臨床婦人科産科72巻8号

2018年08月発行

今月の臨床 スペシャリストに聞く　産婦人科でのアレルギー対応法

疾患各論

輸血関連急性肺障害（TRALI）

著者： 岡崎仁¹

所属機関： ¹東京大学医学部附属病院輸血部

ページ範囲：P.786 - P.792

文献概要

●白血球抗体（HLA／HNA抗体） : 経産婦に多く見出される抗体で，妊娠に伴い検出されるが，男性に検出されることもある．保持者は通常健康体である．HLA抗体はclass Iおよびclass II抗体があり，どちらも輸血関連急性肺障害（TRALI）などの副反応に関連することがある．HNA抗体のなかではHNA-3a抗体が重篤なTRALIを起こすといわれているが，検出頻度は低い．

●輸血関連循環過負荷（TACO） : 輸血により，循環過負荷となり，うっ血性心不全，肺水腫となる輸血副反応である．輸血の入れすぎだけが原因というわけではなく，輸血以前の患者の循環状態の把握がされていないことも原因の1つではないかと考えられており，特に高齢の患者では注意すべき副反応である．TRALIとの鑑別が重要となる．

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