarkabledifferenceinthereportedincidenceofNHTRs,accordingtothekindofPCtransfused.TransfusionreactionsstilloccurafterthetransfusionofWBC-reducedPCs.Thus,underlyingpathomechanismsbesidesthepresenceofWBC-derivedinflammatorycytokinesmightalsobeinvolvedinNHTRs.ABBREVIATIONS:BC=buffycoat;IL=interleukin;MIP-1α=macrophageinflammatoryprotein1α;NHTR(s)-nonhemolytictransfusionreaction(s);PC(s)=plateletconcentrate(s);SD=single-donor;TNFα=tumornecrosisfactorα;WBC(s)=whitecell(s)TRANSFUSIONVolume39,November/December1999Febrileandallergictransfusionreactionsafter

thetransfusionofwhitecell-poorplateletpreparations

(Continuous)

FromtheInstituteofImmunologyandTransfusionMedicine,UniversityofLubeck,Germany;andtheproDERMInstituteforAppliedDermatologicalResearch,Hamburg,Germany.

Addressreprintrequeststo:Harald

Kluter,MD,InstituteofTransfusionMedicineandClinicalImmunology,GermanRedCrossBloodTransfusionServiceofBaden-Wurttemberg,Friedrich-Ebert-Strasse167,D-68167Mannheim,Germany;e-mail:h.klueter@blutspende.de.

ReceivedforpublicationJanuary11,1999;revisionreceivedApril6,1999,andacceptedApril30,1999.

TRANSFUSION1999;39:1179-1184.TRANSFUSIONVolume39,November/December1999Removalofsolublebiologicresponsemodifiers(complement

andchemolines)byabedsidewhitecell-reductionfilter

E.L.SNYDER,S.MECHANIC,L.BARIL,ANDR.DAVENPORTCONCLUSION:Thethird-generationbedsidefilterusedinthisstudyreliablyreducedthelevelofwhitecellcontaminationto4log10whitecellsperPC.Italsoloweredthelevelsofinterleukin8,RANTES,andC3a.Thefilterdidnot,however,remove(scavenge)theproinflammatorycytokinesinterleukin1βand6.ThemechanismofchemokineandC3aremovalbythefilterisunknown,butitmayberelatedtoionicinteractionsbetweenthesebiologicresponsemodifiersandthefiltermedium.TRANSFUSION1996;36:707-713.C3aAccumulatesinStoredPlateletProductsC3aandC3adesArg77InhibitNKCellsEffectofPallPL100TMLeukodepletionFiltersonC3aRemovalFromPlateletConcentratesEffectofStorageonC3ainPooledRandomDonorPlateletsandFiltrationwithPXL8TMNotallFiltersaretheSameP8.13

Twocasesofadversereactionduetoleukocyte-reductionfilter

AKokubunji*1,SKai1,RImaizumi1,JIkemoto1,MMisawa2,MNatsuaki3andHHara1,2

Departmentsof1TransfusionMedicine,2InternalMedicine(DivisionofHematologyandOncology).3Dermatology,HyogoCollegeofMedicine,Hyogo,JapanAims:Mostadversereactionsassociatedwithtransfusionarenonhemolytictransfusionreactions(NHTR)withallergicsymptomssuchasrash,itchingandurticaria.Thecausesofthereactionaredifficulttobedeterminedinmostcases.WeexaminedthecauseofNHTRinassociationwithleukocyte-reductionfilters(L-Rfilters)thatarewidelyusedtopreventalloimmunization.Materialsandmethods:NHTRoccurredintwopatients;a13-year-oldfemalewithaplastic

