• 대한수혈학회지
• /
• 제29권3호
• /
• pp.320-327
• /
• 2018

72세 남자 환자가 전신 무력감을 호소하면서 본원 혈액내과 외래로 내원하였다. 환자는 내원 2년 전 온난자가항체에 의한 자가면역용혈빈혈로 진단받고 치료 중이었다. 내원 당시 환자의 혈색소 수치는 6.3 g/dL로, 빈혈을 교정하기 위해 수혈이 의뢰되었다. 환자의 혈액형은 A형, RhD 양성이었고, 비예기항체 검사에서 범응집 소견 및 자가대조검사에서 양성 소견을 보이고 과거 교차시험에서 최소반응강도를 보이는 적혈구 3단위를 수혈받은 기왕력이 있어, ABO 동형의 적혈구와 교차시험을 하여 최소반응강도를 보이는 적혈구 1단위를 출고하였다. 환자는 수혈을 받은 후 별다른 증상 없이 귀가하였으나, 귀가 후 약 5시간 후부터 발생한 발열, 오한, 호흡곤란, 복통, 혈뇨를 주소로 수혈 다음 날 본원 응급실로 내원하였다. Polyethylene glycol을 이용한 자가흡착검사 후 획득한 상층액을 이용하여 시행한 비예기항체검사에서 항-$Fy^a$가 동정되어, 자가 항체에 의해 가려져 수혈 전에 검출하지 못한 항-$Fy^a$에 의한 급성용혈성수혈반응으로 진단하였다. 본 증례를 통해 자가항체가 동정되는 환자에 대해서 반드시 공존하는 동종항체 확인에 대한 고려가 필요하다는 것을 인지하게 되었고, 이런 자가항체를 제거하여 검사하기 위해 자가흡착검사 방법에 대해 좀 더 익숙해질 필요가 있다는 경험을 하였다.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제17권3호
• /
• pp.163-181
• /
• 2017

In the field of orofacial surgery, a red blood cell transfusion (RBCT) is occasionally required during double jaw and oral cancer surgery. However, the question remains whether the effect of RBCT during the perioperative period is beneficial or harmful. The answer to this question remains challenging. In the field of orofacial surgery, transfusion is performed for the purpose of oxygen transfer to hypoxic tissues and plasma volume expansion when there is bleeding. However, there are various risks, such as infectious complications (viral and bacterial), transfusion-related acute lung injury, ABO and non-ABO associated hemolytic transfusion reactions, febrile non-hemolytic transfusion reactions, transfusion associated graft-versus-host disease, transfusion associated circulatory overload, and hypersensitivity transfusion reaction including anaphylaxis and transfusion-related immune-modulation. Many studies and guidelines have suggested RBCT is considered when hemoglobin levels recorded are 7 g/dL for general patients and 8-9 g/dL for patients with cardiovascular disease or hemodynamically unstable patients. However, RBCT is occasionally an essential treatment during surgeries and it is often required in emergency cases. We need to comprehensively consider postoperative bleeding, different clinical situations, the level of intra- and postoperative patient monitoring, and various problems that may arise from a transfusion, in the perspective of patient safety. Since orofacial surgery has an especially high risk of bleeding due to the complex structures involved and the extensive vascular distribution, measures to prevent bleeding should be taken and the conditions for a transfusion should be optimized and appropriate in order to promote patient safety.

• 기본간호학회지
• /
• 제22권2호
• /
• pp.180-189
• /
• 2015

Purpose: The purpose of this study was to identify the types of errors that occurred and were recovered in a simulated transfusion scenario by nursing students. Methods: Twenty-eight teams of a total of 89 nursing students participated in a transfusion simulation using a high fidelity simulator. Data were collected by observing rule based errors and built in errors recovered according to the framework of Eindhoven model. Reflective journaling was used to identify perceived safety-threatening errors and commitment to improvement. Data were analyzed using descriptive statistics. Results: All teams committed the rule based errors in the scenario. The most common errors occurred in the coordination category related to communication with physician. Most of students perceived the transfusion reaction as a safety-threatening error. Conclusion: The findings indicate that students lack patient safety competence. The simulation training to decrease errors and improve safe practice provides nursing students with an effective strategy to develop patient safety competence.

