? ? ? ? ? ? Autologous Transfusion

1
? ? ? ? ? ?
Autologous Transfusion

• ????????

2
? ? ? ?

• 1. ????????????????????????????????????,??????
  ????????
• ???????600800?
• ???????60?

3

• 2. ?????????1.2???,
• ???????????????20
• ???????????1020
• ??????????6070

4

• 3. ????(??????????????????????)????????????????
  ????
• ??HIV???2002?6????100?,????10????

5

• 4. ????????????,??????(5002000ml??),????,?????
  ?
• ????,???????????????????????????

6
???????

• ??????????(hemolytic reaction)
• ????????(alloimmuni reaction)
• ????(allergic reaction)
• ????(febrile reaction)
• ?????????????????????

7
?????? ??

• ??????????????
• ??????(?RH??)???????????????????
• ??????,??????

8
????????

• ??????
• Preoperative blood donation
• ?????????
• Acute normovolemic hemodilution
• ?????????
• Intraoperative and Postoperative blood
  recovery (blood salvage)

9
???????

• ????????????????
• ?????????
• ?????????
• ????????
• ??????????
• ?????????

10
?????????

• Lock wood CD. 1917
• American literature????
• 1931-1970 ????? ??????
• 1966? Symbas ??????????
• ??
• 1966-1978? ?400?????????
• ???????????

11

• Dyer RH 1966?Am J Surg.????????????????????????
• Wilson JD 1969???,???????????????????????????????
  ?????

12

• ????????????????????Bentley
  Laboratories??,????De Bakey-type roller
  pump?????????????
• ???????Klebanoff G ?1970????
• ???Am.J
  Surg.120351. 1970

13

• ???????????1975??Stehling LC.
  ??,??71???,??????4000ml???????????3??/??????????,?
  ????????????
• 
  Anesthesiology 43337.1975

14

• ??,?????????????????????????????????,??????
  ???
• ??????????????????,????????

15

• ??1974??Haemonetics Corporation??????????????
  ????????Cell Saver
• ???,????????????,??,????????????????????????
  ?????????????,????????????????????(Platelet-rich
  plasma PRP)

16
Cell Washing
17
???????Characteristics of processed blood

• HCT ???????,?50-60???
• ?????????
• 2,3?????? 2,3-diphosphogly cerate
• ?????????????Baele PL?
• ?,???????????????
• 
  Transfus. Sci 15455.1994

18

• ???????????????,?51Cr??????,????????????????
  ?????????.
• ??RBC?PH???,????????
• Br. J Surg
  781472.1991

19

• ??????Hb????????400mg/dl,??????????,??????,??
  ???????90???
• Yawn
  DH Lab Med 25626 1994

20

• ????????????????????????,????????????????
  ??????????????????,???????????????????????????????
  ???????????????
• Perttila J. Acta Anessh.
  Scand 39445.1995

21

• ??????Collection phase
• ??????????????,????????150mmHg????????????
  ????????????,???????????,???????????

22

• ?????? Washing phase
• ???????------????????,??????,??(???????????
  )???????(?????????????)????????????????(??????????
  ????????)????????????????

23

• ??????????,???????????????,??????????????
  ?????????,??????????,???????????

24

• ??????????????????????????????????????????
  ??()??????,??????()????????
• ???? ?? ??
  2002?

25

• ???????????????????
• 1.HCT 50 Plt.WBC????K Na Cl???????Hb????
• 2.???????,?????????????????????????
• 3.????????? gt 40um??,??Pall40SQ??????,???gt
  40um???
• ???? ?? ???

26

• ?????????????????
• ??????a(Tumor necrosis factor),???????????????????
  (Cytokine).
• ???????(Plasma elastase)?????ARDS???????
• ?????????????.

27

• ??????????????ACT(activated clotting
  time)???????????RBCs?????????????ACT???????(coagul
  ation proteins)???????III(antithrombin
  III)????????????????RBCs????????????
• Louser P G.Anestheiology 87719.1997

28

• ??(amniotic fluid)????????????????.
• ?????????????????,???????????????,????????????
  ??????.
• Rice MJ Anesttosiology 671017.1987
• Bernsein HH Anesth. Analg.85831.1997

29

• ??D---???(D-dimer)????????????????????????????
  ??????,???????????????D???????85?,???????????????
  ??
• Lawrence-Brown MMD.Aust NZJ Surg 5967.1999

30

• ??? Complications
• ????????????????????
• ???????
• ?????
• ??? Coagulopathy
• ?????
• ???
• ????????

31

• ????????,????????,????127000????????,?????(fat
  al air embolism)????130000----138000
  ???????????????,?????????,???????????????
• ??,???????????????????,?????????
• Linden JV Anesthe.Analg
  84422.1997

32

• ?????,????????????????????????,???????,???????
  ?????????.
• ????????????????????????,???????????????,?????
  ??????????

33

• ????????????????????????,?????RBCS???Kasper
  SM??????????????(dialysis)????????,???????????????
  ??????????????
• Kaspersm. Transfusion
  37829.1997

34

• ????????????????300mmHg,??????????(excessive
  hemolysis)???,????????????,????????????100-150mmH
  g?

35

• ???????????????????????,??????????????,??????
  ?????????,????????????,???????????????????????,???
  ??????????
• Gregoretti S Transfusion
  3657 1996

36

• Murray DJ ????????????????????DIC(disseminated
  intiavascular coagulation)???????????????????????
  ????????????300mmHg???

37

• ??,??????????????(coagulation
  proteins)??????????,Horst HM???????RBCS??15????,??
  ??????????,??????????

38

• ?????????????????????????????????3152163
  5ml???,???26621135ml,???????????1310710ml???????
  ????????
• ????????????,?????????????
• 
  2002

39

• ?????????????????????,??????????,????????,??
  ??????
• ??????,???????????,?????????????

40

• Ozmen V 1992?????????????????????????,(???
  ?????)????????????????????????????
• Ozmen V J
  trauma 3236.1992

41

• ???????,???????????????????????????????,????
  ???????,???????,??????????????????????
• Bland LA J.Thorac Cardiovasc Sura
  103582.1992
• Wollinsky KH Acta Orthop Scand
  68225.1997

42

• ??????????,????????,?????????????????????????
  ???????,????????????????????
• ?????????????????(Third-generation
  leukocqte-reduction filter)?????????

43

• ??,???????????????????????,???????????????
  ???????????
• ?????????????????????,?????????????????????
  ?????????????????????????????????
• Edelman MJ
  urology 47179.1991
• 
  Park KI J urol 1571777.1997

44

• ??????????????????????????,????????????????
  ???????????
• ????????????????????,?????????????

45

• ???????,?????(thrombin)???????(Avitene)???,????
  ??????
• ????????????,??20µm?????????97
  Avitene???????(thrombogenic Particles)
• Orr MD Ann Thorac Surg
  571007.1994

46

• ???????????????????????????????(methylmetha
  crylate)???,???????????,??????????????????

47

• ? ?