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ڿ켺
10-06-25 10:26
13,052
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, , platelet ;blood platelet ; thrombocyte
. :
߿ ü̴. [] ϸ
, ȿҵ Ǿ ִ
ϰ а Բ ߿ Ѵ
ִ ٱ(megakaryocyte) κ ȴ
ǻ̸ 23 m ̴
1mm 13 32( ʹ 15004000ﰳ) ϸ
8ϡ12 ̴ ų ߷
ϸ
ٸ Ű鼭 Ͽ
1 ϼѴ
ϰ Ҿϱ
ʿϴ
. ӻ :
츮 1mm 15 45
20 30 Ѵ
ӻ ġ 13 15 10 ̸
˻縦 غƾ Ѵ
. װ ȯ Ǽ̳ ҷ , ,
ġ ްϰ ǰ Ÿ
ִµ ߿ 5 10
ȯ ¿ 2 찡 ִ
ǻ ó 3 Ϸ
µ 5 10 輺 ,
ո, , , Ÿ
ġ ó
. Ϲ ǰҼڹ ִ 쵵 䱸ȴ
. ۿ Ͻ 10 Ϸ
쵵 ִµ ̶ ʰ
Ͽ ȸŲ
1. (Platelet Concentrates)̶ Դϱ?
κ Ǹ 50 mL ӿ 5 X 1010 ֽϴ.
õõ ִ ġ ϸ
µ 20-24CԴϴ.
Ϲ 3ϰ
ϸ 5ϰ ֽϴ.
쿡 ˴ϱ?
Ǵ Դϴ.
Ǵ ְ ִ ȯڿ ȸŰ ˴ϴ.
Ǵ ҷ , ġ, Ǽ ħ,
Ͽ
Ǽ 20,000/L Ϸ ҵ ȯڵ鿡 ַ ˴ϴ.
Դϱ?
Ǽ ڰ鿪 Ҽ ڹ(ITP) (DIC) Ͽ
ı Ͼ ȯڿԴ 밳 ȿ ϴ.
Ǵ ε ǰ ȯڿԵ Ǽ ʽϴ.
ۿ , ߿ ˷⼺ Ͼ ֽϴ.
߿ÿ ƽǸ ؿ Ǵµ
ƽǸ cyclooxygenase Ȱȭ
Ű Դϴ.
ӿ ҷ Ƿ Rh ȯڿԴ
ݵ Rh Ͽ մϴ.
ӿ ȯڿ Rh 缺 Ұ
Rh 鿪 ϱ Ͽ ݵ Rh 鿪۷κҸ(Rhogam) ؾ մϴ
ؾ մϱ?
1 ϸ Ǽ 5,000/L ̻ ˴ϴ.
ǰ 6-10 ϸ
Ҿ ü 10 kg 1 մϴ.
(DIC), , , ü ,
Ǵ ġÿ Ǽ ɴϴ.
1ð Ŀ Ǽ ʴ
HLA 鿪 ɼ ϴ.
CCI (corrected count increment) θ ֽϴ.
Ǽ - Ǽ
CCI = -----------------------------------------------
x üǥ(m2)
Ǽ x 1011
1ð Ŀ CCI 7.5 x 109/L ̸̰ų
18-24 ð CCI 4.5 x 109/L ̸ ǹմϴ.
ݵ Ͱ ִ Ʈ Ͽ Ǿ մϴ.
2. ä(Apheresis platelets)̶ Դϱ?
ä(plateletpheresis) ä⸦ ̿Ͽ
ڷκ Ǹ äϴ
밳 2-3ð ҿǸ ̷κ ä ̶ մϴ.
6-8 شϴ 3 X 1011
差 200-250 mL Դϴ.
ä 6-8 ڷκ ִ ǿ شǴ
1 ڷκ Ƿ
ȯڿ Ǵ ٿ ŭ HLA 鿪 ȸ ְ
ļ ȯ ȸ ִ ֽϴ.
쿡 ˴ϱ?
ǰ մϴ
* ̷
1950 Ҽ ȯ Ͽ ż (fresh whole blood)̳
dz (platelet rich plasma: PRP) Ͽ.
̴ volume overload" Ͽ ȿ ۿ .
1950 1960 ɺи ̿Ͽ иϴ ߵǾ
ȿⰣ ðۿ ʾҴ. 4ɿ
ȿ Ⱓ 24ð ۿ ʾҴ.
1970뿡 4 ȿ ٴ ߰ϰ Ǿ.
1980 ߹ݿ ǿ 22ɿ
5ϰ ϰ Ǿ. 1985 ¿ 7ϰ
high reaction rate"
Ⱓ 5Ϸ ѵǰ Ǿ.
( )
ǰ ִ (Whole blood-derived platelets)
ä (plateletpheresis) ִ.
