Heavy breathing in the blood bank

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1、Heavybreathinginthebloodbank:isittransfusion-relatedacutelunginjury,ouranxiety,orboth?DavidF.StroncekTRALIAlthoughconsiderablesuccesshasbeenachievedinreducingtheriskoftransfusiontransmittedinfection“transfusion-relatedacutelunginjury”(TRALI)isrecognizedastheleadingcauseoftrans

2、fusion-associatedfatalitiesreportedtotheFDATRALI是一種不尋常且較為複雜的輸血反應症狀之一，主要的典型特徵包括：呼吸急促、發燒及低血壓。目前已躍升成為經由輸血所引起的重大傷害之一，甚至導致死亡原因的第二位或第三位，其重要性不容忽視。直到1980年代後期對症狀及發生原因有更進一步了解之後，才認為是經由輸血所引起的急性呼吸窘迫症候群定義排除病人本身臨床上所表現的心臟或呼吸系統症狀外，經輸注含血漿的血液製品6小時內，產生急性呼吸困難、肺水腫、血壓降低及體溫升高1℃以上的症狀。徵候及症狀fromtheAmer

3、icanRedCross(ARC)BloodServicesevaluate550reportsofsuspectedTRALIintheirnationaldatabaseandreachseveralprovocativeconclusions1)63percentoffatalitieswereassociatedwithplasmainfusion,2)femaledonorsweredisproportionatelyimplicated,3)reactionswereproportionaltothevolumeofplasmainfuse

4、d,4)limitingplasmafromfemaledonorsmightpreventAmpledatasupportadoptingstrategiesthatavoidthetransfusionofplasmafrommultiparousfemales.comparedcardiopulmonaryresponsesin100intensivecareunitpatientstransfusedwithaunitoffresh-frozenplasma(FFP)fromamultiparousfemale,toFFPfromadonorw

5、ithnohistoryofprevioustransfusionorpregnancyclinicallyapparentpulmonaryreactionsareassociatedwithtransfusionofantibodiestowhitebloodcells(WBCs),particularlyneutrophil-specificantibodies(NSAs)AnimalmodelshavedemonstratedthatNSAscancauseacutelunginjurySeveralcasereportshavelikewis

6、eassociatedthetransfusionofbloodcomponentscontainingHLAantibodieswithTRALI.AnanimalmodelalsosupportsaroleforHLAClassIantibodiesinacutelunginjury輸血相關的急性肺損傷須與其他輸血反應及心因性肺水腫鑑別。此症候群有兩型：免疫型及非免疫型。免疫型常因所輸血品中含有白血球抗體（包括對抗：「人類嗜中性白血球抗原(humanneutrophilantigens,HNA)」、「HLAClassI抗原」及「HLAClassII

7、抗原」的抗體）醫學界還不確定TRALI成因，但懷孕婦女血液中的免疫細胞嫌疑最大。女性懷孕時，身體會對來自胎兒父親的「外來」細胞產生抗體，這種抗體對孕婦、胎兒或絕大多數輸血者無害，可是少數輸血者的白血球會察覺到此抗體，導致輸血者肺部水NationalBloodService,whichsuppliesmorethan80percentofbloodintheUnitedKingdom,hasintroducedapolicyofpreferentialuseofplasmacollectedfrommaledonors.limitedavailabili

8、tyofABplasmamightrequireplasmafromfemaledonorsW