수혈관련 순환량과다 1예 보고
A Case Report of Transfusion-associated Circulatory Overload
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
수혈관련 순환량과다는 최근 수혈관련 급성폐손상보다 확진 환자 수 및 예후 면에서 중요성이 높아지고 있다. 수혈관련 순환량과 다를 진단하기 위해서는 전산화된 의무기록 및 구축된 전산망을 통해 수혈 이상 반응으로 의심되는 증상에 대한 빠른 파악이 도움이 되며, 이는 수혈 이상 반응 전후 검체 확보 및 BNP 측정에도 도움을 준다. 본 저자들은이 증례를 통해 수혈관련 순환량과다로 진단할 수 있었던 사례를 보고하고자 한다. 62세 여자 환자가 출혈 경향으로 인해 응급실로 내원하였다. 신선동결혈장 2단위와 백혈구제거적혈구 1단위 수혈을 시행하였다. 수혈 도중 혈압이 증가하였고, 흉부 X 선 촬영에서 폐부종 소견이 새롭게 관찰되었다. NT-proBNP 검사를 위해 냉장보관 중인 검체를 확보하였다. NT-proBNP는 수혈 전 12 시간 시점보다 수혈 후 6 시간 시점에서 현저히 (수혈 전 대비 > 48 배) 상승하였다. 결과적으로 본 증례는 수혈관련 순환량과다로 진단되었다.
Abstract
Transfusion-associated circulatory overload (TACO) is recently becoming more important than transfusion-related acute lung injury (TRALI) in terms of the number of patients with definite diagnosis as well as its prognosis. In order to diagnose TACO, it is helpful to recognize early the symptoms suspicious of transfusion reaction through electronic medical record system and computer network, and this will be of help for obtaining samples for brain natriuretic peptide (BNP) measurement before and after the onset of transfusion reaction. We report a case in which a transfusion reaction was diagnosed as TACO. A 62-year-old woman was admitted to the emergency room due to bleeding tendency. Two fresh frozen plasma units and one unit of leukocyte-reduced red blood cells were transfused. Blood pressure increased during transfusion, and the chest X-ray showed findings suggestive of newly developed pulmonary edema. N-terminal prohormone of BNP (NT-proBNP) test was carried out using the specimens in refrigerated storage. Compared with the NT-proBNP level measured 12 hours before the transfusion, that measured 6 hours after the transfusion was markedly increased (>48 fold of pre-transfusion level). As a result, this case was diagnosed with TACO.
참고문헌 (14)
- Sanders RP, "A revised classi cation scheme for acute transfusion reactions", Transfusion, 47, pp.621~628 (2007)
- Stroncek DF, "Pulmonary transfusion reactions", Semin Hematol, 44, pp.2~14 (2007)
- Bolton-Maggs PH, "SHOT conference report 2016: serious hazards of transfusion - human factors continue to cause most transfusion-related incidents", Transfus Med, 26, pp.401~405 (2016)
- 조주영, "Frequency and Pattern of Noninfectious Adverse Transfusion Reactions at a Tertiary Care Hospital in Korea", Annals of Laboratory Medicine, 36(1), pp.36~41 (2016), 대한진단검사의학회
- Han K-S, "Transfusion Medicine", pp.298~300 (2014), Korea Medical Book Publishing Company
- 안광진, "전자의무기록자료를 활용한 수혈이상반응 보고시스템", 대한수혈학회지, 26(2), pp.152~158 (2015), 대한수혈학회[DOI]
- "Transfusion-associated circulatory overload (TACO) Draft revised reporting criteria"[URL]
- Zhou L, "Use of B-natriuretic peptide as a diagnostic marker in the differential diagnosis of transfusion-associated circulatory overload", Transfusion, 45, pp.1056~1063 (2005)
- Tobian AA, "N-terminal pro-brain natriuretic peptide is a useful diagnostic marker for transfusion-associated circulatory overload", Transfusion, 48, pp.1143~1150 (2008)
- Januzzi JL, "NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure : an international pooled analysis of 1256 patients : the International Collaborative of NT-proBNP Study", Eur Heart J, 27, pp.330~337 (2006)
- Downie PF, "Assessment of the stability of N-terminal pro-brain natriuretic peptide in vitro: implications for assessment of left ventricular dysfunction", Clin Sci(Lond), 97, pp.255~258 (1999)
- Dasgupta A, "Stability of NT-proBNP in serum specimens collected in Becton Dickinson Vacutainer(SST)tubes", Clin Chem, 49, pp.958~960 (2003)
- "Fatalities Reported to FDA Following Blood Collection and Transfusion Annual Summary"[URL]
- "Annual Report of the Korea Blood Safety Commission (KBSC) Performance"[URL]