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输血不良反应的诊断标准

2017-10-24 12页 doc 39KB 22阅读

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输血不良反应的诊断标准输血不良反应的诊断标准 输血不良反应的诊断标准 一、 非溶血性发热反应 1、 原因:属于血液成分引起的免疫反应,大多数发热反应与多次 输入HLA不想合的白细胞、血小板有关。 2、 症状与体征 一般在输血开始15分钟至2小时,突然发热、 胃寒、寒战、出汗,体温可达38~41?。个别患者可伴有恶 心、呕吐、皮肤潮红、心悸 和头痛。血压多无变化,30分 钟至2小时后症状逐渐缓解。 3、 诊断 (1) 输血开始至2小时以内体温升高1?以上,并伴有发热症 状。 (2) 受血者有多次输血或多次妊娠史,既往有输血发热反应病 史,...
输血不良反应的诊断标准
输血不良反应的诊断 输血不良反应的诊断标准 一、 非溶血性发热反应 1、 原因:属于血液成分引起的免疫反应,大多数发热反应与多次 输入HLA不想合的白细胞、血小板有关。 2、 症状与体征 一般在输血开始15分钟至2小时,突然发热、 胃寒、寒战、出汗,体温可达38~41?。个别患者可伴有恶 心、呕吐、皮肤潮红、心悸 和头痛。血压多无变化,30分 钟至2小时后症状逐渐缓解。 3、 诊断 (1) 输血开始至2小时以内体温升高1?以上,并伴有发热症 状。 (2) 受血者有多次输血或多次妊娠史,既往有输血发热反应病 史,或受血者或献血者血清中有HLA、粒细胞和血小板抗 体。 二、 过敏反应 1、 原因 (1) IgA抗体和IgA同种异型抗体:由于多次输血可使缺乏IgA 患者产生类特异性抗-IgA抗体,当再次输血时可引起严重 的过敏性休克; (2) 过敏体质:有过敏体质的患者,输血浆时,特别是含有变 性蛋白血浆,会引起过敏反应。另外受血者对某些药物过 敏,而接受用过青霉素等药物的献血者血液,也可引起严 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 重的过敏反应。 (3) 过敏体质的鲜血者、免疫球蛋白多聚体等。 2、 症状和体征 (1) 轻度过敏反应:全身皮肤瘙痒、皮肤红斑、荨麻疹、血管 神经性水肿和关节痛。 (2) 重度过敏反应:支气管痉挛、喉头粘膜水肿、呼吸困难、 哮喘、发绀,更严重者出现过敏性休克。有些患者可伴有 发热、寒战、恶心、呕吐、腹泻、腹痛等。 (3) 相关实验检查: ? 嗜酸性粒细胞:血液中嗜酸性粒细胞增多。 ? IgA:患者血浆中IgA的含量低于0.05g/L,抗IgA抗体滴 度>1:256. 三、 急性溶血性输血反应 1、 原因:患者接受不相容红细胞或对其自身红细胞有同种抗体 的供着血浆,使供着红细胞或自身红细胞在体内发生异常破 坏,而引起的不良反应,最严重的是ABO血型不合。 2、 症状与体征:发冷、寒战、发热、头痛、腰背酸痛、腹痛、 胸前压迫感、呼吸困难、发绀、血红蛋白尿、黄疸等;严重 者发生休克、DIC和急性肾衰竭。在此处于全麻状态下,出 现不能解释的手术区严重出血及低血压。 3、 诊断 (1) 根据症状判断:在输血过程中或输血后患者出现寒 uirements: understand various image checkls reqow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skilroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flse thyestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal diseaies: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intdisease myocardial infarction ... 3. high requirements (1) learning disease spec-of study requirements: severe pneumonia in diseasee of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases urbancure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disttechnology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failgency d card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emerpplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adaptea200 宁城县蒙医中医医院输血科 NCXMYZYYYSXK 战、高热、腰背酸痛、面部发红、尿呈酱油或葡萄酒色, 或全麻状态下,手术野过度渗血或出血不止,患者发生不 明原因的血压下降,均应考虑急性溶血反应的可能。 (2) 两项初步检查 ? 肉眼比较患者输血前后血浆的颜色,如果输血前血标本颜色正 常,输血反应后血浆呈粉红色或红色,明血浆中有游离的血 红蛋白,提示血管内溶血;如果输血反应后血浆呈黄色或棕色, 表明有较高含量的胆红素存在,也是红细胞坏的依据。 ? 直接抗球蛋白试验:输血反应后血标本直接抗球蛋白试验阳性, 并呈混合外观凝集,是免疫性溶血的证据,但须与输血前血标 本直接抗球蛋白试验结果对比。 ? 两项初步检查中只要任何一项为阳性,或虽然两项检查均为阴 性但临床高度怀疑溶血性输血反应,必须进一步作系统的血型 血清学检查。如果两项检查均为阴性,又无明显临床症状,急 性溶性输血反应的可能性不大。 (3) 相关实验检查 ? 尿血红蛋白检测:最好在输血反应发生后4h内采集尿标本送 检,显微镜观察到红细胞破碎或新鲜尿标本离心后上层尿液出 现呈酱油或葡萄酒色。 ? 血清胆红素测定:溶血后血清间接胆红素呈一过性升高,溶血 快者1~2h胆红素开始升高,一般5~7h达到高峰,如果肝功能 和排泄功能正常,24h后可消失。 