馬偕紀念醫院輸血反應的分析

Analysis of Transfusion Reactions in the Mackay Memorial Hospital

林媽利(Marie Lin) ； 潘曉蕙(Shau-Huei Pan) ； 吳乙澂(I-Cheng Wu) ； 張小琳(Shiau-Ling Chang) ； 洪慶智(Ching-Chu Hong) ； 李明珠(Ming-Chu Lee) ； 張秀萍(Shiou-Ping Chang) ； 朱志芬(Chih-Fen Chu) ； 蘇穎文(Ying-Wen Su) ； 何信重(Hsin-Tsung Ho)

《台灣醫學》 9卷1期 (2005/01) Pp. 1-7

https://doi.org/10.6320/FJM.2005.9(1).01

摘要

本篇分析馬偕紀念醫院在1999年1月到2002年12月四年當中發生輸血反應的情形，而且對其中有做輸血反應的探討及評估的403個案加以分析。輸血反應的症狀以發燒反應佔最高比例(87%), 其次為蕁麻疹反應及呼吸困難等。發燒反應的個案199例有做血袋的細菌培養，結果8例培養陽性，8例輸入帶菌血液的病人，只有一例在發燒反應後可能因輸血引起菌血症再度發燒，但無死亡病例。調查56例輸血後產生呼吸急促或呼吸窘困個案是否因此有使用氧氣治療，發現其中有14例使用氧氣罩或鼻管，這14例均無合併肺水腫，所以沒有發生輸血相關的急性肺傷害(TRALI)案例，血清中的IgA也沒發現有缺少或低值。輸血後發生血紅素尿的2例當中（血清haptoglobin下降）l例為Jk(上標 b)抗體引起的遲緩性溶血性輸血反應；而另1例並沒找到不規則抗體。馬偕醫院在2000年到2002年，三年間發生輸血反應率台北院區為2.86~3.06%淡水院區為1.05~1.37%平均為2.25~2.28%。

關鍵字

輸血反應 ； 台灣 ； 頻率 ； 分析

並列摘要

This report analyzed 403 cases of 4 years transfusion reactions investigated between January 1999 and December 2002 in the Mackay Memorial Hospital (MMH). The most common clinical manifestation of transfusion reaction was found to be febrile reaction (87%) followed by urticaria and dyspnea. The bacterial culture was performed on returned units of 199 cases increminating febrile transfusion reaction. Eight cases grew gram-positive bacteria and two had fever relapsed after febrile reaction. One of these fever relapse was most likely due to transfused contaminated blood. However, no mortality was found in all cases. Although 14 cases out of 56 further investigated cases had received O2 application (mask or nasal tube), no TRALI (transfusion related acute lung injury) was found among the 104 cases who suffered from dyspnea after transfusion. Additionally no case with low serum IgA level or IgA deficiency was found among the 104 cases with dyspnea. Two cases with hemoglobinuria showed low serum haploglobin and indicated intravascular hemolysis. One of them was proved to be a delayed hemolytic transfusion reaction due to anti-Jk(superscript b). Between 2000 and 2002, the average incidence of transfusion reaction in MMH was 2.25% to 2.28%. Interestingly Taipei main MMH was 2.86% to 3.06% and Tamshui branch MMH was 1.05% to l.37%.

並列關鍵字

transfusion reaction ； incidence ； Taiwan