同種與異種輸血在巴西龜的療效評估

Evaluation of whole blood transfusion in red-eared slider (Trachemys scripta elegans)

吳志純(Chih-Chun Wu)

指導教授 ： 季昭華

國立臺灣大學/獸醫專業學院/臨床動物醫學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.02310

摘要

由於爬蟲類的生理與飼養方式較特殊，且貧血在早期不一定會出現可察覺的臨床症狀，通常只有當貧血是急性的或已經很嚴重、出現主要病因引起的其他症狀時，才會在臨床上被發現並治療。和其他動物相同，爬蟲類在急性失血或貧血程度危及生命時應考慮輸血。但由於全世界有超過八千種的爬蟲類，當需要輸血時並不一定找得到同屬同種的捐血者，因此可能需考慮同類間的異種輸血。目前爬蟲類輸血方面已發表的研究相當有限，且多為病例報告性質，沒有一致的輸血流程、以及輸血前後血檢與血相變化的完整記錄，因此本研究的主要目的為評估急性失血後輸血作為治療的臨床療效。
本實驗以巴西龜 (Trachemys scripta elegans)作為研究對象，將20隻巴西龜分成三組：第一組為控制組，自頸靜脈抽取其1.5%體重的血量後不做任何處理；第二組為同種輸血組，自頸靜脈抽取其1.5%體重的血量，於48小時後輸入等同於其體重1.5%之巴西龜全血；第三組為同科異種輸血組，自頸靜脈抽取其1.5%體重的血量，於48小時後輸入等同於其體重1.5%之斑龜 (Ocadia sinensis)全血。
輸血過程中記錄心跳與體溫，輸血後十五週內定期抽血監控其血容比、血紅素、紅血球總數、白血球總數、以及未成熟紅血球的比例，並觀察輸血後六個月內是否有相關併發症出現。
結果經統計分析顯示，同種輸血組和同科異種輸血組在各時間點的血容比、血紅素、紅血球總數、白血球總數皆無顯著差異，不過同種輸血組的血檢值與同科異種輸血組相比較快恢復至放血前的數值。而在輸血過程中，同科異種輸血組的體溫相較於同種輸血組顯著升高，顯示可能有潛在的免疫反應發生。因此雖然臨床療效上沒有太大差異，在情況允許下還是應該優先選擇血液配對相容的同種捐血者，其次才是血液配對相容的同科異種捐血者，而無論如何輸血前皆應進行血液配對以確認相容性。

關鍵字

巴西龜 ； 急性失血 ； 輸血 ； 同種輸血 ； 異種輸血 ； 血容比 ； 血紅素 ； 紅血球 ； 血液配對

並列摘要

Due to the unique anatomy and husbandry of reptilian species, early signs of anemia are not easy to recognize even for the most dedicated owners or keepers. It is only when the anemia is acute or severe, or when other signs of an underlying disease become evident, will the anemia be discovered and treated. As in others animals, whole blood transfusion should be considered in reptiles suffering from acute blood loss or life-threatening anemia. However, there are over 10000 species of reptiles all over the world. Finding an identical species may not always be easy when in need for blood transfusion, making there no choices but to consider heterologous blood transfusions at times. There have been limited numbers of published researches and reports evaluating whole blood transfusion in reptiles. The aim of this study was to evaluate the efficacy of homologous and heterologous whole blood transfusions for treating acute blood loss in reptiles.
Twenty red-eared sliders (Trachemys scripta elegans) were divided into three groups: in group 1, blood of 1.5% of their bodyweight was drawn from the turtles, and they were left untreated; in group 2, blood was drawn from the turtles as described above, then they were transfused with cross-matching-compatible homologous blood 48 hours later at 1.5% of their bodyweight; in group 3, blood was drawn from the turtles as described above, then they were transfused with cross-matching-compatible heterologous blood from Chinese striped-neck turtles (Ocadia sinensis) 48 hours later at 1.5%of their bodyweight. Body temperature (BT) and heart rate (HR) were closely monitored during transfusions. Packed cell volume (PCV), hemoglobin (Hb), red blood cell (RBC) count, white blood cell (WBC) count, and ratio of immature RBC were monitored in all sliders for 15 weeks.
There were no significant differences found in the value of PCV, RBC, and Hb between the homologous and heterologous transfusion groups at each time point. Nevertheless, in contrast to the heterologous group, PCV, RBC, and Hb in the homologous group recovered faster to the baseline values. Body temperature in the heterologous group was significantly elevated after the transfusion, suggesting a potential immune response.
Whole blood transfusion from a heterologous donor of the same family provides similar clinical therapeutic effect with that from a homologous donor in this study. However, homologous donor with a compatible cross-matching result should always be top priority before considering heterologous donor within the same family. And cross-matching is mandatory before both homologous and heterologous transfusion.

並列關鍵字

Trachemys scripta elegans ； whole blood transfusion ； homologous ； heterologous ； packed cell volume ； hemoglobin ； red blood cell ； cross-matching

參考文獻

2. Norton, T. Chelonian emergency and critical care. in Seminars in Avian and Exotic Pet Medicine. 2005. Elsevier.

3. Wack, RF and Anderson, NL, Resuscitation of a Hispaniolan slider, Trachemys decorata, using oxyglobin and a blood transfusion. J. Herp. Med. Surg, 2004. 14(4): p. 4.

11. Eatwell, K, Hedley, J, and Barron, R, Reptile haematology and biochemistry. In Practice, 2014. 36(1): p. 34-42.

12. Sypek, J and Borysenko, M, Reptiles, in Vertebrate blood cells, A.F. Rowley and N.A. Ratcliffe, Editors. 1988, Cambridge University Press: Cambridge. p. 211-256.

14. Fudge, AM, Laboratory medicine: avian and exotic pets. 2000: Saunders Philadelphia.