Blood Safety

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????????
??????? ???
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Blood Safety

• ???th Congress of the International Society of
  Blood Transfution(ISBT)
• Increasing Patient Safety and Blood
  Availability a 21st Century Paradigm
• Shift

3
?????????

• ????????87ml
• ???????Hblt60g/L
• ????????
• ?????????????
• ?????????????

4
??????????

• 2009??????????35000?
• ?????30000U,??????0.86U
• 2009????????35000?,?
• ????34988U,??????1U
• 2010????36600?,??0.81U

5
???????????????

• ????2000???,???????2?????3000????
• ????3500???,2011?????7.6?????4000?????

6
???????????

• ?????????????2009???????????,??????????,?????17,
  ?????7
• ????????????????????

7
???????????

• ????????????????4.7,?????9,??0.4
• ????,??????????????????,???????????????
• ????????????

8
????????

• ???????????,Hblt70g/L
• ??????????24hr?????Hb7080g/L
• ?????????,??????Hb?100g/L?Hct?0.30

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????????

• ??????????????????????????????????????????????????
  ????,??Hb70100g/L

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????????

• ????????????
• ????3U

11
????????

• ?????????
• ?????lt6U
• ??????????????

12
????????????

• ????????,Hb?????
• Hb??????????,????????
• ?????
• ??????
• ????????

13
???????????

• ?????????????
• PT?APTTgt???1.5?
• ?????
• ???????
• ?????????????
• ???????
• ????????????????

14
????????

• Pltlt50109/L????????????
• Pltlt100109/L,???????????
• ?????????????(??????????????????),?????????

15
????????

• Plt gt 50109/L ????
• Plt 10 50109/L ????
• Plt lt10109/L ????

16
??????

• ???
• ????
• vWF??
• ?????
• ??????

17
????????

• ????????????????
• ????????(lt1g/L)
• DIC???
• VitK?????????
• ??????,????????DIC

18
????

• ??????????
• Hb?Hct??????
• ???600800ml?????????
• ?????????
• ?????????

19
??????

• ?????????????????????????????????????????????,????
  ?????????????????????NO?ATP?

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????(????)

• ??????,?????
• ??????????
• ???????
• ??,NO??????????????????

21
??????

• ?????????????????????????????????????,?????????,??
  ???????????

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?????????

• ??3hr?????NO??70
• ??35-42????NO????
• ??????????????,?????15-18
• ????????,?????18
• ?????????????????
• ??????EPO?????????

23
6-542?????????

• ?a??
• ??????????
• ?????????5-???

24
??????

• ??????????????????????????????????????????????????
  
• Global circulation?????????????????,??????????????
  ??

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????????
26
????????

• ???????????????,????????,???????????????????????
  ??
•  

27
????????

• ??????
• ?????????,?????,???????? ???????????????????

28
????????

• ????
• ??????????,????????,???????????,?????????
  ??????DIC??????????

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?????????????

• ???????????
• ???????,??????,????,??????
• ???????,???????
• Plasmatic microvessels?????????????

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?????????????

• ?????,????0.10.2/S?,???????????
• HCT???
• ???????????
• ????????????

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????????????

• ??????
• ????????????
• ????45??????????2030??????????
• ??????????

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DIC?????(DIC???)

• ???DIC??????,??????????
• ????????,?????,??????,???????
• ????????????,?????????
• ????????????

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?????

• ?????????,????????????????????????DIC?
• DIC???????,????????????????????
• ???????????????????????,???????DIC???

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?????????????

• ?????,??cap???
• ????????,??????
• ??????????,???????,???????

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????????????????

• Frame from the real-time video recording of
  microcirculation. ??????2????3??????????????
  ??????????????

36
????????????????

• ????2??????????????(??)
• ??? 91.8
• ??? 83.2

Tissue oxygenation levels
37
???????????

• ?????????????????,???????????
• ???????????????????,???????????

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???????Massive bleeding

• 24???????????
• 3??????gt1/2?????
• ????gt150ml/min

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???????(??)Massive transfusion,MT

• ???????gt10U
• ????gt2000ml

40
????

• ???????????????50
• ????????????50
• RBC??gt20U???????
• ?????????????????
• ???????

41
?????????

• ????????????????????????????????
• ??????????????
• ???????????,??????32??,?????????,??????
• ??????HES??VWF?F???

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?????????

• ???gt2500ml??????
• ???gt5000ml?1/3?????
• ?????7000ml??????
• ??????????????,???????????????????

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??????

• ?????????????,????,????
• ??????????,??????
• ????40?????????????50100109/L,????????????

