貝爾曼特輸液管理系統可以輸注血小板嗎?NO!!

所有輸液加溫器(Fluid Warmer)或快速輸液系統(Rapid Infuser)都會有類似“不得用於血小板輸注”的警語,最主要參照的是美國血庫協會AABB發行的輸血加溫器使用指南[4],當中指示不建議經由加溫器輸注血小板,因加熱後可能導致其效果降低[4]。

其次則是血小板容易附著在輸液加溫器、快速輸液系統的管壁上,導致僅有少量的血小板實際進到病人循環[3]。因此,血小板一般在輸注時會使用單獨的輸注管路。當然我們也要澄清禁用血小板並不限於貝爾曼特的機器,一般加溫器或快速輸液裝置都會有類似的血小板禁用限制。

Guidelines for the use of blood warming devices

Warming to body temperature does not harm the contents of most components. Therefore, there are few absolute contraindication to use of a blood warming device. However, blood warmers are not usually needed or provide no clinical advantage in situations such as:

……
Administration of Platelets, Cryoprecipitate, or Granulocyte suspensions (Warming may render these products less effective.)

Hrovat, Teresa M. Guidelines for the use of blood warming devices. AABB, 2002.

Miller’s Anesthesia

Platelets should not be administered through filters, warmers, or rapid infusion systems because they will bond to the inner surfaces of these devices, thereby reducing the quantity of platelets actually reaching the circulation.

Gropper, Michael A., et al. Miller’s Anesthesia, 2-Volume Set E-Book. Elsevier Health Sciences, 2019.

貝爾曼特輸液管理系統可以輸注全血YES!!

有抗凝處理(anti-coagulated)的Packed RBC、FFP、全血以及經Cell Saver洗滌的自體回收血都適用於貝爾曼特輸液管理系統。使用者要特別注意輸注血品前、後,不要有促凝劑進入耗材管路如乳酸林格氏液(Lacteted Ringer’s)、任何含鈣溶液或是葡萄糖溶液,否則可能導致血液在耗材中凝固。

Cell Saver與Rapid Infuser搭配使用

但全血中也有血小板呢?

在輸注全血時,不可避免地會有血小板通過系統管路,但少有研究說明影響性。近期佛羅里達大學醫學院麻醉科(Anesthesiology, University of Florida College of Medicine)即對此發表研究[1],它們觀察貝爾曼特輸液管理系統在輸注全血時當中的血小板有哪些負面效果。結果發現血小板數(Platelet Count)、血小板平均體積(Mean platelet volume, MPV)在經過輸液系統之後會減少,血栓彈力分析的血凝塊最大震幅(Maximum amplitude)也降低。換言之,血小板數量、血栓彈性強度在通過系統後都會減少,不過作者說明造成的差異很些微,快速輸液系統能夠提供更快、更即時的血品輸注速度,相較之下的效益較大

全血輸注前、後的血小板變化[1]

參考資料:
[1].Sappenfield, Joshua W., et al. “Effects of a Single Rapid Infusion System on Platelet Function in Stored Whole Blood: An Ex Vivo Study.” Cureus 13.7 (2021).
[2].Hess, Aaron Stansbury, et al. “Administering Platelets through a Fluid Warmer or Rapid Blood Infusion System Does Not Impair Their Function.” 2018 Annual Meeting. AABB, 2018.
[3].Gropper, Michael A., et al. Miller’s Anesthesia, 2-Volume Set E-Book. Elsevier Health Sciences, 2019.
[4].Hrovat, Teresa M. Guidelines for the use of blood warming devices. AABB, 2002.

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