Ç 29 È Ïñ a w ë Ñ } ñÀ ® ® « ûplaza.umin.ac.jp/yuketsuk/resources/平成29... ·...

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Transcript of Ç 29 È Ïñ a w ë Ñ } ñÀ ® ® « ûplaza.umin.ac.jp/yuketsuk/resources/平成29... ·...

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29 10 11 ( )12

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92

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28

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28

98 8,500 13

1,120 116 9,620

226 8,620 109 9,000

116 9,620

30

15

12

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2025

15

2025

26

2,500

28

5,000

12

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29

27

30

10

31

29

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COI COI

COI

30

50

2025

2025

45 360

720

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31

36

30

31

11 12

11 12

12

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20

11

14

31

14

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10

20 30

2020

28 191

483

2

68 21

17 28

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g/dL 1A 1A

2C 2D

5 / L 2D

2 /mL 2D

PT 2.0 30 APTT

2 25 100mg/dL

150

2B

10 15mL/kg

2.5

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3.0g/dL 2.5g/dL

1B 2D 1B

2B 2D

2D

1B

200 400mL

1A

2C

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MTP Massive Transfusion Protocol

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AABB

AABB Trauma hemostasis&Oxygenation Research:

THOR AABB/THOR Joint Working Group

Hemorrhagic Shock Resuscitation Workshop

preventable death

COI

30

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100

FFP 1.5

FFP

civilian

FFP FFP

FFP

16 FFP

FFP

30

1:1:1

FFP,

FFP

FFP

FFP

FFP FFP

FFP FFP

FFP

survivorship bias

survivorship bias

survivorship bias Plasma: RCC

FFP

cutoff 1 1 30

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survivorship bias 30

905 25

24

plasma:RBC

platelets:RBC 6

24 FFP 24

FFP

FFP

survivorship bias 24

disadvantage

FFP Thawed plasma

plasma

AB

AB AB low titer B A

TRALI

FFP

vWF von Willebrand factor vWF N

FFP

FFP

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PROPPR study Plasma:

FFP container

container

FFP

FFP

10

24 30 all-cause mortality

1:1:1

24

thawed plasma

AB AB

A Universal donor

Massive Transfusion Protocols

30

PROPPR study

container

container

15

Massive Transfusion Protocols

15 10

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AABB

FFP

Massive Transfusion Protocols

post-hock 24

survivorship bias 24

FFP

plasma

Massive

Transfusion Protocols

FFP

Blood Bank

Blood Bank

1-

thawed

plasma

AABB

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AABBstandards

AABB low titer group O AABB standards

low titer group O A

B 256 O

FFP

400cc

Freeze-dried plasma

Refrigerated Platelets

cold platelets FDA

cold platelets

cold platelets 14

cold platelets

Massive Transfusion Protocols

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Massive Transfusion Protocols

VII

primary endpoint

Rahe-Meyer Hannover

150

2017

200

feasibility study

ROTEM PCC

prothrombin complex concentrate

RCT

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plasma

Grade 1B 1C

30

ROTEM

TEG

FFP

AABB

40

FFP

POC device

1 1 1

DIC

PAI-1

MTP MTP MTP

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MTP

prehospital

Freeze-dried

plasma MTP

MTP

FFP

FFP

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Massive Transfusion Protocols Damage

Control Resuscitation

Damage Control

Resuscitation Massive Transfusion Protocols

cold platelets

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cold platelets

FDA

AABB

MTP

FFP

MTP

1B

150 200

1C

Transfusion

125 123 MTP

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93

ER 4 1

2 25 28

10

108

8,345

O

11.5 1,225

O

MTP

MTP

MTP 10

O MTP

10 n=10

MTP

FFP

FFP MTP

2016 1 106 23

10 n=10

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MTP 15

FFP 30

15 50 MTP

MTP

MTP

MTP

MTP

FFP

MTP TACO

MTP

MTP O 10

FFP FFP

FFP

FFP

MTP 72

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AMED

MTP

O

MTP

FFP

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MTP

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19

5.5 12.7

21

12

ABO

20

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O

A4

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2006

2012 58

2023

Advanced OSCE

Post-Clinical Clerkship OSCE

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53 73

37 44

39 38

Cell Processing Center

40

90

78

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93 100

199 164 25

145

616 313 15

240

52

14 31 4

731 HLA 50

FFP

20

28 11 6,000

20

21 13.2 25

9.8

FFP PC 20

FFP

79

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23

HLA

A&T

78

72

92

12

10

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IC

IC

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31 64

31

2019 31 11 14

18

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10 19

10

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