44
??????

• ?????????????????
• ????????
• ????????????

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????????

• ???,???
• ???,???
• ????,???
• ???????
• ??FFP????????????????,????????

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??????Massive Transfusion Protocol,MTP

• ?????????????????
• ??????????????,?????????,????????????,????????????
  ,?????,??????,??????????

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??????Massive Transfusion Protocol,MTP

• ?????????MTP6U????4U???????1U???????????(641),?
  ??????????????MTP?,??????????????,?????????????1?M
  TP
• ??MTP?????????????

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??????Massive Transfusion Protocol,MTP

• ????????????MTP

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??????Massive Transfusion Protocol,MTP

• ??????????????????????????????MTP
• ????????????
• ?30???????????,????????????

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??????Massive Transfusion Protocol,MTP

• ?????????MTPRCC68U?FFP4U??????1U/7kg,,??????507
  0109/L
• ??????,??FFP???68U
• ????????rF?a(6090ug/kg)

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??????Massive Transfusion Protocol,MTP

• rF?a(Niastase)????????,???????????????,??????????
  ?????,?????????

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??????Massive Transfusion Protocol,MTP

• MTP?????
• ?????RCCgt10U
• ??RCCgt5U,????????
• ???????????????????

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??????Massive Transfusion Protocol,MTP

• 641???Hct40?????
• ??????,??????????
• ???MTP????

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????????()
?? ?? ?? ??
?? 0.03 0 1.88 0.5 ??? 37.01 34.2 29.26 42.89 ?? 36.02 36.1 28.09 11.96 ??? 6.11 10.24 4.69 ??? 20.22 19.46 40.77 39.96 ??? 0.61
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????????

• ?????????MTP
• ???????,??37????????????????????
• ???????????,???????????,?????????
• ?????????????

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MTP???

• Hbgt80g/L
• Pltgt75109/L?????????????2???????????????
• ???????????,??Plt??100109/L,PT?APTTlt???1.5?
• Ca2gt1.13mmol/L
• ?????gt1.0g/L

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MTP?????

• ????????????,????????????,????????
• ???????,???????????????,?????????
• ??????????
• ??????MTP???????

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? ?
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?????

• ???????????ICU???????????,?????30-50?

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????????????

• Disseminated Intravascular Coagulation
• ????????????, ?????????????,??????????????????,
  ?????????????????????????????????????

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????????????

• ??????????,????????,????,??????????
• ???????????????,?????????????,????????
• ??????????????????ATP????????????????,??????
• ?????????????
• ???DIC???

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???????????

• TNR-a?IL-1?IL-6?????,?
• ????????
• ???????
• EPO????
• ??????????,?????
• ??????????????

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???????????

• ????
• ??????
• ??????
• ?????????

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??????

• ??????????????????????,????????

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???????????
??????????????
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???????????

• DIC ????????????????
• ??????DIC??????????,????????
• ????DIC????????????
• ????DIC??????????????????????,??????

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???????????

• Miller???????????????????????????,????????????????
  ??????????
• ???????????????,???????????
• ?????????????????????????,??????,???????????????,?
  ?????????????

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???????????

• ???????????????
• ?????????????,??????????
• ???????
• ATP??,??????????

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????????????

• ??????????????????????????
• ???????

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????????????

• ???????????? Hb ??????????????,????????????? Hb
  100 g/L ???????????????????????????

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????????????

• ???????
• ????????????,????????
• ?-??????????
• ??????

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?????????

• ???(??????????????),?????????????
• ??????????????
• ????,??????
• ??????cap??????
• ?????

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???(????)?????

• ????????,??????
• ??????,?????
• ?????????,cap???
• ????
• ??????,????????
• ???????????????DIC

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TRALI in JAPAN
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??TRALI???

• ???
• ???????????
• ???
• ???????????????????????????,????1/800,????11
  0?

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TRALI???

• ????????6?????
• ????,???????????
• ??X??????????
• ????18mmHg
• ????300mmHg
• TRALI????,????,??????????

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TRALI?????

• ????????????????????? ???? ??????? ????
• ????????????????????
• ???????????????????

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??TRALI???

• ??????
• ???????????

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???????1

• ?????,67?,Hb139g/ L,??????,?????,??????????RCC15U,
  FFP1650ml,???Hb128 g/L?

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???????2

• ???????,??????,???RCC4U,FFP1400ml,??800ml?

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???????3

• ?,44?,????,??Hb142g/ L,Hct50.9,????800ml,??RCC3U,
  ??????????
• ?4???(2???,1???,1???),??????,????Hb???135g/ L???

