tailieunhanh - Hanbook of pediatric transfusion medicine - part 4

Trong trường hợp đặc biệt, nước muối, rửa sạch các tế bào máu đỏ (hồng cầu) có thể là cần thiết để giảm nguy cơ phản ứng bất lợi cho thành phần nhất định (s) trong huyết tương hoặc trong các giải pháp lưu trữ bảo quản. | CHAPTER 10 Washed and or Volume-Reduced Blood Components S. GERALD SANDLER MD AND JAYASHREE RAMASETHU MD FAAP INTRODUCTION In special situations saline-washed red blood cells RBCs may be needed to reduce the risk of adverse reactions to certain constituent s in plasma or in the preservative storage solution. For example small infants may require saline-washed RBCs if freshly collected RBCs are not available for rapid or large-volume transfusions during exchange transfusions extracorporeal membrane oxygenation ECMO procedures cardiopulmonary bypass or liver transplantation. Also children with recurrent severe allergic reactions including IgA anaphylaxis may require saline-washed RBCs to reduce exposure to allogeneic plasma proteins. RBCs salvaged from sterile surgical fields or traumatic injury sites should be saline-washed to remove tissue debris and other potentially biologically active material before return to the patient. In children with T activation and hemolysis saline-washed RBCs avert the risk of further hemolysis induced by anti-T in normal donor plasma. Washed platelet concentrates are rarely required. However washed maternal platelets may be the only source of serologically compatible platelet transfusions for a fetus or newborn with neonatal alloimmune thrombocytopenia. Occasionally group A B or AB patients may require volume-reduced pooled random-donor or single-donor apheresis platelets if out-of-group platelets are the only platelet components available to avoid ABO-related hemolysis. Super-concentrated or recentrifuged platelets to reduce volume and prevent circulatory overload are rarely necessary. Conventional doses of standard platelet components 5 to 10 mL kg should be tolerable for most children including preterm infants and newborns and are usually adequate for increasing the platelet count to a safe level. For the rare small infant who requires reduction of all intravenous IV fluids to avoid circulatory overload protocols are available for .