anemia(case1)anda69-year-oldmalewithmyelodysplasticsyndrome(case2).ToinvestigatethecauseofNHTRinthem,severalantibodiessuchasanti-platelet,plasmaanti-IgA,C4andC9antibodies,andIgAdeficientwerechecked.WetriedtouseL-Rfiltersfromdifferentmanufacturersandtransfusetheproductsofwashedredbloodcellsandwashedplatelets.Results:Incase1,sheshowedrash,cough,anddyspneaimmediatelyaftertransfusionofRC-MAPwithL-RfilterfromTcompanyathersixthtransfusion.Incase2,athisthirdtransfusion,hecomplainedofnausea,chillnessafterstartingtransfusion.WashingofthebloodproductswasnoteffectiveforpreventionofNHTRforthem.Anti-platelet,anti-IgA,anti-C4,andanti-C9werenotdetected.NoneofthepatientshadIgAdeficiency.Atpresent,wecouldtransfusethebloodproductssafelytothemwithuseoftheL-RfiltersfromtheothermanufacturersorwithouttheL-Rfilter.Conclusions:TheL-RfiltersfromTcompanyweresuspectedasthecauseofNHTRinthecases.cISBT2004BlackwellPublishingLtd.Vax

Sangguinis(2004)87(Suppl.3),S17-S92Figure1TransfusionsituationofCase1Pall&Fresenius比较表Pall&Fresenius比较表(Continuous)全民健保医疗费用支付标准一、使用血小板专用白血球过滤器之适应症：骨髓功能不足而引起的缺血，如再生不能贫血、急性白血病、其他恶性血友病、骨髓因化学治疗或放设治疗而抑制功能者。严重血液病而需输血小板者。3.大量输血、交换输血、及心肺体外循环而大量失血者。4.配合HLA使用之血小板输血者。5.避免因输血引起巨细胞病毒之传染，如器官移植的受血者，骨髓移植受血者，新生儿交换输血或经常输血者，免疫不全的受血者。因白血球引起之发烧发冷输血反应二次以上之病人，需再次输血治疗时。全民健保医疗费用支付标准一、使用红血球专用白血球过滤器之适应症：需长期输血者，而有缺少或不良之红血球病症：如再生不能性贫血红血球发育不全、恶性肿瘤或药物抑止红血球生成者。血液病性贫血、地中海型贫血、镰型血球贫血、严重阵发性夜间血红素尿症自体免疫血液性贫血。3.器官移植、避免异体排斥。4.避免因输血引起巨细胞病毒之传染，如器官移植的受血者，骨髓移植受血者，新生儿交换输血或经常输血者，免疫不全的受血者。5.因白血球引起之发烧发冷输血反应二次以上之病人，需再次输血治疗时。PALL红血球专用白血球过滤器产品特性：适用于1-2单位红血球厚浆或全血之用过滤效果：白血球过滤残余量<2x105红血球回收率：>91%型号：RCXL1，RCXL1K，RCXL1YPALL血小板专用白血球过滤器产品特性：适用于6-12单位血小板厚浆或分离术血小板过滤之用过滤效果：白血球过滤残余量<5x105血小板回收率：>90%型号：PXL8，PXL8K，PXL8Y血液成份及颇尔(PALL)血品专用过滤器一览表血品名適應症過濾器使用白血球減量輸血方法的優點全血

1

提供紅血球與血漿以增加適氧能力及擴張血液容積，適用於休克伴隨大量出血超過總血量30%的病人2.交換輸血RCXL系列BPF4系列1.減少非溶血性發熱反應(FNHTR)2.降低因輸血而出現免疫機能被抑制的現象，而造成術後感染率及腫瘤復發的增加3.降低因輸血而感染或再活化細胞性病毒(如:CCMV,HTLV-I)紅血球濃厚液

1.

貧血2.

血中紅血球不足或功能喪失RCXL系列BPF4系列NEO1(小兒專用)1.減少非溶血性發熱反應(FNHTR)2.降低因輸血而出現免疫機能被抑制的現象，而造成術後感染率及腫瘤復發的增加3.降低因輸血而感染或再活化細胞性病毒(如:CMV,HTLV-I)洗滌紅血球

1.陣發性夜間血尿症患者，需要長期輸血的慢性貧血患者2.對IgA或其他血漿蛋白產生過敏性輸血反應者RCXL系列