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???????4

• ??,41?,??????,??Hb152g/ L,????600ml,??RCC7U,FP300m
  l
• ?,40?,???, Hb114g/ L,Hct35.5,????300ml,??RCC3U?

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???????5

• ??????,Hbgt 74g/ L,??RCC6U?

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???????6

• ?,65?,???,?????,??????8001000g, Hb96g/
  L,Hct32.5,2????RCC6U?

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???????7

• ?,80?,MDS????, Hb47g/ L,?5??????RCC1.5U10?,?Hb???
  ??113g/ L?

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???????8

• ??,42?,?????????,Hb3040g/ L, Plt3540109/L,
• ????RCC1.5U 23?,PC12?,
• ???RCC85?,PC23?,????
• ?????,??????????
• ?,???

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???????9

• ?,27?,??????, Hb101g/L,??2?,?? RCC1.5U4?,????????
  ??,???????????,???

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???????10

• ?,54?,???????????????,????????????,?????RCC10U,Hb?
  ????,??????,??????????

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???????11

• ?,60?,?????,???30.5g/L,???10g/L ?
• ??????,????
• Hb?100g/L???65g/L?
• PT?APTT??1.5????
• ?????RCC2U6?,FFP1000ml?
• ?DSA??,4h????

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???????12

• ????????,PT?APTT???,??FFP600ml?
• ??????, Hb145162g/L, PT?APTT??,?????,??????,??FFP
  150 ml6??

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???????13

• ??????????,??,??????,????1400ml
• ????????????????

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???????14

• ?,96?,COPD?????,???????,?????,??3?????900ml?

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???????15

• ?,70?,ITP,????,??????,Plt50109/L,?????????????,??
  ?1h??Plt70109/L,1d?Plt???10109/L?
• ?,25?,SLE,Hb113139g/L,Plt1924109/L,????????????
  ???

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???????16

• ?,45?,???5h?????????PT?APTT????(gt???1.5?)Plt10410
  9/L
• ??????????????5000ml????RCC1.5U15?,FFP150ml5????
  ???????,Plt25109/L

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???????17

• ?,48?,?????,??????????RCC22U,FFP2150ml,Cryo5?,???3
  3?,Hb103g/ L,Plt172109/L,??????,7?????????,?????

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???????18

• ?,38?,???,?????,???Hb108.4g/L,Hct32,Plt130109/L?
  ???5500ml,??RCC1.5U16?FFP150ml4?,FP150ml11?,???
  Plt36109/L,PT19.6,APTT109.9,????????1?,2h??????

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???????19

• ???,???????,????, Hb135140g/L, Plt230109/L
  PT25.6s,APTT114.9s,?????0.75g/L,?RCC0.75U2,?????,
  ?????

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???????20

• ?,50?,???????,??Hb105g/L,Pt289109/L?????800ml,??R
  CC4U??????????,????????300ml,??????,???????WBC1.3
  109/L,N85,Hb56g/L,Pt18109/L???????RCC?????

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???????21

• ?,38??SLE??AIHA?Hb45109/L
• ????????AB?(??????)
• ???????AB?RCC4?(7.5U),?????????????????????,???
  ???????15???,???????????,???????????,?4????2??????
  ?????,????,?????????????O???

100
????????????????

• ?3????????????
• ????ABO????,?O??
• ????????
• ???????????????,???????Rh???,??,1?????????

101
????????????????

• ????????????,??2???????
• ???1??????????????
• ????????8???????,????????

102
?????

• RhD?????????,?????????
• RhD???????????????
• ???????
• ??????????

103
?????

• ????????
• ????
• ??
• ????????

104
?????

• ?????????????????????????????,??????????????
  ,??????????lt10

105
?????

• ???????(???????????),?????,?????????,?????????,???
  ?????,????????
• ????????????????????,?????,?????

106
?????

• ??????????,??????

107
?????????????

• ???????????????
• ??????????????????????????????
• ??????

108
????

• ???????????????,???????????????,?????????????????
  ????????
• ??????????
• ????????????????
• ?????????????,?????????????,????????,??????????

109
????

• ?????????????,????????,??????????
• ???????????MTP????????,??????????????,????????????
  ?,??????,???????
• ????????,????????????????,????????????????

110
????

• ?????????????????????????,????????????????,???????
  ??,?????????????,?????????????,????????????????6
  0???

111
????

• ??A??O??????,???????????????????,???????,???????
  ?????????

112
Thank you !