PRP ̿Ͽ (ַ Ϲ̿ ) ̿Ͽ
( ַ ) ִ.
PRP κ PRP PRPκ
ٽ Ե 60-75% Ű ̴.
PRP-platelet 40-50mL Ͽ Ǹ, 22ɿ 5ϰ ϰ,
ҿ ̻ȭźҰ ֵ Ư bag ȴ.
ݸ иϴ ܰ踦 ϰ ִµ,
Ե 4-6 unit poolingϿ ɾν
ϰ Ű ̴.
̷ 200-300mL Ƿ 22ɿ 5ϰ Ѵ.
ä ä⸦ ̿Ͽ ä ϸ鼭 Ǹ и
ٸ ڿ ִ и
äⰡ ߵǾ ִ. ä
250mL Բ Ǵµ,
̴ PRP-derived platelet 5 unit ϰ ֱ
pooling ġ ʴ´.
ұϰ
鿪
ª ȿⰣ
ϰ ִ.
Ų ü Ͽ
Ʒ 䱸ǰ ִ.
1. ȿ
2. 鿪
3. ǰ迡 Ͼ
4. ռ(Sterile)
5. Ȱ Ⱓ
6. ȿⰣ ,
7. ̼
̷ ü ȿ ϸ 䱸ǰ ,
̿ܿ Ǻ기 (fibrinolysis) ,
(inflammation), 嵵 ٸ ɵ ִ.
̵ ǰ ִ.
ο
ο Ȥ üδ ͵ ִ.
.
(1) (Frozen platelets)
ü ִ ̴.
ϰ ̾ 鿪 ȯڸ
ڰ ַ ̿ǰ ִ. Դٰ ɰ ִ
, κ ʿ ü̳,
, η ߰ ʴ. ̷ θ ʴ´.
5-6% dimethylsulphoxide(DMSO) Բ Ű -80ɿ Ⱓ
ϸ, ̰ ֱ Ǿ ִ.
ô DMSO ϴ ʿϸ, ص ȸ 75%,
1ð ü ȸ 33%̸, ü
8ϰ ȴٰ Ǿ ִ. ü ܿ ,
Ÿ, ü ȿ ̴ Ÿ ִ.
ֱ ϸ, ȸμ ־ Ǻٵ
ȿ Ÿ ִ.
ֱٿ amiloride, adenosine, sodium nitoprusside ȣ(ThromboSolTM)
÷ϸ, DMSO 6% 2% ־ ص ȸ ȿ̶
Ǿ ִ. ̷ "second messenger effector" ڱ
ν ջ ݰų ִ.
̷ ThromboSolTM 2% DMSO ̿Ͽ
ü ȸ, 6% DMSO Ͽ 캸 Ÿִ.
(2)
· 4ɿ ϸ ,
̷ ¿ 24ð ̻ Ǹ,
ȿ پ Ÿִ. ¿
ϱ õ ̷ , ̷
ջ Һи .
ThromboSolTM Ẹȣ ȿ ̿ܿ ÷ Ǿ
ϰ Ѵ. ̷ 4ɿ ϸ
Ÿ in vitro ϰ ȴ.
in vivo ɰ Ͽ Һиϴ. ٸ
߰ߵ antifreeze glycoprotein(AFGPs) ϴ ̴.
AFGPs ȭ Ȱȭ , in vivo
ȿ Ͽ Һиϴ.
(3) ȭ ó
Psoralen ó ڿܼ(UVA 320-400nm) ϸ
ٻ ǥ pathogen inactivation ִ.
ڿ donor û ˻翡
μ ġ Ѵ.
Psoralen ȯ ȭչμ ܰ迡 DNA RNA Ͽ Ѵ.
Psoralen ٻ double helical region Ѵ. UVA ϸ,
psoralen pyrimidine Ͽ ٻ 罽 cross-link ϰ ȴ.
̷ psoralen ϰ Ǹ Ͼ Ǿ ,
̷, ڸ Ȱȭ ְ ȴ. ռ psoralen S-59
̿ ȭ ó ÷Ǿ ɿ 鼭
̷ Ȱȭ ִ. Դٰ ̷ ν
ī ̽ ֺ ݰų
Ͽ Ȱȭ ų ִٰ .
(4) ̼
̼ڴ Ȱȭ Ǵ ջ ÿ Ǵ ڷ
ÿ Ǹ , ż, ħ
߰ߵ ִ. ̼ڴ Ȱ ϸ, յǾ
ȭŲ. ̼ڴ ü ɰ
ϰ ֱ, ü ִ.
ʱ õ(1959) ̼ڰ ȿ Ÿ ʰ
ɰ ջ . 30 ̿ ߴܵǾ
1987 ̴ 䳢 迡 ġ
ȿ Ÿ´.
