2009年1月14日 星期三

Jka 溶血輸血反應

Jka 溶血反應? 2006年9月產生 Anti-E+c, 現在抗體消失,備MP方法做抗體篩檢無法篩檢出anti-Jka。


Report to medical director and involved for treatment.


根據aabb 15ed delayed hemolytic transfusion-reactions Hemolytic

發生率: 1:11,000 - 1:5000


原因: Anamnestic immune response to red cell antigens


症狀: Fever, decreasing hemoglobin, new positive antibody screeningtest, mild jaundice


診斷方式:

■ Antibody screen

■ DAT

■ Tests for hemolysis (visual inspection for hemoglobinemia, LDH, bilirubin, urinary hemosiderin as clinically indicated)


治療/預防方法:

■ Identify antibody

■ Transfuse compatible red cells as needed


transfusion history

  • The most common presentation of a DHTR is a declining hemoglobin and a newly positive antibody creen, but fever, leukocytosis, and mild jaundice may be present.
  • If a DHTR is suspected, a freshly obtained blood sample may be tested for unexpected alloantibodies, both in the serum and, by DAT, on the red cells. Discovery of a new red cell alloantibody in a recently transfused patient with hemolysis strongly suggests a DHTR, and the diagnosis is supported by emonstration of the corresponding antigen on the red cells from a retained segment from one or more transfused units.
  • Specific treatment is rarely necessary, although it may be prudent to monitor the patient’s urine output and renal function and observe for changes in coagulation function. If transfusion is still necessary, donor red cells should lack the antigen corresponding to the newly discovered antibody


依照血品,輸血日期 降冪排列

血品

血品數量

輸血日期(月日年)

PRBC

2

01 14 2009

PRBC

2

01 13 2009

PRBC

2

01 12 2009

PRBC

2

01 3 2009

PRBC

2

01 2 2009


第一次入院

1/2

ER

Hb=6.3

WBC=15.11

PRBC x 2U

Check donor cell Jka(+)

備血 Ab screen with MP method: Neg

(1/14) Recheck Ab screen with AHG phase:Neg.

1/3

Hb=9.5

PRBC x 2U

Check donor cell Jka(+)

(1/14) Recheck Ab screen with AHG phase:Neg.

1/5

Hb=10.7


第二次入院

1/11

ER

Hb=8.4

WBC=11.71

Urine OB=(4+)

Urine Bil=(-)

Serum color:

dark brown with hemolysis

T-Bil=3.06 LDH=2010

GOT=123 GPT=14

Na=124 K=2.9

CRP=6.16

1/12

Urine Na=96, K=10.8

Blood Na=130 K=3.5

PRBC x 2U

Check donor cell Jka(+)

備血 Ab screen with MP method: Neg

1/13

Hb=7.5

DAT(+), IgG(+), C3d(+)

IAT(+), Ab ID with AHG phase

Anti-Jka

T-Bil=2.47

LDH=2514

Urine OB=(3+)

Urine Bil=(2+)

PRBC x 2U

輸一半,請病房停止輸血

Check donor cell Jka(+)

1/14

C3=63.3(ref 90-180)

C4=12.2(ref 10-40)

Hb=7.08

WBC=6.85

BUN=16 CREA=0.62

PRBC x 2U

(E+c+Jka Neg)

備血 Ab screen with AHG phase: Pos

DAT (+)

Serum color: dark brown with hemolysis

1/15

PRBC x 2U

(E+c+Jka Neg)

1/17

Hb=10.0

1/19

Hb=10.0

BUN=7 CREA=0.64

Na=123 K=3.6

GOT=32

TBIL=0.69 DBIL=0.27

LDH=713 ALB=2.3

Serum 外觀 clear

2009年1月6日 星期二

想像戀愛

最近同事公開一對辦公室戀情、另外還有學弟愛上學姊的消息。

自己開始想像戀愛的感覺,好像有點兒遠,但其實也唾手可得;想像戀愛時,時時刻刻想著女朋友,休息時就想跑去找她,聊天 and ...。
現在的差別,在於不會用那時的心情去想像這種對女朋友的渴望。
無怪乎,太太常抱怨 "好想再談一次戀愛!",就是想再一次感受戀愛的感覺吧。

想像戀愛,想像戀愛時的我會做些什麼事,我也想再一次感受戀愛的感覺呢。