Melmed Gavin M, Hulsey Meredith E, Newhouse Mike, Holmes Houston E, Mays Edward J
Department of Oncology (Melmed, Holmes) and the Department of Pathology (Newhouse, Mays), Baylor University Medical Center and Baylor Sammons Cancer Center, Dallas, Texas, and the Department of Pathology, Midland Memorial Hospital, Midland, Texas (Hulsey). Dr. Melmed is now at Baylor Medical Center at Garland.
Proc (Bayl Univ Med Cent). 2009 Oct;22(4):316-20. doi: 10.1080/08998280.2009.11928545.
Hemorrhaging patients who cannot be transfused due to personal beliefs or the lack of compatible blood products provide a unique challenge for clinicians. Here we describe a 58-year-old African American man with a history of sickle cell-beta(+) thalassemia who had recently received a multiunit exchange transfusion and developed hematochezia followed by severe anemia. Due to the presence of multiple alloantibodies, no compatible packed red blood cell (pRBC) units could initially be located. The patient was managed with mechanical ventilation, colloid and crystalloid solutions, procoagulants, and recombinant erythropoietin. After an extensive search by our blood bank, enough compatible pRBC units were identified and the patient survived without significant clinical sequelae. Management of the untransfusable hemorrhaging patient requires a multidisciplined approach, with coordination between blood banks, hematologists, intensivists, and other specialists. Steps should be taken to avoid or limit blood loss, identify compatible pRBC units, control hypotension, maximize oxygen delivery, minimize metabolic demand, and stimulate erythropoiesis. In dire circumstances, use of experimental hemoglobin substitutes or transfusion of the least serologically incompatible pRBCs available may be considered.
由于个人信仰或缺乏匹配的血液制品而无法接受输血的出血患者给临床医生带来了独特的挑战。在此，我们描述一名58岁的非裔美国男性，他有镰状细胞-β（+）地中海贫血病史，近期接受了多次成分输血置换，随后出现便血并发展为严重贫血。由于存在多种同种抗体，最初未能找到匹配的浓缩红细胞（pRBC）单位。患者接受了机械通气、胶体和晶体溶液、促凝血剂以及重组促红细胞生成素的治疗。经过我们血库的广泛搜寻，找到了足够数量的匹配pRBC单位，患者存活下来，没有出现明显的临床后遗症。对无法输血的出血患者进行管理需要多学科方法，血库、血液学家、重症监护医生和其他专家之间要相互协调。应采取措施避免或减少失血、识别匹配的pRBC单位、控制低血压、最大化氧气输送、最小化代谢需求并刺激红细胞生成。在极端情况下，可以考虑使用实验性血红蛋白替代品或输注血清学上不相容性最小的可用pRBC。
