Hemolytic reaction in the washed salvaged blood of a patient with paroxysmal nocturnal hemoglobinuria
Hemolytic reaction in the washed salvaged blood of a patient with paroxysmal nocturnal hemoglobinuria
复制标题
DOI：
10.1186/s12871-019-0752-4
复制
发表时间：
2019-05-22
影响因子：
2.2
通讯作者：
Yorozuya, Toshihiro
中科院分区：
文献类型：
--
作者：
Kawamoto, Yuko;Nishihara, Tasuku;Yorozuya, Toshihiro
背景资料：在阵发性睡眠性血红蛋白尿症（PNH）患者中，红细胞（RBC）上形成的膜攻击复合物（MAC）由于感染、炎症或手术应激导致患者自身激活的补体系统而导致溶血。输血治疗PNH患者的疗效已被记录，但没有研究集中在围手术期使用抢救自体血PNH patients with PNH.Case presentation：一名71岁的男子接受全髋关节置换手术。由于出血量大和存在不规则抗体，放置了自体血液回收装置。在洗涤过程后，回收的RBC的转移袋中的钾浓度高达6.2 mmol/L，尽管洗涤通常从血液中去除>90%的钾。这可能是由于即使在清洗过程后仍持续溶血所致。PNH患者的补体一旦被激活，就会在红细胞上形成MAC，即使用RBC洗涤，溶血反应也可能不会停止。结论：PNH患者的输血应使用包装的RBC，而不是回收的自体RBC。在PNH患者中使用回收的自体红细胞应仅限于严重情况，如大出血。医生应注意，即使在清洗过程后，输血袋内也可能存在溶血反应。
Background: In patients with paroxysmal nocturnal hemoglobinuria (PNH), the membrane-attack complex (MAC) formed on red blood cells (RBCs) causes hemolysis due to the patient's own activated complement system by an infection, inflammation, or surgical stress. The efficacy of transfusion therapy for patients with PNH has been documented, but no studies have focused on the perioperative use of salvaged autologous blood in patients with PNH.Case presentation: A 71-year-old man underwent total hip replacement surgery. An autologous blood salvage device was put in place due to the large bleeding volume and the existence of an irregular antibody. The potassium concentration in the transfer bag of salvaged RBCs after the wash process was high at 6.2 mmol/L, although the washing generally removes >90% of the potassium from the blood. This may have been caused by continued hemolysis even after the wash process. Once activated, the complement in patients with PNH forms the MAC on the RBCs, and the hemolytic reaction may not be stopped even with RBC washing.Conclusions: Packed RBCs, instead of salvaged autologous RBCs, should be used for transfusions in patients with PNH. The use of salvaged autologous RBCs in patients with PNH should be limited to critical situations, such as massive bleeding. Physicians should note that the hemolytic reaction may be present inside the transfer bag even after the wash process.