๊ธ‰์„ฑ ์šฉํ˜ˆ์„ฑ ์ˆ˜ํ˜ˆ๋ฐ˜์‘ / Acute hemolytic transfusion reaction

์ •์˜

์ˆ˜ํ˜ˆ ์ค‘ ๋˜๋Š” ์งํ›„ ๋ถ€์ ํ•ฉ ์ˆ˜ํ˜ˆ ๋“ฑ์œผ๋กœ ๊ธ‰์„ฑ ํ˜ˆ๊ด€๋‚ด ์šฉํ˜ˆ์ด ๋ฐœ์ƒํ•˜๋Š” ์ค‘์ฆ ์ˆ˜ํ˜ˆ๋ฐ˜์‘.

์ž„์ƒ ํ•ต์‹ฌ

๋ฐœ์—ด์ด ์ „ํ˜•์ ์ผ ์ˆ˜ ์žˆ์ง€๋งŒ ์ดˆ๊ธฐ์—๋Š” ์ €ํ˜ˆ์••๋งŒ ๋ณด์ผ ์ˆ˜ ์žˆ์–ด fever absence๋กœ ๋ฐฐ์ œํ•˜์ง€ ์•Š๋Š”๋‹ค. ๋“ฑ/์˜†๊ตฌ๋ฆฌ ํ†ต์ฆ, DIC, hemoglobinuria๋ฅผ ์ ๊ทน ํ™•์ธํ•œ๋‹ค. ์ˆ˜ํ˜ˆ ์ค‘ ์ €ํ˜ˆ์••์ด ์ƒ๊ธฐ๋ฉด hypotensive transfusion reaction์œผ๋กœ ๋‹จ์ •ํ•˜๊ธฐ ์ „ ๋ฐ˜๋“œ์‹œ ๋ฐฐ์ œํ•ด์•ผ ํ•œ๋‹ค.

์ง„๋‹จ

์ฆ‰์‹œ ์ˆ˜ํ˜ˆ์„ ์ค‘๋‹จํ•˜๊ณ  ํ˜ˆ์•ก๋ฐฑ/์ˆ˜ํ˜ˆ์„ธํŠธ๋ฅผ ๋ณด์กดํ•ด ํ˜ˆ์•ก์€ํ–‰์— ์—ฐ๋ฝํ•œ๋‹ค. clerical check๋กœ ํ™˜์ž-ํ˜ˆ์•ก์ œ์ œ mismatch๋ฅผ ํ™•์ธํ•œ๋‹ค. ํ˜ˆ์•ก์€ํ–‰ workup์œผ๋กœ repeat ABO/Rh, DAT, plasma free hemoglobin ๋ฐ hemolysis check๋ฅผ ์‹œํ–‰ํ•œ๋‹ค. CBC, CMP, bilirubin, LDH, haptoglobin์„ ํ™•์ธํ•œ๋‹ค. UA๋กœ hemoglobinuria๋ฅผ ํ‰๊ฐ€ํ•œ๋‹ค. ์ค‘์ฆ์ด๋ฉด PT/aPTT/fibrinogen/D-dimer๋กœ DIC๋ฅผ ํ‰๊ฐ€ํ•œ๋‹ค.

์น˜๋ฃŒ

NS๋กœ ์ •๋งฅ๋กœ๋ฅผ ์œ ์ง€ํ•˜๊ณ  ABC ๋ฐ ํ˜ˆ์—ญํ•™์„ ์•ˆ์ •ํ™”ํ•œ๋‹ค. ํ‰๊ฐ€ ์ „ ๋™์ผ product ์žฌ๊ฐœ๋Š” ๊ธˆ์ง€ํ•œ๋‹ค. ํ˜ˆ์•ก์€ํ–‰ ๋ฐ ๊ธฐ๊ด€ ์ˆ˜ํ˜ˆ๋ฐ˜์‘ ํ”„๋กœํ† ์ฝœ์— ๋”ฐ๋ผ ์ถ”๊ฐ€ ์ฒ˜์น˜์™€ ๋ณด๊ณ ๋ฅผ ์ง„ํ–‰ํ•œ๋‹ค.

์ถœ์ฒ˜

CDC/NHSN transfusion reaction criteria; AABB transfusion reaction workup.

๐ŸŒฑ ์ถœ์ฒ˜ raw

๋ณธ ๋ฌธ์„œ๋Š” ํ•™์Šตยท์ฐธ๊ณ ์šฉ์ด๋ฉฐ ์‹ค์ œ ์ง„๋ฃŒ ๊ฒฐ์ •์€ ์ž„์ƒ์˜์˜ ํŒ๋‹จ์ž…๋‹ˆ๋‹ค.