白血球過濾器對於犬隻全血之影響評估

Effect Evaluation of Leukoreduction Filters on Canine Whole Blood

王琪雅(Wang Chi-Ya)

指導教授 ： 蔡宜倫

國立屏東科技大學/獸醫學院/獸醫學系所/碩士(2018年)

https://doi.org/10.6346/THE.NPUST.VM.011.2018.D07

摘要

臨床上最常見的輸血反應為發熱型非溶血性反應，而其形成原因和輸注血品中來自捐血者的白血球及血小板所產生之細胞激素和趨化因子之影響有關，因此如能在血品處理過程中減除其中的白血球及含量，即可顯著降低該輸血反應之發生機率。在人醫輸血醫學領域，根據美國人醫血庫協會的標準定義，白血球減除技術為最終血品必須達到每單位血品少於5x10^6個捐血者白血球，且該血品的紅血球數必須維持原來的85%。隨著醫學材料技術快速發展，目前白血球減除技術除了依不同孔徑大小篩選血液成份的方式，也發展出利用不同的細胞電荷來進行白血球及血小板之篩選及吸附。白血球過濾技術在獸醫臨床輸血醫學上尚處於發展階段，未受廣泛應用，本研究利用20個以CPDA-1抗凝的犬隻全血樣本(285mL)，以白血球過濾器進行過濾，並分析過濾前（第0天）、過濾後/保存前（第0天），以及過濾後4℃保存(第35天）對於各項血液學數值以及紅血球形態的差異。血液學數值利用IDEXX Procyte Analyzer進行紅血球數、血小板數、血紅素濃度以及血容比之檢測，而紅血球形態將會以鏡檢方式進行紅血球形態指數分級，所得之三個時間點的結果利用SAS統計軟體經過常態分布檢定後，選擇使用Kruskal-Wallis Test進行分析，並利用Dunn’s Test進行事後檢定，結果顯示白血球的人工計數如下：過濾前(第0天)為1.93 (± 1.42) ×10^9 / 250mL，過濾後(第0天)為5.29 (± 5.02) ×10^7/ 230mL，以及過濾後經過冷藏保存(第35天)為4.0 (± 6.71) ×10^7 / 230mL，根據統計分析的結果得知，白血球數和血小板數在過濾後皆顯著降低，另外值得注意的是紅血球形態在過濾後亦產生顯著差異，針對所有過濾的全血樣本的分析結果雖顯示該濾器平均可以回收原血品過濾前紅血球總數之92%，且可以去除90%以上的白血球以及血小板數，未來仍需要調整白血球濾器之結構，以提高白血球濾除率且同時不影響紅血球形態。

關鍵字

犬隻全血 ； 輸血反應 ； 白血球減除 ； 血液學 ； 紅血球形態

並列摘要

The most common transfusion reaction during blood transfusion is febrile non-hemolytic reaction, which is highly associated with the accumulated cytokines and chemokines released from the donor leukocytes and platelets. If these blood components could be eliminated during the processing procedure, the incidence of the febrile non-hemolytic reactions can be significantly reduced. In human transfusion medicine, leukoreduced blood products were required to achieve the cell counts of less than 5x10^6 residual donor WBCs while maintaining 85 % of the original RBC count. Among the leukoreduction techniques, filtration is the most clinical effective and relatively cheap method. As the rapid progress on medical material technology, electrical-charge selecting filters were developed for clinical use besides the pore-sized selecting ones. However, leukoreduction filters have not yet been broadly utilized in the field of veterinary transfusion medicine. In this study, 20 canine whole blood samples anticoagulated with CPDA-1 were filtrated through the electrical-charge selection leukoreduction filters. Evaluations on the hematology and erythrocyte morphology from each sample at three timepoints (pre-filtration, post-filtration and 35-day post-storage) were conducted. The values acquired at the three time-points were also statistically analyzed with Kruskal-Wallis test followed by post-hoc tests. The hematologic values were measured with IDEXX Procyte Analyzer, and the morphology examination was done manually under light microscopy according to the erythrocyte morphological evaluation scale. According to the analyses on the collected samples, the whole blood samples maintained 92% of the original erythrocyte counts which were higher than the human standard on RBC retrieval. The WBC manual counts at the three different timepoints were 1.93 (± 1.42) ×10^9 / 250mL, 5.29 (± 5.02) ×10^7/ 230mL and 4.0 (± 6.71) ×10^7 / 230mL, respectively. The WBC and platelet counts were both significantly reduced by the leukoreduction filter; however, the erythrocyte morphology also showed significant difference according to the analyses among the three timepoints. The result of filtered samples averagely restored 92% of the RBCs and depleted 90% of the WBCs and platelets. Further investigations and modifications on the filter structure are still required to achieve a better leukoreduction efficacy without altering the erythrocyte morphology.

並列關鍵字

Canine whole blood ； transfusion reaction ； leukoreduction ； hematology ； erythrocyte morphology

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