臺灣博碩士論文加值系統

摘 要
美國血庫學會 (AABB)工作指導書內文提到，收集500 mL血液時平均時間，少於10分鐘，若收集時間超過15至20分鐘，可能不適合收集血小板或血漿使用於輸血，然而高雄捐血中心仍超過15分鐘採血時間的血袋製成各類血品，此成份製備流程行之有年，卻未與AABB建議相符，基金會建議進行研究，確認超過15分鐘的採血時間是否影響血液品質。本研究依採血時間和刮過兩條件將血袋分成四組：10分鐘以內 (第一組)、15分鐘以上 (第二組)、刮過之血袋且採血時間超過15分鐘 (第三組)、15分鐘以內刮過 (第四組)，依此四組分類重整或分血型探討對凝血相關因素：凝血酶原時間 (PT)、部份活化酶原時間 (aPTT)、第V因子、第VIII因子的影響。結果顯示四組的凝血相關因素相較之下第四組與第一組有顯著差異，且依數據來觀察第二組、第三組、第四組新鮮冷凍血漿的第VIII因子活性比第一組高出許多；而且紅血球濃厚液出現凝塊的檢體，其新鮮冷凍血漿內含高活性的第VIII因子，與第一的正常組比較，具有統計學上的意義；其中第二組、第三組、第四組的紅血球濃厚液發生凝塊的機率比第一組高，甚至第三組之紅血球濃厚液出現凝塊的機率高達31%。本研究結果建議，採血時間和刮過不造成凝血相關因素的血液品質下降，所以超過15分鐘以上或刮過的血袋都適合製備成新鮮冷凍血漿，但紅血球濃厚液必須要觀察是否有凝塊的產生。
關鍵詞：新鮮冷凍血漿、凝血因子、採血收集時間。

Abstract

According to the American Association of Blood Banks (AABB) Technical Manual 18th Edition, the average time of collecting 500 mL blood should be less than 10 minutes. Sampling time longer than 15 to 20 minutes may not be suitable for collecting platelet concentrate or plasma for transfusions. The isolation procedures used to make of various types of blood products in Kaohsiung Blood Center (KSBC) did not care whether sampling time over 15 minutes or not. Because these processes of KSBC did not dependent the AABB recommendations, the Taiwan Blood Services Foundation recommended to perform the study for the “Effects of sampling time on the quality parameters of blood products”. The study methods divided into four groups: (1) within 10 minutes, (2) over 15 minutes, (3) Scraping of blood bag over 15 minutes and (4) Scraping of blood bag within 15 minutes. The blood clotting factors (PT, aPTT, V, VIII) were estimated in four groups and the relationships of ABO blood types were studied. Results showed that the clotting factors of the 4th group were significantly higher compared with the normal 1st group. Additionally, the VIII factor of the 2nd, 3rd, 4th groups were higher than the normal 1st group. We found that the bood bags with clot contained significantly higher factor VIII activity in fresh frozen plasma than the normal 1st group. The the 2nd, 3rd, 4th groups have the higher clot percentage than the 1st groups, even the clot percentage of the 3rd group was high to 31%. The study suggested that blood sampling time and scraping of blood bags do not decrease the the quality parameters of clotting factor. Therefore, the over 15 minutes, scraping of blood bag over 15 minutes and Scraping of blood bag within 15 minutes are still suitable for preparation of fresh frozen plasma, but the packed red blood cell should be observed whether the generation of clot.

誌謝 i
中文摘要 ii
英文摘要 iii
目錄 iv
圖目錄 v
縮寫表 vi
第一章 緒論 1
第二章 文獻探討 4
第一節 血液成品輸注 4
第二節 分離成分血品介紹 12
第三節 血漿內凝血因子介紹 13
第四節 檢測項目 14
第三章 研究方法 17
第一節 研究設計 17
第二節 材料與試劑 19
第三節 檢體收集 21
第四節 實驗方法 25
第五節 統計方法 27
第四章 實驗結果 28
第一節 採血時間與刮過對第VIII和V因子在不同血型的影響 28
第二節 依採血時間和刮過且不分血型探討凝血相關因素的影響 32
第三節 依ABO血型探討採血時間和刮過對凝血相關因素的影響 33
第四節 紅血球濃厚液出現凝塊對凝血相關因素的影響 37
第五章 討論與結論 40
第一節 本研究與先前研究比較 40
第二節 檢體收集遭遇的困難 40
第三節 刮過與血球濃厚液凝塊出現機率 41
第四節 纖維蛋白胜肽A與新鮮冷凍血漿的關係 42
第五節 採血時間對凝血因素的影響 43
第六節 結論 45
第六章 參考文獻 46
附錄一 72
附錄二 73
附錄三 74
附錄四 76
附錄五 82

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