血液及其相关制剂在特护病房重病房的应用.pptxVIP

大纲说明; ;3; ;;Severe Sepsis: New Concepts in Pathogenesis and Management;7;Drotrecogin Alfa (Activated); ;;Mortality and APACHE II Quartile;Mortality and Numbers of Organs Failing;Recombinant Human Activated Protein C (rhAPC); ; ; ; ;“Who ?＂Patient selection for rhAPC;19; ; ;Heparin Effect in Drotrecogin alfa (activated) Treatment; ;Transfusion Strategy (PRBC) in the Critically Ill Patients;Blood Products AdministrationRed Blood Cells;Conditions in Septic Patients that May Require a Higher Hemoglobin;Documented coagulopathy Bleeding Planned invasive procedures Warfarin intoxication Grade E; Platelet administration Transfuse for ≤ 5000/mm3 (prophylaxis) Transfuse for 5000/mm3 30,000/mm3 with significant bleeding risk Transfuse 50,000/mm3 for invasive procedures or bleeding Grade E;先看症状再看数值, 治疗病人而非血色素 一般内科病人 7 gm/dl 一般外科病人 7~10 gm/dl Acute coronary syndrome 10 gm/dl 化疗及放射线治疗 10 gm/dl ;治疗性, 视出血状况而定 预防性 (感染发热) 20,000/ul (非感染发热) 15,000 - 5000/ul Massive transfusion ITP TTP 不可直接输血小板 ; 治疗性输血PT17.5 seconds 预防性输血PT17.5 seconds 肝病合并多凝血因子缺乏 血栓性血小板低下症;什么时候可以输白血球?;有弥漫性血管内凝血者(DIC)?; ; 避免TA-GvHD by lymphocytes Donors 是HLA-haplotype 相似 Recipients 是细胞免疫不全 理论上只有washed PRBC, FFP, cryoprecipitate不用照;所有的血品理论上都要加粗过滤器(170um) 白血球过滤器 vs 减白血球制品 (5x106) 参考价 reduced WBCs, NT 4200 leucocyte filter, NT 900-1200 usual iv set, NT 6.7 transfusion set, NT 16.7; RAPID TRANSFUSION COLD AGGLUTININ PAROXYSMAL COLD HEMOGLOBINURIA COLD ALLOANTIBODY ;输血速度怎么决定?;Risks of Transfusion of Blood Products;Do not use erythropoietin (EPO) to treat sepsis-related anemia. Granulocyte growth factor (G-CSF) IntraVenous ImmunoGlobulin: IVIG Monoclonal anti-CD14 antibody Antithrombin Albumin (5%) Coagula