Kusagawa H, Sato T, Mizumoto T, Mizutani T, Yada I, Yuasa H, Kusagawa M, Ichikawa S, Kitade K, Nakamura Y
Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine.
Kyobu Geka. 1990 Sep;43(10):783-8.
"Postoperative erythroderma", the pathogenesis of this disease have solved as graft-versus-host disease (GVHD) due to blood transfusion, is fatal and impossible to cure for the time being. Therefore the prevention against the disease is very important. One woman and three men who underwent an operation and blood transfusion at our department died of this disease. They fell into high fever on 11-13 days, erythroderma on 12-16 days, liver dysfunction on 14 days, and leukocytopenia on 17-19 days, after surgery and transfusion. Eventually, they all suffered from thrombocytopenia, diarrhea, renal dysfunction, and sepsis which led to death. The clinical course, macroscopic and microscopic findings of them coincided with those of GVHD. Since 1989, we have tried following methods for prevention of postoperative erythroderma: Reducing blood transfusion, especially fresh blood and fresh thrombocyte plasma, by using predeposited autologous blood, autologous washed erythrocytes collected from the operative area before and after extracorporeal circulation (ECC), concentrated residual blood from the ECC using a hemoconcentrater, and 1,500 rad of cobalt-irradiation of fresh blood, fresh thrombocyte plasma, and blood collected within 7 days prior to the transfusion. Postoperative erythroderma has not been experienced by introduction of these methods since 1989.
“术后红皮病”，这种疾病的发病机制已被确认为输血所致的移植物抗宿主病（GVHD），目前是致命且无法治愈的。因此，预防这种疾病非常重要。在我们科室接受手术和输血的一名女性和三名男性死于这种疾病。他们在手术和输血后，于第11 - 13天出现高热，第12 - 16天出现红皮病，第14天出现肝功能障碍，第17 - 19天出现白细胞减少。最终，他们均出现血小板减少、腹泻、肾功能障碍和败血症，导致死亡。他们的临床病程、宏观和微观表现与GVHD相符。自1989年以来，我们尝试了以下预防术后红皮病的方法：通过使用预存自体血、体外循环（ECC）前后从手术区域采集的自体洗涤红细胞、使用血液浓缩器浓缩ECC中的残留血液以及对新鲜血液、新鲜血小板血浆和输血前7天内采集的血液进行1500拉德的钴照射，减少输血，尤其是新鲜血液和新鲜血小板血浆的输注。自1989年采用这些方法以来，未再出现术后红皮病病例。
