Miyao H, Shimizu K, Kawazoe T
Department of Anesthesiology, Saitama Medical Center, Saitama Medical School, Kawagoe.
Masui. 2000 Apr;49(4):383-90.
Transfusion of the irradiated blood has become popular in Japan to prevent the graft-versus-host disease. Case reports, however, of hyperkalemic death or lethal ECG change have been increasing since the irradiated blood was introduced nation-wide. The potassium concentration of the supernatant of irradiated blood becomes about 60 mEq.l-1 by the end of storage period. If the potassium concentration is 60 mEq.l-1, the estimated safe transfusion rate would be 6 ml.min-1 and this can not be agreed with by clinicians who transfuse daily in cases of massive bleeding. The calculated safe transfusion rate (10 mEq.hr-1 of potassium load) ranges from 6 to 72 ml.min-1 considering the storage period from the day of gathering and irradiation. This difference could affect the survival rate. On the other hand, only the difference of the potassium concentration in the supernatant between the irradiated blood and the non-irradiated blood could not explain the increasing number of hyperkalemic case report. The mechanical factors may be related to hemolysis that causes extreme hyperkalemia. Control studies of proper transfusion rate of irradiated blood should be performed to establish a safety guideline for rapid transfusion of irradiated blood.
为预防移植物抗宿主病，辐照血液的输注在日本已变得普遍。然而，自辐照血液在全国范围内推广以来，高钾血症死亡或致命性心电图改变的病例报告一直在增加。辐照血液在储存期末时，其上层清液的钾浓度约为60 mEq·l⁻¹。如果钾浓度为60 mEq·l⁻¹，估计的安全输注速率将为6 ml·min⁻¹，而这对于在大出血病例中进行日常输血的临床医生来说是无法接受的。考虑到从采集和辐照之日起的储存期，计算得出的安全输注速率（钾负荷为10 mEq·hr⁻¹）范围为6至72 ml·min⁻¹。这种差异可能会影响存活率。另一方面，仅辐照血液与未辐照血液上层清液中钾浓度的差异并不能解释高钾血症病例报告数量的增加。机械因素可能与导致极度高钾血症的溶血有关。应进行辐照血液适当输注速率的对照研究，以建立辐照血液快速输注的安全指南。
Zotero 插件