ֱٿ(1996) ҿ뼺 (infusible platelet membrane, IPM)̶ ϴ
̼(IPMs, CyplexTM, Cypress Bioscience) ߵǾ.
IPM ȿ κ ȴ. ɺи
Ŀ ظ ؽŲ. ô 60ɿ 20ð ó
̷ Ȱȭ sonication ɺиѴ. Sucrose ˺ι ó
Ű 4ɿ 2Ⱓ ¸ Ѵ.
IPM 0.6 ڵ ̷ ܹ Ǿ ִ.
䳢 IPM ּ 6ð ð Ű
Ÿ.
24ð Ǿ ̻ ȿ Ÿ ʾҴ.
ӻ II 迡 ġ <50109/L ״ ġ
<br/> ȯ 31 IPM(2-6mg/kg) Ǵ Ͽ.
IMP 26 17, 5 3
Ǵ . IPM ӻ III ȹ ߿ ִ.
(5)
1950 Ϻ ȯڿ ȿ
Ÿ ȿ ʾҴ
Դ. ǿ
Ÿ ʾҴ.
ֱ Ͽ ӻ 迡 ־ Ÿ.
Read 50-60% ִ
Ͽ. ̴ ô paraformaldehyde(1.8% for human platelet)
5% ˺ι Ų , -20-40ɿ 20-24ð Ų.
1.8% paraformaldehyde ̷ ȿ ִ
Ǿ. ϸ ż ǰ ¸
ϸ, GPIb, GPIb/IX, GPIV, GPIIb/IIIa ణ Ѵٴ м
Ͽ .
(6)
üܿ leukapheresis κ͵
ִ. ̷ 翡 ̿ Һи
ϳ ɼ Ѵ.
. ü
(1) Fibrinogen Ǵ RGD peptide
Fibrinogen ڱص cross-linkingϿ ü ϴ
ֿ ligandμ ̴ fibrinogen RGD(Arg-Gly-Asp) 迭
GPIIb/IIIa integrin տ ̴. Fibrinogen 1 ̻ RGD迭
ϰ Ƿ ü ְ ȴ. fibrinogen̳
RGD peptide Ű ؿ Ǿ
in vivo ȿ Ͽ и ʴ.
(2) Fibrinogen ˺ι ̼ ĸ(FAMs)
˺ι ǥ鿡 fibrinogen fibrinogen Ű
ϴ ̴. FAM ӻ ߿
ȿ ̴ Ÿ ִ.
(3) lyposome
̿ ִµ, ϳ liposome glycoprotein ս
ΰ ϴ ̰ ϳ procoagulant liposome Ȱȭ factor X
ϴ ̴. Ϻ 迡 ȿ Ÿ ǰ ,
Ϻο Ÿ ִ ǰ ִ.
. HLA
Ұ Ǿ ִµ, Ư ȸ ڿԴ
Ÿ. ߿ ϳ HLA 鿪̴.
̿ Ͽ ϱ Ϲ HLA
ڸ ã ̴. ٸ HLA ϴ ̴.
HLA Ÿ ؼ (i) Ŭη ó (ii) 꼺 ó ִµ,
꼺 ó ó Ͽ ̷. HLA Ŵ ״
ƴ, ̸ Ͽ ǰ ִ. ֱ
HLA ȿ Ͽ ġ
ܰθ ӻ õ Ǿ ̴.
ϱ õ Ǿ κ
ӻ ̱ܰ , δ. 22
ü ִ 쵵 ʴ´.
ǥ ణ (, ȭ ó )
ٸ ü ӻ δ. ü Ÿ
DZ ӻ Ǵ ӻ ܰ踦 ľ Ѵ.
ʿ ȯڴ ,
± Ե ε ȭ ̴. ȭġ
ִ Interleukin 11̳ thrombopoietin ڰ θ ǰ
, ̷ ο õ ü ȯ濡
Ž ̶ ش. б ,
ȿ̰ ü
ӻ ġῡ ̴.
ϴ ǰ
ڷκ ٷ äϴ äǿ ؼ
̳ ʴ ϴ
쿡 ڴ 뷮 εٰ
ŸԱ ¾ƾ ϴµ
̷ Ȳ ȯڳ ȣ ߸
Ǹ ϱ ǰ ϰ Դϴ
忡 1ð 10 ð
쿡 3-5 ؾϴ
ũ Ư ڿ ʿ Դϴ
ʿ ̵ ä̵
ȯڳ ȯںȣڿ û ϰ ǰ
Ư ü ä
ڸ ϴ 쵵 ִ Դϴ
Ǵ 3
1. ä̳
2.ü ä
3.ڰ ̼ Ͽ ȯڿ
ȣ ̷ ִٰ մϴ
żӼ ǰ輺 [---ȸ] Ʈ
κ ϵǾ Ѵٰ մϴ.
