大劑量輸血原則與臨床效果疑難血型與交叉配血課件

1、1轉化醫(yī)學與輸血科研 2趙樹銘教授, 主任醫(yī)師醫(yī)學博士博士研究生導師第三軍醫(yī)大學西南醫(yī)院輸血科從事專業(yè): 輸血醫(yī)學專業(yè)任職:中國輸血協(xié)會理事全軍血液管理專業(yè)委員會理事中國臨床輸血專業(yè)委員會常務委員重慶市輸血協(xié)會副理事長美國血庫協(xié)會會員國際輸血協(xié)會會員電話: 68754270; E-mail: shumingzhao3教學目的熟悉轉化醫(yī)學與輸血醫(yī)學熱點了解新技術新方法4教學內(nèi)容轉化醫(yī)學與輸血醫(yī)學特點輸血醫(yī)學-我的思考?美國輸血醫(yī)學的科研課題5輸血醫(yī)學定義:研究血液及其成分(包括生物制品)治療有關疾病，防治輸血不良反應及并發(fā)癥(包括輸血傳播疾病)的一門多學科的臨床應用學科。這門學科是集中運用醫(yī)學和

2、技術手段研究血液及其成分(包括生物制品)如何安全、有效地輸給患者，使患者受益。 -中國輸血醫(yī)學常用術語6 In actuality, there is no single basic science discipline of transfusion medicine; instead basic science research in transfusion medicine cuts across a multitude of fields including genetics, molecular biology, cell biology, biochemistry, immunolo

3、gy and virology. TRANSUFION MEDICINE實際上，輸血醫(yī)學不是單一基礎性科學學科，包含了遺傳學、分子生物學、細胞生物學、生物化學、免疫學和病毒學等多學科的綜合學科7輸血醫(yī)學的特點采供血機構及其管理獻血者的征集與管理血液樣品的采集及檢驗血液成分的研制及質(zhì)量控制血型及配血HLA分型及組織相容性試驗外周血保存骨髓和臍血干細胞分離與保存血液代用品研制輸血指征和各種成分血適應證自身輸血治療性血液成分單采輸血相關疾病和輸血并發(fā)癥及其預防獻血管理血液研究臨床輸血8輸血醫(yī)學的特點基礎研究的成果轉化成為實際應用， “從實驗臺到病床旁”Bench to Bedside，簡稱B2B 1

4、992年，美國科學雜志；1996年，在著名醫(yī)學雜志柳葉刀上，第一次出現(xiàn)了“轉化醫(yī)學”這個新名詞 轉化醫(yī)學應該是B2B2B，即從實驗室到病床，再從病床回到實驗室 9輸血醫(yī)學的成功案例nucleic acid testing for infectious disease agents 核酸試驗the use of monoclonal antibodies in immunohematology 單抗血清the transfusion of pathogen inactivated platelet and plasma products 血小板和血漿的病原體滅活10NAT基礎研究的工具，在短短不

5、到10年內(nèi)被用于血液病原體篩查美國FDA、重要商業(yè)公司、NIH國立心-肺-血液研究所11病原體滅活研究基礎科學研究-試劑和投送體外研究-證實滅活多種傳染性病原體的效果動物毒理學實驗I 和 II期臨床試驗-證明在健康自愿者中的安全性III期擴大的臨床試驗-證實安全性以及效果產(chǎn)品制備的認可常規(guī)血液中心制備的設備和條件，甚至定價等由于對受血者接受血液后產(chǎn)生未知副作用的疑慮，還需在多個國家進行臨床回顧性監(jiān)督調(diào)查藥物開發(fā)12動物模型研究中仍存在的科學問題red cell alloimmunization紅細胞同種免疫graft versus host disease移植物抗宿主病transfusion

6、related immunomodulation輸血相關的免疫調(diào)理transfusion related acute lung injury輸血相關的急性肺損傷 13輸血輸血科學問題紅細胞同種異體免疫反應、GVHD、TRALI常規(guī)是驗證在良好控制的動物模型中的特定科學假說，再應用這些研究成果去設計對受血者的臨床和流行病學研究對一個科學假說的驗證需要從基礎研究、動物實驗以及結合臨床試驗的結果等獲得廣泛的信息才能確立 科學研究基本原則14探索臨床使用產(chǎn)品的最適指征輸血治療的廣泛性血液成分的復雜性15美國臨床輸血科研輸血醫(yī)學和血細胞發(fā)育臨床試驗網(wǎng)項目Transfusion Medicine Hemo

