「血液製剤の使用指針」 - mhlw.go.jp

1 17 26 11 .. 0.. 1 .. 1 2 . Hb 7g/dL .. Hb 10g/dL . B12 .. 2 . Hb 6g/dL . 2 . Hb 10g/dL 6g/dL .. Hb . 3 . 1 .. 10/30 Hb 10g/dL . Ht 30 . 2 . 1. 20 50 . HES .. 5 . 50 100 . 1,000mL . 24 100 100mL/ .. Hb 7 8g/dL . Hb 10g/dL .. 3 . 1 2 .. Hb .. Hb g/dL Hb g / dL . 70mL/kg dL kg 70mL/kg/100 . 50kg 35dL Hb 19g/dL 2 400mL. -LR 280 L 1 . Hb 19g/dL 280/100dL 53g Hb .. 1 . 2. 2 . 3 . 4 PT-GVHD . 5 . 6 . 7 . 8 ABO Rh . 9 CMV . 3.. 2 5 L . 1 2 L . 1 L .. 5 L .. 5 1 L .. 1 .. 5 L . 2 . 5 L .. 5 L .. 3 . 3 L .. 5 L . 3 . 4.. oozing . 5 L 10 / L .. 4 . 24 2 .. 5 DIC . DIC . 5 L .. DIC . 6 . 1 . 1 2 L. 1 2 L .. 2 . 5 L .. 1 L . 5 L .. 3 . ITP .. ITP . ITP .. 5.. NAIT .. PTP . 4 TTP HUS .. 5 .. 6 Heparin Induced Thrombocytopenia HIT.

2 HIT .. 7 .. 2 L 1 2 . L . 8 . 1 2 L .. 1 2 / L .. 2. L . (mL) 103 3. 70 mL/kg . 5 1 0 1011 5,000mL. 71kg 13,500/ L .. 10 . 6. 25kg 10 3 4 .. 1 . 2 . 3 PT-GVHD . 4 (CMV) . 5 HLA . 6 ABO Rh . 7 ABO . 7.. PT . APTT .. 1 . 1 PT APTT PT INR . 30 . APTT 2 25 .. PT INR 30 .. L- .. DIC 1 PT APTT . 100mg/dL 1 DIC .. XI .. PT INR 30 . K . 8.. 2 100mg/dL . DIC . L- . 2 . C S .. 3 PT APTT . TTP TTP . TTP . HUS .. 20 . 30 . 40mL/kg 70mL/kg 1 Ht/100 . 100 20. 30 8 12mL/kg 40mL/kg 20. 30 .. 1 . 2 . 3 . 4 . 5 . DIC .. 9.. 1 . 2 . 3 . 4 . 5 . 6 ABO . 10.. 1 . 30 .. 50 .. 1,000mL .. 2 .. 10kg .. 3 . 4L . 1 .. 4 .. 11. (1 . ) . 5 .. 6 .. 7 . 50 .. 18 18 .. 8 .. 9 .. 2 3 . g = g/dL dL . 12. 4/10 40 .. 1.

3 2 . 3 . 4 .. 1 . 2 . 3 . 4 . 5 . 13.. 1986 .. 1989 . 1994 .. 1999 .. 1992 . 5 1985 (2007 ) . 40 1995 (2007 ) . 11 19 3/5 . 2/3 . 15 .. / 2003 3 .. 31 160 15 7 .. 1 .. 14.. 2 .. 35 145. 68 21 . 3 . 1 .. 20 .. 15.. 80 90 2,000mL .. 2 .. 70 80 .. 16. 3 .. 17 7 6 .. HES .. TTP/HUS .. 4 .. 17.. 384 L 1985. 146 L 2010 62 .. 5 .. 1 . Red Cell Concentrate RCC .. 15 . 2 . 1 .. 18.. B12 .. Hb . Hb7g/dL .. Hb7g/dL .. Hb .. 1 2 .. Hb 10g/dL . Hb . iron overload . 1 .. 2 . Hb 6g/dL .. 2 .. 19.. Hb . 15 class . 15 30 class .. 30 40 class . 40 class . 1) . , . Hb 10g/dL ,6g/dL . 2) Hb 6 10g/dL Hb .. 3 .. 2 10 .. 1 .. 10/30 Hb 10g/dL Ht 30 .. 11 . Ht 12 .. 20.. 2 . 15 .. 16 .. 15 . 1 .. 15 20 . 2 3.