• Parasites, Hosts and Diseases
• /
• 제58권5호
• /
• pp.565-569
• /
• 2020

This report describes the first clinical case of a transfusion-associated Mycoplasma haemocanis infection in a dog in Korea. A 6-year-old male Maltese underwent a red blood cell transfusion for idiopathic immune-mediated hemolytic anemia. Eighteen days after the blood transfusion, the recipient's packed cell volume decreased and basophilic organisms were found on erythrocytes. A polymerase chain reaction and sequential analysis showed that both the donor dog and recipient dog had M. haemocanis. Six weeks after doxycycline administration, no organisms were detected and the recipient's anemia had improved.

• 한국임상수의학회지
• /
• 제34권3호
• /
• pp.197-199
• /
• 2017

A 14-year-old castrated male ShihTzu diagnosed with chronic kidney disease (CKD) 6 months prior was referred to our clinic. The patient had been experiencing symptoms such as vomiting, poor appetite and hind limbs weakness. Hematology tests showed that he had a non-regenerative anemia. With aggressive treatment, the patient's state had gotten worse. He showed ragged breath, vomiting blood and loss of consciousness temporarily. Hematocrit maintained low level. Gastric hemorrhage was strongly suspected by hematemesis. Whole blood transfusion was performed and heparin was used as an anticoagulant. Prior to transfusion, the blood cross matching between donor and patient was performed and the result was compatible. After the transfusion was stabilized, 1 mg of protamine sulfate for each 100 units of heparin was prepared and given intravenously over 3 minutes to reverse the effects of heparin. Immediately after protamine injection, the patient conducted severe anaphylactic shock. Protamine sulfate is used to reverse the anticoagulant action of heparin in dogs and humans. The adverse reaction of protamine sulfate range from mild reaction to fetal cardiac arrest. When using protamine sulfate as heparin neutralization, it can lead to the death of a patient cause of anaphylactic shock. For this reason, the protamine sulfate should be injected slowly with antihistamine and the clinician should carefully monitor patients.

• 한국임상수의학회지
• /
• 제34권5호
• /
• pp.356-358
• /
• 2017

A dog (neutered male Schnauzer, 11 years old, 8 kg) presented with recurrence of immune-mediated hemolytic anemia. Rapid whole blood transfusion was initiated, and then sudden tachycardia and dyspnea were observed. Invasive arterial blood pressure, arterial blood gas analysis, and thoracic radiograph indicated transfusion-associated circulatory overload (TACO). Persistent high blood pressure of 160-205 mmHg was observed; the thoracic radiograph revealed interstitial infiltration and a fissure line, which suggested pulmonary edema and pleural effusion. Despite furosemide administration and nasal oxygen supplementation, hypertension and respiratory distress were not completely controlled. Finally, cardiac arrest occurred and the patient expired due to TACO 24 hours after the transfusion.

• 한국동물위생학회지
• /
• 제41권4호
• /
• pp.271-276
• /
• 2018

This study was conducted to investigate the prevalence of dog erythrocyte antigen (DEA) 1 with DEA 1.1 and DEA 1.2 on 122 Jindo dogs (29 males, 93 females) from 2014 to 2015 using a monoclonal antibody card kit (blood typing card kit, Korea Animal Blood Bank Inc., South Korea). Among the tested dogs, 14.8% (18/122) were positive for the DEA 1.1 antigen and 85.2% (104/122) were positive for the DEA 1.2 antigen. The prevalence of positive types for the DEA 1.2 antigen was significantly higher than the DEA 1.1 antigen (P<0.01). The prevalence of positive types for the DEA 1.1 antigen was higher in white-haired Jindo dogs than yellow-haired dogs (P<0.05). However, there was no gender difference in the prevalence of the DEA 1.1 antigen (P=0.665). The incidence of sensitization after the first transfusion without blood group test was 12.6% and the incidence of acute hemolytic transfusion reaction after the second transfusion in the same immunized dogs was 1.6%. Therefore, the blood group test for the DEA 1 antigen should be performed for Jindo dogs to ensure safe and effective transfusion therapy and further studies remain to be conducted for other DEAs among Jindo dogs.

