Jka 溶血反應？ 2006年9月產生 Anti-E+c, 現在抗體消失，備血以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 |
