(2016 )

KSBT

The Korean Society of Blood Transfusion

11-1352159-000534-01

4

(

2016

)

4

ISBN: 978-89-6838-277-2(93510)

,

. 2009

2011, 2013

.

(WHO)

, ,

,

.

4 .

,

.

, ,

.

, , ,

.

, .

.

.

2016 8

. - 1. 1

1. 3

. 3

. 4

. 4

. 5

. 5

. 5

2. , 6

. 6

. 6

3. 7

. 7

. 7

. 8

. 8

4. 9

. 9

. 9

. 9

. 10

. 10

. 10

5. 11

. 11

. 12

. 4 14

. 4 14

. 15

. 15

. 16

. 17

. 17

. 18

. (Disseminated intravascular coagulation, DIC) 18

6. 19

. 19

. 20

. - 2. 21

1. (Red Blood Cells) 23

. 23

. 23

. 24

. 24

. 25

. 26

. 26

. 27

2. (Platelets) 32

. 32

. 32

. 32

. 33

. 33

. 33

. 34

. 35

. 36

3. (Fresh Frozen Plasma) 41

. 41

. 41

. 41

. 42

. 42

. 42

. 44

4. (Cryoprecipitates) 47

. 47

. 47

. 47

. 48

. 48

. 48

. 50

5. (Leukocyte-Reduced Blood) 52

. 52

. 52

. 52

. 53

. 53

. 54

6. (Irradiated Blood) 55

. 55

. 55

. 56

. 56

. 56

. 56

7. (Washed Blood) 58

. 58

. 58

. 58

. 59

. 59

. 59

60

. 63

1. 65

. 65

. 65

. 65

2. () 67

. 67

. 67

[ 1] 70

3. ( ) 72

. 72

. 72

. 72

. 72

. 74

. 74

[ 1] 75

[ 2] 76

4. 77

. 77

. 77

. 77

. 77

. 78

. 79

5. 80

80

[ 1] 89

[ 2] 90

[ 3] 95

[ 4] 96

6. 98

1. 98

2. 101

[ 1] 105

[ 2] 106

[ 3] 107

. 109

[ 1] 111

4 (2016 )

3

01

.

.

.

.

,

.

.

1) (erythropoietin, EPO),

2) (anti-

fibrinolytic agent)

.[1]

01

4

() ()

.

,

.

, () .

.

,

, , ,

, ( ,

) ,

.

1) : .

2) : .

3) 1

.

( ) .

, , (, , , ), ,

, .

( ) .

5

. ,

(, , , ) .

.

ABO, RhD ,

.

, , .

ABO, RhD ,

.

(immediate crossmatching)

.

,

.

ABO RhD (Type and Screen, T&S)

(Maximum Surgical Blood Order Schedule, MSBOS)

(Surgical Blood Order Equation, SBOE)

6

02 ,

, , ABO RhD ,

, , , , ,

.

, ,

, .

.

,

.[2]

,

.

10 .

30 10 .

.

.

.

7

03

, ,

.

.

.

(crossmatching) (

) , , ABO RhD

. ,

.

(PDA )

.

, , .

[3]

, ,

15 5~15

. 15 ,

.

8

, ,

. ,

.

,

. .

, ( ),

. ,

.

10( ), 3(),

13( )

(transfusion premedication)

.

30, 10

.[4]

9

04

18~20 ,

22~24 .

[5]

1~3

.

(blood warmer) .

1) 50 mL/kg

2) 15 mL/kg

3)

4) (cold agglutinin)

5) (central catheter)

42

4 .

.

4

. .

10

[6-8]

.

.

(citrate)

,

.

0.9% , , ABO ,

. (dilution)

.

[9-12]

.

2~4 , 6

. 1

.[13]

(infusion devices)

.

.

11

05

.

,

.

1) ABO ABO , ABO

O .

2) RhD RhD

.

3) 5 ,

,

.

1 .

, (

) ( ),

.

.[14]

12

[ 1] (ABO RhD )

1. AB A B

2. RhD RhD

1. AB A B

2. A, B AB O

1. RhD RhD

2. RhD RhD

1. RhD RhD

2. RhD RhD

1. O B A

2. O A B

3. O A, B AB

[6, 15-17]

24 8-10 1 4-5

.

1 kg 75 mL 70 kg 5,000 mL

10

. 3 50% , 1

4 , 150mL

.

() . 7-9 g/dL

.

75% ,

13

30% . 0.9%

(hyperchloremic acidosis)

.

, ,

(prothrombin time, PT), (activated partial

thromboplastin time, aPTT), (fibrinogen) .

1.5~2

, 50,000/uL

.

PT ( 1.5 INR 1.7) aPTT (

1.5 )

(fibrinogen) 100 mg/dL .

10-20 mL/kg .

111(, 6,

6, 6 1),

.

desmopressin(1-desamino-

8-D-arginine vasopressin, DDAVP), (, -aminocaproic acid, tranexamic acid), (, fibrin glue, thrombin gel), prothrombin complex

concentrate (PCC), (recombinant factor VIIa),

(fibrinogen concentrate) .

tranexamic acid 1

.

, .

14

4

100 mL/kg, 85 mL/kg

, 3 70~75 mL/kg .

10 mL/kg 2~3 (hematocrit)

10% .

, 24

.

ABO, RhD , 4

ABO .

IgG

.

4

,

ABO

.

4

, , ,

.

,

.

, , ,

, ,

.

.

15

.

.

O AB

.

-D RhD .

.

[18-22]

RhD

RhD , , .

( )

RhD ,

RhD .

D RhD

, -D

(alloimmunization) Rh

. Rh 3, 1

2-4 .

RhD ,

Rh .

RhD

RhD (-D, -D, DEL) RhD , ,

. , RhD

16

RhD , ,

RhD

, . , RhD RHD

Asia type DEL(1227 G>A) D

-D RhD

.

ABO (Cis-AB )

ABO .

,

,

. Am O,

A . , A2B3

O A( A cell ),

AB , ABO

cis-AB .

ABO

ABO

. , O,

AB , ABO

.

. anti-E

A+(A, RhD) A+ E

(, CDe) .

17

[23, 24]

. (prothrombin time, PT) 1.5

50,000/uL .

,

.

(fibrinogen) 100 mg/dL (fibrinogen

concentrate) .

K

.

(disseminated intravascular coagulation, DIC)

.

[23]

(erythropoietin, EPO)

.

, ,

desmopressin (1-desamino-8-D-arginine vasopressin, DDAVP),

.

(erythropoietin, EPO)

.

18

[25]

(, warfarin, anti-Xa , antithrombin

) (, heparin, heparin)

. (percutaneous coronary intervention)

,

-(non-aspirin) (,

clopidogrel, ticagrelor, prasugrel) .

(risk-benefit), .

(Disseminated intravascular coagulation, DIC) [24]

(pathophysiologic hemostatic response)

,

. - (anti-fibrinolytic therapy)

.

(prothrombin time, PT),

(activated partial thromboplastin time, aPTT), ,

(fibrinogen) . (TEG, TEM)

(hyper-coagulable)/

(hyperfibrinolytic) .

19

06

[26, 27]

, , ,

.

, , ,

.

, .

(acute normovolemic hemodilution),

(intraoperative cell salvage) .

(intraoperative cell salvage) (40

micron) . (amniotic fluid embo