Hepatitis B Virus Nucleic Acid Amplification Technology 乙型肝炎病毒核酸扩增技术

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1、BloodComponentsTherapyBrianPoirier,M.D.UniversityofCalifornia,DavisMedicalCenter1TopicsWholeBloodPackedRedBloodCellsPlasmaPlateletsSpecialTransfusions/Modifications2ModernHemotherapyAdministerthatcomponentofbloodthatthepatientneedstopreventmorbidityorm

2、ortality.Theneedmaybeduetolackofproduction,increaseddestructionorbloodloss.WholeBloodDonation45Transfusioncriteriaforwholeblood(Hct~40%ifavailable)OvertbleedingwithclinicalsignsofhypovolemiaExchangetransfusionofaneonate(ifRBCsreconstitutedwithFFPnotava

3、ilable)67Bristol,England,1941PackedRedBloodCells8Transfuseredbloodcells…toincreaseoxygen-carryingcapacityinanemicpatientsDoNOTtransfuseredbloodcellsForvolumeexpansionInplaceofahematinicToenhancewoundhealingToimprovegeneral“well-being”9RBCconcentratesto

4、raiseHgblevelofaverage-sizeadult1g/dLAnticoag/preservativeHctFlowrateDatingCPDA-170-80%Slow35daysAS-5(Optisol-mannitol)45-59%Rapid42daysAS-3(Nutricel-nomannitol)45-59%Rapid42days10RBCtransfusiontrigger:7vs.9.5or10g/dL7g/dLisaseffectiveas10g/dLinadult

5、s*9.5g/dLor10g/dLinPICUpatientswithoutcardiovasculardisease(similarmorbidityandmortality)***HebertPCetal.Amulticenter,randomized,controlledclinicaltrialoftransfusionrequirementsincriticalcare.NEnglJMed1999;340:409-17.**LacroixJetal.Transfusionstrategie

6、sforpatientsinpediatricintensivecareunits.NEnglJMed2007;365:1609-19.1112PropertiesofStoredRBC’sSupernatantCitratePotassiumfreehemoglobinpHlowRBC2,3DPGlowspherocyticchangeUCDMCMassiveTransfusionGuideline(MTG)Pack6unitsofpRBC3FFPJumbo(or6regular)*1Platel

7、etpheresis*Keptthawedat4°Cforupto5days14WashedRedCellsAllPlasmaand85%ofWhiteBloodCellsareremovedbywashing.15IndicationsforWashedRedCellsUrticarialtransfusionreactiontoseveralconsecutiveredcellstransfusions.Anaphylactoidreactiontopackedredcelltransfusio

8、n(suspectIgAantibodiesinanIgAdeficientpatient).Frozen,ThawedDeglyceralizedRedCellsWhitecellsandplasmaareremovedfromtheproduct17IndicationforFrozen,ThawedDeglyceralizedRedCellsPredepositionofautologousbloodforelectivesurgerytooccur>42day