4 20 50 .. HES .. 5 .. 20mL/kg . 20mL/kg . 50 100 .. 1,000mL .. 24 100 100mL/ .. 90mmHg 60 70mmHg 1mL/kg/.. Hb 7 8g/dL . Hb 10g/dL . 21.. 1 . 3 . 1 2 .. 3 . Hb .. 22. Hb g/dL . Hb g / dL . 70mL/kg dL . kg 70mL/kg/100 . 50kg 35dL Hb 19g/dL 2 400mL. -LR 280 L 1 . Hb 19g/dL 280/100 dL 53g .. Hb . 4 .. 5 . 1 .. 2 .. 6 . 1 .. 23.. 37 . 2 .. Yersinia enterocolitica .. 3 . 1 200mL 100mg 1. 1mg . Hb1g 40mg . Hb .. 4 PT-GVHD . 15 50Gy . 4 10 . 12 . 14 .. 15 50Gy .. 5 .. 24. 6 . ABO . ID .. 7 .. 8 ABO Rh . ABO . Rh Rh .. 9 CMV . CMV CMV .. CMV CMV . CMV .. 1) American College of Surgeons:Advanced Trauma Life Support Course Manual. American College of Surgeons 1997;103-112. 2) American Society of Anesthesiologists Task Force:Practice guideline for blood component therapy.

5 Anesthesiology 1996;84:732-742. 3 Lundsgaard-Hansen P, et al:Component therapy of surgical hemorrhage:Red cell concentrates, colloids and Haematol 1980;46:147-169. 4 GVHD GVHD . 1999 45 47-54. 25.. 1 .. Platelet Concentrate;PC 16 .. 2 1) 3 .. 5 / L .. 2 5 / L .. 1 2 / L . 1 / L .. 5 1 / L .. (f 2 ) .. 26. a .. 5 / L .. b .. 5 / L . 1. 2 / L . 7 10 / L . 5 / L .. c .. 1 2 3 / L .. 3 / L .. 5 L . 3 .. oozing .. 5 / L 10 / L . 27. d . 24 2 .. e Disseminated Intravascular Coagulation;DIC . DIC . 5 / L . DIC . DIC .. DIC . DIC 1 . f .. 1 .. 1 2 / L . 1 2 / L .. 1 / L 4) 6 . HLA DIC . 2 / L .. 2 . 5 / L .. 28.. 5 / L . , 1 / L.. 1 . 3 . Idiopathic Thrombocytopenic Purpura;ITP . ITP .. ITP.

6 Neonatal Alloimmune Thrombocytopenia ; NAIT .. Posttransfusion Purpura;PTP .. 4 Thrombotic Thrombocytopenic Purpura;TTP . Hemolytic Uremic Syndrome;HUS . TTP HUS .. 5 .. 29. 6 Heparin induced thrombocytopenia;HIT . HIT .. g .. 2 / L 1 2 / L.. 2 / L .. h . 1 2 / L .. 1 2 . / L .. 1 2 3 . i HLA .. DIC . HLA . 30.. HLA HLA .. 2. HLA HLA .. HLA .. HLA .. HLA .. HLA .. 3 .. / L . ( L). 2.. (mL) 103 3. 2 3 . 70mL/kg . 5 1 0 1011 5,000mL. 71kg 13,500/ L .. 10 . 25kg 10 3 4 . 31. 4 .. 1 24 . corrected count increment CCI CCI . CCI( L). ( L) (m2).. ( 1011). 1 CCI 7,500/. L 24 CCI 4,500/ L .. 5 .. 6 . 1 .. 2 . 20 24 .. 32.. pH .. 3 PT-GVHD . PT-GVHD 15. 50Gy . 4 CMV . CMV CMV .. CMV CMV .. CMV.