• 대한의생명과학회지
• /
• 제23권2호
• /
• pp.111-117
• /
• 2017

Leukocytes in blood components are involved in diverse adverse transfusion reactions such as febrile non-hemolytic transfusion reactions. Therefore, leukocyte reduction is required to reduce these adverse reactions. The objective of this study was to compare the efficiency of pre-storage filtration and post-storage filtration. Filtration time, residual leukocyte count, RBC recovery, and hemolysis were assessed after pre-storage or post-storage filtration. Compared to pre-storage filtration, filtration time was prolonged and hemolysis was dramatically increased when post-storage filtration was performed. Residual leukocytes count and RBC recovery after post-storage filtration were similar with those obtained after pre-storage filtration. These results suggest that pre-storage filtration has better efficiency than post-storage filtration. These are thought to contribute to the production of better quality of leukoreduction blood components.

• Tuberculosis and Respiratory Diseases
• /
• 제61권5호
• /
• pp.473-478
• /
• 2006

저자들은 폐암 및 항암치료에 의한 만성 질환으로 유발된 중등도의 빈혈이 있어 농축적혈구의 수혈치료 후 발생한 호흡곤란 및 발열 호소하여 다른 원인 감별 후 수혈에 의해 유발된 급성 폐 손상 진단하에 대증치료후 환자의 증상은 호전되었다. 이러한 수혈에 의해 유발된 급성 폐 손상은 그간 국내에서 보고 된 적이 없었던 증례로 이를 문헌 고찰과 함께 보고하는 바이다.

• 대한임상검사과학회지
• /
• 제54권4호
• /
• pp.279-284
• /
• 2022

환자의 긴급 상황에서 수혈 시 일부 수혈 전 검사를 수행하지 않는다. 수혈 후 항체 선별검사를 실시하여 용혈성 수혈 반응을 일으키는 비예기 항체의 실태를 조사를 비교평가하기 위해 국내·외에 보고된 공시자료를 포함하여 조사하였다. 2014~2016년 P병원에서 항체 선별 검사 68,602건과 항체 동정검사 528건을 선정하였다. 68,602건 중 1,198건(1.74%)이 양성이며 Rh계열 161건(30.49%), Lewis계열 67건(12.69%), 기타(Di (a)등) 28건(5.30%)으로 나타났다. Anti-E는 93건(17.61%), c는 13건(2.46%)이다. 국내·외 공시자료 중 국내 경우는 2007년 이전에는 Anti-E 196건(22.45%), Anti-Le(a) 82건(9.39%) Anti-E+c 60건(6.87%)으로 조사되었지만 2008년 이후에는 Anti-E 107건(17.12%), Anti-E+c 56건(8.96%), Anti-Di (a) 28건(4.48%)으로 조사되었다. 한편 다른 국내의 경우는 S병원(2012~2015년)에는 Anti-E, Anti-Le (a), Anti-E+c이며Anti-E+c이며 D병원(2016~2017년)에는 Anti-E, Anti-D Anti-E+c,Anti-E+c, Anti-C+e로 조사되었다. Saudi의 경우는 Anti-D, Anti-E, Anti-Jk (a)순이며, India 경우는 Anti-M, Anti-N, Anti-Le (a), Anti-D로 조사되었다. 권역별 외상센터 개설 전후시기에 응급수혈요청의 빈도 비교에서는 1.8배 이상이 증가한 것으로 조사되었다. 결론적으로 장기간의 항체분포로 효율성을 검증할 수는 없었지만 수혈의 안전성을 높이고 응급 수혈 상황에서 용혈성 수혈 부작용을 줄일 수 있는 대안을 위해 기초 정보를 제공하고 추가적인 검증연구가 필요할것으로 사료된다.