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Jafarpoury M R, Shiri Y, Yazdandoust E. Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO): Pathophysiology, Prevention and Management. bloodj 2025; 22 (3) :248-263
URL: http://bloodjournal.ir/article-1-1580-fa.html
جعفرپوری محمدرضا، شیری یاشار، یزدان دوست احسان. آسیب حاد ریوی ناشی از انتقال خون و گرانباری گردشی مرتبط با تزریق خون: پاتوفیزیولوژی، پیشگیری و مدیریت. فصلنامه پژوهشی خون. 1404; 22 (3) :248-263

URL: http://bloodjournal.ir/article-1-1580-fa.html


مرکز تحقیقات انتقال خون ـ مؤسسه عالی آموزشی و پژوهشی طب انتقال خون
چکیده:   (177 مشاهده)
چکیده
سابقه و هدف 
آسیب حاد ریوی مرتبط با انتقال خون (TRALI) و گرانباری گردش مرتبط با تزریق خون  (TACO)از مهم‌ترین علل عوارض شدید و مرگ‌ومیر ناشی از تزریق فرآورده‌های خونی به شمار می‌روند. این واکنش‌ها عمدتاً در طی شش ساعت نخست پس از تزریق رخ می‌دهند و در گروه واکنش‌های حاد انتقال خون طبقه‌بندی می‌شوند. هدف این مرور، بررسی تاریخچه و اپیدمیولوژی، عوامل خطر، پاتوفیزیولوژی، تظاهرات بالینی، روش‌های تشخیصی، مدیریت و راهکارهای پیشگیری از این عوارض است.
مواد و روش‌ها
در یک مطالعه مروری، برای دسترسی به مطالعه‌های پیرامون TRALI و TACO در پژوهش‌های معتبر منتشر شده و پایگاه‌های اطلاعاتی Google scholar ، PubMed و MEDLINE جستجو صورت گرفت و یافته‌های 105 مقاله از سال 1996 تا 2025 مورد استناد قرار گرفت.
یافته‌ها
TRALI معمولاً با ادم ریوی غیرقلبی، هیپوکسی و دیسترس تنفسی مشخص می‌شود. مکانیسم‌های ایمنی شامل وجود آنتی‌بادی‌های ضد HLA و HNA و نیز عواملی مانند سیتوکاین‌ها و لیپیدهای فعال در ایجاد آن نقش دارند. TACO بیشتر ناشی از حجم یا سرعت زیاد تزریق در بیماران پرخطر (سالمندان، بیماران قلبی–کلیوی) رخ می‌دهد و با ادم قلبی ـ ریوی، افزایش فشار وریدی و پاسخ مطلوب به دیورتیک‌ها همراه است. مطالعه پیش رو هم‌چنین نشان داد که راهکارهای تشخیصی TRALI و TACO با توجه به شناخت پاتوفیزیولوژی آن‌ها امروزه بهبود یافته و به کارگیری اقدامات پیشگیرانه از جمله استفاده از فرآورده خون شسته شده و استفاده از Solvent-detergent plasma در پیشگیری از رخداد TRALI و کاهش حجم یا سرعت تزریق فرآورده‌های خونی و استفاده از داروهای مدر (دیورتیک) قبل از تزریق ممکن است در پیشگیری از TACO مؤثر باشد.
نتیجه گیری            
مرور حاضر نشان داد که اجرای سیاست استفاده از پلاسمای اهداکنندگان مرد و غربالگری آنتی‌بادی‌های ضد HLA/HNA در مراکزی که این اقدامات انجام شده‌اند، موجب کاهش بروز TRALI گردیده است. از نظر اپیدمیولوژیک،TACO  در بیماران سالمند و مبتلایان به بیماری‌های قلبی یا کلیوی شایع‌تر است و در سطح پاتوفیزیولوژیک، مکانیسم‌های ایمنی در TRALI و فاکتورهای حجم و فشار در TACO نقش اصلی را دارند. به‌ کارگیری بیومارکرهایی مانند BNP و NT-proBNP می‌تواند در افتراق دقیق‌تر این دو عارضه مؤثر باشد. پیشرفت در شناخت پاتوفیزیولوژی، توسعه بیومارکرهای تشخیصی و اجرای راهکارهای پیشگیرانه می‌تواند به کاهش بروز این عوارض و ارتقای ایمنی انتقال خون کمک کند.
 
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نوع مطالعه: مروري | موضوع مقاله: ايمونوهماتولوژي

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