The colour of plasma.
The colour of plasma.
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血浆的颜色。
DOI：
10.1007/s12630-013-0078-5
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Brown4th,CharlesH
中科院分区：
文献类型：
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作者：
Kirk3rd,FLouis;Bandhlish,Anshu;Arora,Vivek;Brown4th,CharlesH
在一次重复的单肺移植手术中，一名患者出现了严重的凝血功能障碍伴出血，随后需要大量输血和血制品。从血库送来的三个单位的新鲜冷冻血浆（FFP）具有明显不同的颜色（图）。我们询问了手术室的麻醉科和手术团队成员，所有人都不知道病因，因此不知道是否适合输注其中一个单位（3号袋：绿色变色）。随后，该袋被送回血库。在随访中，我们意识到给患者使用这种绿色变色单位的FFP是安全的。我们不仅发现了医疗保健提供者在常规处理血液和血液制品输注方面的知识差距，而且还认识到宝贵的血库和手术室资源被转用于处理这个问题。麻醉医师必须识别FFP外观的正常和异常变化。因此，我们提出了一个简短的回顾，在日常实践中遇到的广泛的外观FFP。FFP（袋1）的典型黄色由胆红素、类胡萝卜素、血红蛋白和转铁蛋白赋予。含有甘油三酯的悬浮脂质颗粒可导致浑浊的乳白色外观（袋2）。这是由于捐献前脂肪餐后观察到的捐献者脂血症或捐献者高脂血症。除非甘油三酯浓度超过3，000 mg 4dL-1，否则这些单位对患者给药是安全的，因为甘油三酯浓度超过3，000 mg 4dL-1会干扰传染病的诊断测定。1绿色变色（袋3）是由血浆铜蓝蛋白水平升高引起的，发生在高雌激素状态下，包括妊娠或使用口服避孕药。绿色变色也可能是由于血浆单元被革兰氏阴性嗜冷生物污染所致，但在当今广泛使用抗生素的时代，这种情况很少发生。2鲑鱼色或红色FFP（袋4）是由全血生产FFP过程中红细胞分离不完全引起的。具有这些外观的新鲜冷冻血浆，即乳白色、绿色或红色，可以安全输注。3在临床实践中可能会看到我们图像中未显示的FFP的其他几种表现。首先，深黄色变色与供体黄疸有关。使用目前用于筛查供体感染性病原体的高灵敏度测定，这可以安全地归因于非感染性遗传性肝病，例如吉尔伯特综合征和胆石症，并且此类单位对于患者给药是安全的。3，4第二，橙子变色可能发生由于维生素A或大量的b-类胡萝卜素的存在。与红色、黄色和绿色变色单元类似，这些单元可安全用于患者输血。3第三，细菌污染偶尔会导致不寻常的气泡和凝血系统的激活，从而导致凝块、纤维蛋白束和增加的不透明度。这些单位不应给予，应返回血库。3第四，偶尔可看到白色或不透明的颗粒物，轻轻搅拌不会消散。这种颗粒物质通常由血小板、白色或红细胞和纤维蛋白组成。新鲜冷冻血浆含有这样的细胞和
To the Editor, During a repeat single-lung transplant, severe coagulopathy with hemorrhage developed in a patient who then went on to require massive transfusion of blood and blood products. Three units of fresh frozen plasma (FFP) that were sent from the blood bank had strikingly different colours (Figure). We queried anesthesiology and surgical team members in the operating room, and all were unaware of the etiology and therefore the suitability to transfuse one of these units (Bag No. 3: green discolouration). Subsequently, this bag was returned to the blood bank. On follow-up, we realized that it was safe to administer this green discoloured unit of FFP to patients. We not only identified a knowledge gap in health care providers routinely dealing with blood and blood product transfusion, but also recognized that valuable blood bank and operating room resources were diverted to deal with the issue. It is essential that anesthesiologists recognize normal and abnormal variations in the appearance of FFP. Accordingly, we present a brief review of the wide-ranging appearances of FFP encountered in daily practice. The typical yellow colour of FFP (Bag 1) is imparted by bilirubin, carotenoids, hemoglobin, and transferrin. Suspended lipid particles containing triglycerides can result in a turbid milky appearance (Bag 2). This is attributed to donor lipemia seen after a fatty meal prior to donation or donor hypertriglyceridemia. These units are safe to administer to patients unless the triglyceride concentration exceeds 3,000 mg4dL-1, which can interfere with diagnostic assays for infectious diseases. 1 Green discolouration (Bag 3) results from increased ceruloplasmin levels, which occurs in high estrogen states, including pregnancy or use of oral contraceptives. Green discolouration can also be due to contamination of plasma units by gram negative cryophilic organisms, but this rarely occurs in the current era of widespread use of antibiotics. 2 Salmon-tinged or redcoloured FFP (Bag 4) is caused by incomplete separation of erythrocytes during production of FFP from whole blood. Fresh frozen plasma with each of these appearances, ie, milky-white, green, or red coloured, are safe to transfuse. 3 Several other appearances of FFP not shown in our image may be seen in clinical practice. First, a deep yellow discolouration is associated with donor icterus. With the current highly sensitive assays used to screen donors for infectious agents, this can be safely attributed to noninfectious inherited liver disorders, eg, Gilbert syndrome and cholelithiasis, and such units are safe for patient administration. 3, 4 Second, orange discolouration may occur due to the presence of vitamin A or large quantities of b-carotenoids. Similar to red, yellow, and green discoloured units, these are safe for patient transfusion. 3 Third, bacterial contamination can occasionally result in unusual air bubbles and activation of clotting system resulting in clots, fibrin strands, and increased opacity. These units should not be administered and should be returned to the blood bank. 3 Fourth, white or opaque particulate matter that does not dissipate with gentle agitation may be seen occasionally. This particulate matter is generally composed of platelets, white or red blood cells, and fibrin. Fresh frozen plasma containing such cellular and