̻ ˾ƺٿ ̶ ߿
߿ μ Ư, װȯ
ʿϰ ̽ļ Ŀ
ʿ ŭ Ȯ ū ְ
Ư Rh(-) 쿡 ް ȴ
濵 帣-3( ̾! -װ-)
ߵ Rh Negative ȸ Ǹ ̿
400cc ̸
Ѹ ̰
400cc Դϴ
Ͽ ģ ֽ Բ 縦 帳ϴ
ڷ ϼ^^
.
1. Rh Ÿ ġ
- ӿ ҷ Ƿ Rh ȯڿԴ
ݵ Rh Ͽ մϴ.
ӿ ȯڿ Rh 缺 Ұ
Rh 鿪 ϱ Ͽ ݵ Rh 鿪۷κҸ(Rhogam / Partobulin / WinRho) ؾ մϴ
2. 뷮
-(Platelet Concentrates)- ϰ Ű ̴.
̷ 200-300mL Ƿ 22ɿ 5ϰ Ѵ.
ä(Apheresis platelets)-ä
250mL Բ մϴ
3. ä 뷮
-(Platelet Concentrates)- Դϴ 320cc 400cc
ä(Apheresis platelets)-κ ä ̶ մϴ.
6-8 شϴ 3 X 1011
差 200-250 mL Դϴ.
ä 6-8 ڷκ ִ ǿ شǴ
1 ڷκ ֽϴ
ο1
ȵǰų ġ ִ ȯڿ ֱ Ͽ
ǰ κ Ǹ äϴ Դϴ
1κ Ϲ 6 شϴ Ƿ ſ ȿ Դϴ.
Ŀ ̸ 3-4 ĸ ͵ǹǷ Ͻ 쿡
2ְ ϸ Ͽ ƹ ̻̾ϴ.
ٷ ȯ ü ּȭ ų ִ ֽϴ.
ʿ ȯ
ȯ( , ҷ , , )
Ÿ ġ ij ̽ ҵǾ
ڴ 湮Ͽ ϰ Բ ˻縦 մϴ.
˻翡 ڴ ȯڰ ʿ
湮մϴ.
湮Ͽ Ǽ Ż ī带 ۼ ˻ µ,
Ȯ ° ϴµ ̻ ٰ Ǹ մϴ.
ƿ ֻٴ մϴ.
и äϰ, ڿ ϴ.
1ð 30а ҿǸ, ä 250ccԴϴ
ο2
, , Ǿ ֽϴ.
̷ ü ϴ ̰, ä 踦 ̿Ͽ
, Ǵ и ϴ ٽ ڿ ǵݴϴ.
⼭ ! ļ ó Ǹ ܰϴ ۿ ϸ,
̻ ϴ ӿ ʿ , , Ÿ,
ȣ, ȿ ü ߿ ܹ е ֽϴ.
, ҷ , ȯڵ鿡 ʿ
ְ, Ͽ յ鿡
ɷ ȯڿ ˴ϴ. ˺ι, ߿ ȹ
µ ˴ϴ.
ϴ ٸ ϴ.
ٸ , Ǵ ʿ и äϰ ǵ ֱ
ټ ð ɷ 2ð ҿǸ ˻縦 ް ڷ ƾ ֽϴ.
ι ǿ 湮ؾ ϴ° ŷӱ 10-30 ˻Ͽ
˻縦 ٽ ް ֽϴ.
Ѱ 72ð ƽǸ̳ ƽǸ
ʵ ؾ մϴ. ϵDZ Դϴ.
Ŀ 2 ٽ
Ǵ Ϸ 2 Ŀ, ٽ Ϸ 3Ŀ ֽϴ.
Ϸ 3Ŀ, ٽ Ϸ 2Ŀ ֽϴ.
ŭ ȸ ٴ ..
/ м :
ฮ, ǻ , ¾ д
, ˻, ֽ,
Erythroblastosis fetalis
Hemolytic disease of the newborn
ó / ٰڷ :
Rh(-)ȸ ȸ(http://www.rh.or.kr)
μոƺȸ(http://doosonmor.org)
ѿŸ(-泲 Rh(-)ѿںȸ )
߾Ӿƻ꺴 (http://www.amc.seoul.kr/~swkwon/)
ī [ Rh Negative I.Q. / Rh(-) ](http://cafe.daum.net/ichisalang1)
ѹαǾ[Ŵ¶](http://new.kimsonline.co.kr/)
̹ī [ Rh Negative I.Q. / Rh(-) ](http://cafe.naver.com/rhne)
ڻ װ(http://www.redcross.or.kr_____http://www.bloodinfo.net/)
߾Ӿƻ꺴 (href="http://www.amc.seoul.kr/~swkwon/">http://www.amc.seoul.kr/~swkwon/)
< ڷ .ۼó ; Rh(-)ȸȸ ȫ >
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