医疗系输血医学白细胞血小板.ppt

* 肺损伤只是一种短暂的现象，48-96小时后氧分压一般可恢复到输血前水平。而胸片96小时后一般也恢复正常。该病的死亡率较高，可达5-10％。是目前输血的三大杀手之一。 * Figure 1. Chest x-rays and microscopic pathology examination of a patient with fatal TRALI. (A) Chest x-ray of the patient before surgery demonstrating low lung volumes with subsegmental bibasilar atelectasis, no evidence of pleural effusion, focal consolidation, or pneumothorax, and normal cardiomediastinal silhouette. (B) Chest radiograph at the time TRALI was recognized, which demonstrates extensive bilateral areas of consolidation in the mid and upper lobes of the lung consistent with aspiration or edema with a normal cardiac silhouette, new since the previous examination earlier on the same day. The endotracheal tube tip is 6 cm above the carina, the nasogastric tube is coiled within the hypopharynx before extending to the proximal trachea, and the right internal jugular introducer sheath tip overlies the proximal superior vena cava. These extensive areas of consolidation in mid and upper lobes are most concerning for noncardiogenic pulmonary edema. (C) Plastic-embedded histologic sections of the lungs at autopsy were stained with hematoxylin and eosin, toluidine blue, or Jones stains, and were examined by light microscopy under an OptiPhot-2 microscope equipped with a 20 x/0.4 objective lens (Nikon, Melville, NY). Images were photographed with a Nikon CoolPix 4500 camera and acquired with Apple Mac OS x 10.3.5 (Apple, Cupertino, CA) running Portfolio 7 software (Extensis, Portland, OR). There is significant extravasation of PMNs into the alveoli and air spaces with interstitial and intra-alveolar edema (blue arrows). Toluidine blue and Jones stains demonstrate dilated capillaries and a prominence of inflammatory neutrophils in the capillaries and air spaces (yellow arrows). Histologic findings are consistent with early acute respiratory distress syndrome * 血小板抗原与相关疾病 -血小板减少症 -血小板输注无效症 -新生儿同种免疫性血小板紫癜(NAIT) 预防 IVIG: Blood, 1990; 313-16: 400 mg/kg 5天. 不相合的供者血小板输注后；增加 1-6 ho