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頁籤選單縮合
題 名 | Transfusion-Associated Graft-Versus-Host Disease(TA-GVHD) Following Blood Exchange Transfusion in a Full-term Neonate=足月新生兒換血後之輸血相關移植物抗宿主病(TA-GVHD) |
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作 者 | 劉德良; 周正成; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 2:1 2000.01[民89.01] |
頁 次 | 頁15-21 |
專 輯 | 胸腔重症專題 |
分類號 | 417.517 |
關鍵詞 | 移植物抗宿主病換血; 新生兒黃疸; Graft-versus-host disease; Blood exchange transfusion; Neonatal hyperbilirubinemia; Cyclosporin; Chimerism; |
語 文 | 英文(English) |
中文摘要 | 輸血相關之移植物抗宿主病(TA-GVHD)常發生在輸血後頭兩個星期,且其臨床特徵為皮疹、腹瀉、肝功能異常及嚴重的骨髓抑制。一足月產女嬰因為新生兒黃疸而採用其父親所捐的血進行換血,十天後發現有發燒及皮疹的現象--皮膚泛紅、變硬,即使用了廣效性抗生素仍進展成表皮脫落。後經皮膚切片證實是移植物抗宿主病而投與Cyclosporin。免疫遺傳研究顯示CD45RA-CD4 memory T細胞有增加的現象。相同地,HLA-DR+CD3和CD25+CD3 activated T細胞數目也昇高。染色體檢查亦發現Chimerism的間接證據。即使給與了類固醇、抗生素、Cyclosporin,並且以無菌操作技術保護隔離,膽汁鬱滯、血便及骨髓相衰竭仍陸續發生。鑑於此不幸案例之教訓,吾人等建議在換血前,如果血源來是來自其一等親,此血須經放射處理;否則寧願使用毫無血緣關係人所捐的血。此篇個案報告在強調--即使在足月新生兒黃疸的換血方面,也有可能引起如此罕見且嚴重的併發症。 |
英文摘要 | Transfusion-associated graft-versus-host disease (TA-VHGD) is characterized by skin rash, diarrhea, hepatic dysfunction and severe bone marrow suppression, most often during the first 2 weeks after transfusion. A female full-term newborn was noted to have fever and skin rash 10 days after blood exchange transfusion, with the whole blood donated from the father, because of neonatal hyperbilirubinemia. Erythroderma and sclerema then gradually progressed to epidermolyis despite treatment with broad spectrum antibiotics. Cyclosporin was given under the impression of GVHD. Although steroids, antibiotics, cyclosporin and sterile procedures were used; cholestasis, bloody diarrhea and progressive bonemarrow failure ensued. To prevent this devastating disorder, we recommend cellular blood products from a first-degree relative should be irradiated before exchange transfusion. Alternately, we prefer blood components donated from an unrelated person. The purpose of this report is to highlight the possibility of this serious complication of a blood exchange transfusion given for neonatal hyperbilirubinemia, even in a full-term neonate. (Abbreviations: TA-GVHD= transfusion-associated graft-versus-host disease). |
本系統中英文摘要資訊取自各篇刊載內容。