7 5 HLA . ABO .. 6 ABO Rh . ABO .. Rh Rh . Rh . Rh RHIG . D . HLA HLA .. 7 ABO . ABO ABO . A B . 33. A B ABO .. 1) British Committee for Standards in Haematology,Blood Transfusion Task Force:Guidelines for the use of platelet transfusions. Br J Haematol 2003;122:10-23. 2) Schiffer CA, et al: Clinical Practice Guidelines of the American Society of Clinical Oncology. J Clin Oncol 2001;19:1519-1538. 3) A Report by the American Society of Anesthesiologists Task Force on Blood Component Therapy:Practice Guidelines for Blood Component Therapy. Anesthesiology 1996; 84: 732- 747. 4) Wandt H, et al:Safety and cost effectiveness of a 10 10 (9) / L trigger for prophylactic platelet transfusions compared with the traditional 20 10 (9) / L trigger : a prospective comparative trial in 105 patients with acute myeloid leukemia.

8 Blood 1998;91:3601-3606. 5) Rebulla P, et al:The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Mallgne dell'Adulto. N Engl J. Med 1997;337:1870-1875. 6) Heckman KD, et al:Randomized study of prophylactic platelet transfusion threshold during Induction therapy for adult acute leukemia:10,000 / microL versus 20,000 / microL. J Clin Oncol 1997;15: 1143-1149.. 1 . Fresh Frozen Plasma;FFP .. 17 . 2 .. 34.. PT .. APTT DIC .. 1 . 1 PT APTT PT INR . 30 . APTT 2 . 25 . i .. PT APTT .. 1 . / 14 . PT INR 30 .. L- .. L- . 35.. DIC DIC 1 .. C . S . 1 PT . APTT 100mg/dL . 1 DIC .. 100mg/dL PT APTT .. 1 .. ii .. A B .. iii PT INR 30.

9 36. K . K .. 2 100mg/dL .. PT APTT .. DIC . i DIC . L- L- . 2 . C S . C S .. C . C .. 3 PT APTT . TTP . unusually large UL-vWFM . UL-vWFM . vWF ADAMTS13 . TTP .. 1 / 1 . 37.. 2 . 3 UL-vWFM . 4 . vWF 4 TTP . 1 . O 157 0H7 HUS .. 2 . 3 . 20 30 . 1 . 40mL/kg 70mL/kg 1-Ht/100 . 100 20 30 . 8 12mL/kg 40mL/kg 20 30 . 50kg 400 600mL . -LR . 200mL FFP-LR-1 120mL,400mL . FFP-LR-2 240mL 200mL FFP-LR-1 4. 5 ,400mL FFP-LR-2 2 3 . 450mL 1 Ht .. 1 .. 38. 4 .. 5 . 1 .. 2 .. 5-1 .. 3 .. 39.. 4 .. 5 . DIC .. 6 . 1) . 30 37 . 3 .. 2 6 . 1 .. 2 .. 3 .. 4 . CPD. -LR . 40. 200mL FFP-LR-1 . 120mL,400mL FFP-LR-2 240mL 200mL 19mEq ,400mL FFP-LR-2 38 mEq Na+ . , ACD-A 450mL. , 69mEq Na+ . CPD ACD-A .. 5 .. 6 ABO.

10 ABO ABO . A B .. 1 . 4 .. a.. b.. c.. d.. 2 .. PT APTT .. 5 / L PT INR 30 APTT . 41. 2 25 100mg/dL .. 1 . 2 .. DDAVP A typeI .. 1 VWF ADAMTS13 TTP/HUS . 2004 93 451-459. 2 Mori Y, et al: Predicting response to plasma exchange in patients with thrombotic thrombocyto- penic purpura with measurement of VWF-cleaving protease activity. Transfusion 2002;42:572- 580. 3 AABB:Blood Transfusion Therapy;A Physician's Handbook (7th ed.) ,2002, 42.. 1 .. 18 . 2 .. 1 . 30 . 30 .. 50 .. 1,000mL .. 1 .. 2 .. 43.. Alb . 10kg .. 3 .. 4L . 1.. Runyon BA:Management of adult patients with ascites due to 2004;39:841-856. 4 .. 1 . 5 .. 6 .. 44.. 1 .. 14 . 7 . 18 18 .. 50 .. 8 .. 9 .. 3 .. 2 3 . g =. 45. g/dL dL.