al: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medic rinaryongenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory uion ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart cdisease myocardial infarct-illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease e organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of theultiplshock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and mathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: ed card and clinical application; common life support technology (as cycle breapplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapts explicit like (2) clinical knowledge, and skills requirements: understand various image checkgland201 ? 血清结合珠蛋白测定:正常浓度约为1~1.5g/L,溶血后血浆结 合珠蛋白立即降低或消失。 ? 血常规检查:立即将患者血液作涂片检查,可发现大量红细胞 啐片。 (4) 系统的血型血清学检查 ? 复核血型:如果受血者输血前后血型不符,说明在受血者身份 核对、血型鉴定及配血采集血样过程中某个环节发生了差错, 应尽快追查。 ? 重做交叉配血试验:如果受血者输血前、后血标本与血袋剩余 血标本交叉配血均不配合,说明输血前交叉配血试验结果错误, 可能是供者标本搞错,也可能是配血操作或判读有错误。如果 输血前血标本重做交叉配血试验结果配合,输血后标本做交叉 配血不配合,由数天前输血引起回忆性免疫应答可能性较大。 ? 重做抗体筛检:可能检测出被漏检的不规则抗体。 四、 迟发型性溶血反应 1、 原因 由于反复输血或多次妊娠,使受血者已被不相容的血 型抗原致敏,产生相应抗体,再次输入不相容血液后,受血 者对先前致敏抗原产生免疫回忆反应而导致溶血 2、 症状与体征 在输血24h后,多半发生在输血3~7天,出现 发热、血红蛋白下降、黄疸、血浆胆红素升高。少数可出现 血红蛋白尿、发冷,寒战、腰痛、急性肾衰竭等。 3、 诊断 uirements: understand various image checkls reqow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skilroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flse thyestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal diseaies: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intdisease myocardial infarction ... 3. high requirements (1) learning disease spec-of study requirements: severe pneumonia in diseasee of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases urbancure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disttechnology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failgency d card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emerpplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adaptea202 宁城县蒙医中医医院输血科 NCXMYZYYYSXK (1) 凡有输血史、妊娠史或器官移植的患者,在输血后出现不 能用原发病不能解释的贫血症状,或血红蛋白下降,应考 虑迟发性溶血反应。 (2) 相关实验检查 ? 不规则抗体筛选试验:阳性 ? 血清胆红素:明显升高,以间接胆红素增高为主。 ? 血液涂片:患者血液涂片可发现大量球形红细胞。 ? 红细胞直接抗球蛋白试验:阳性 ? 交叉配血试验:采集患者血液标本,用抗球蛋白法,或聚凝胺 法与鲜血者做交叉配血试验。 五输血相关急性肺损伤 1. 原因 输入含有与输血者白细胞抗原相应的抗-HLA、抗粒细胞特 异性抗体的全血或含有血浆的血液成分,发生抗原抗体反应, 导致急性呼吸功能不全或肺水肿。 2. 症状和体征 常在输血后1~6小时内,突然寒战、咳嗽、气喘、 呼吸急促、发绀、血压下降。肺部听诊两肺可闻及细湿性音。X 线检查可见双侧肺浸润,但无心理力竭。 3. 诊断 (1) 急性呼吸窘迫,双侧肺水肿和低氧血症。 (2) 输注含血浆成分的血液制品是TPALI的直接诱因,常 规吸氧治疗不能改善病情,呼吸机辅助呼吸后迅速改 善病情。 s explicit like (2) clinical knowledge, and skills requirements: understand various image checkglandal: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medic rinaryongenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory uion ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart cdisease myocardial infarct-illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease e organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of theultiplshock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and mathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: ed card and clinical application; common life support technology (as cycle breapplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapt203 (3) 献血者和受血者有多次妊娠或输血史,尤其是献血者 ?3次妊娠史 (4) 患者动脉氧分压降低,肺契压正常或降低,中心静脉 压正常。 (5) 献血者或受血者血清抗-HLA或抗粒细胞特异性抗体 阳性;或献血者血清淋巴细胞毒试验阳性。 五、 输血后紫癜 1、 症状和体征 一般于输血后5~10天,突然发冷、寒战、高热、 荨麻疹、全身皮肤黏膜出血、瘀斑,甚至可有出血性荨麻疹, 鼻腔粘膜和口腔黏膜出血。严重者头痛、呼吸困难、休克、 少数者呕吐、便血、尿血、阴道出血等。 2、 诊断 (1) 症状和体征 9(2) 血小板计数明显减少,严重者血小板计数?1.0×10/L。 骨髓巨核细胞数正常或增多,血小板生成良好。 Al(3) 血清中抗PI抗阳性;有时抗HLA抗体阳性。 六、 细菌污染性输血反应 1. 原因 (1) 血袋、采集器具和输血器具消毒不严;血袋有破损。 (2) 献血者手臂皮肤清洗不彻底。 (3) 采血、血液成分制备中未严格执行无菌操作。 (4) 献血者有菌血症。 ow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skilroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flse thyestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal diseaies: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intdisease myocardial infarction ... 3. high requirements (1) learning disease spec-of study requirements: severe pneumonia in diseasee of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases urbancure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disttechnology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failgency d card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emerpplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapteauirements: understand various image checkls req204 宁城县蒙医中医医院输血科 NCXMYZYYYSXK (5) 血液储存温度过高。 (6) 血液储存前或输注前在室温中放置过久。 2. 症状和体征 发生剧烈发冷、寒战、高热、烦躁不安、面部潮红、 皮肤黏膜充血、头痛、腹痛、恶心、呕吐、腹泻、呼吸困难、 干咳、发绀、大汗、血压下降等临床表现。严重者发生休克、 急性肾衰竭和DIC.在全麻状态下患者可表现血压下降,手术野 渗血不止等体征。 3. 诊断 (1) 输入少量血后立即出现高热、休克、皮肤黏膜充血等,是 细菌污染反应的特征。在全麻状态下,以患者血压下降或 手术野渗血严重等表现为特征。 (2) 观察血袋剩余全血的物理性状。血浆如浑浊,有膜状物、 絮状物、气泡、溶血,红细胞变成暗紫色,有血凝块等, 提示有细菌污染存在。 (3) 取血袋剩余血直接涂片或离心后镜检,找到细菌即可做出 诊断。 (4) 取血袋剩余血和患者血液,分别在低温(4?)、室温(22?) 和377?作需氧菌和厌氧菌的细菌培养。 (5) 外周血白细胞总数和中性分叶核粒细胞明显增多,应与输 血前患者血常规比较更有意义。 s explicit like (2) clinical knowledge, and skills requirements: understand various image checkglandal: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medic rinaryongenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory uion ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart cdisease myocardial infarct-illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease e organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of theultiplshock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and mathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: ed card and clinical application; common life support technology (as cycle breapplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapt205
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