7、stasis Clinical Trials Network (TMH CTN)，包括了美國17家醫(yī)學中心或醫(yī)院和一家數(shù)據(jù)處理中心多中心臨床試驗對血液病-腫瘤患者的血小板輸注劑量試驗心血管外科病人的不同庫存期紅細胞的輸注效果研究干細胞移植后的敗血癥患者的粒細胞輸注研究16輸血醫(yī)學及其特點輸血醫(yī)學-我的思考?美國輸血醫(yī)學的科研課題17輸血醫(yī)學 - 我的思考?獻血者招募獻血者病原體檢測血型血清學規(guī)范化（反定型）稀有血型血液輸注的原則和實踐（Rh陰性血）大劑量輸血原則與臨床效果疑難血型與交叉配血（不規(guī)則抗體、電子交叉配血）血液成分制備的標準化（去白、輻照、冷凍、手工分血小板、24hFFP）細胞治療的

8、規(guī)范化（輸血科、醫(yī)生、研究員）18輸血醫(yī)學研究熱點血型血清學規(guī)范化（反定型） 操作規(guī)范化復核問題簽名問題 試劑規(guī)范化反定型試劑關于紅細胞ABO血型鑒定規(guī)范化的思考及建議. 中國輸血雜志，2009，22（6）：431-4320919輸血醫(yī)學研究熱點血型血清學規(guī)范化 疑難血型鑒定 抗體篩查個體化輸血治療與電子交叉配血. 中國輸血雜志，2012個體化輸血治療與電子交叉配血.doc20血液成分制備的標準化（去白、輻照、冷凍、手工分血小板、24hFP）制備成分后保存質(zhì)量、時間、臨床效果操作規(guī)范、指南（計劃？）輸血醫(yī)學研究熱點趙樹銘.轉化醫(yī)學與輸血醫(yī)學. 中國輸血雜志,2011,24(10):831-83

9、211 21細胞治療的規(guī)范化（輸血科、醫(yī)生、研究員）項目種類：CIK、DC、SC操作規(guī)范（計劃？）質(zhì)量保證趙樹銘. 細胞治療的研究進展. 中國輸血雜志，2010，23（2）：79-8510輸血專題-.pdf輸血醫(yī)學研究熱點22血液治療臨床需求：血漿置換、血脂去除、血小板膠、血液成分去除操作規(guī)范質(zhì)量保證趙樹銘. 重慶地區(qū)輸血醫(yī)學現(xiàn)狀與發(fā)展策略. 重慶醫(yī)學，2009，38（12）：141709cq輸血醫(yī)學研究熱點23輸血科智能與自動化血型與配血 電子交叉配血輸血副反應 預警系統(tǒng)輸血醫(yī)學研究熱點24輸血醫(yī)學及其特點輸血醫(yī)學-我的思考?美國輸血醫(yī)學的科研課題252011年AABB資助輸血醫(yī)學研究課題B

10、ondanza, MD, PhDH San Raffaele Scientific InstituteCell Therapy Of Multiple Myeloma By Genetic Redirection Of T Cells Against Cd44v6基因定向改造抗Cd44v6 的T細胞治療多發(fā)性骨髓瘤Multiple myeloma, a cancer arising from plasma cells, is the second most common hematologic malignancy, constituting 1 percent of all cancers.

11、 Clinical experience with long-term survival after allogeneic HSC transplantation suggests that promising results against multiple myeloma may be achieved through a T cell-mediated immunologic mechanism. Bondanza and colleagues propose to conduct preclinical validation of a novel cell therapy strate

12、gy for multiple myeloma treatment based on the genetic redirection of T cells against the tumor antigen CD44v6.26Mettine H.A. Bos, PhDLeiden University Medical Center, Einthoven Laboratory for Experimental Vascular MedicineMechanisms Regulating the Macromolecular Enzyme Complex Assembly in Blood Coa

13、gulation血液凝固過程中調(diào)節(jié)巨分子酶復合物形成的機制Clotting factors are integral to the blood coagulation process, and disorders in clotting factors can lead to life threatening bleeding disorders. In some cases, clotting factors work together, such as the enzyme factor X and its cofactor, factor V. Bos and coworkers pro

14、pose to investigate the molecular mechanisms that regulate the assembly of enzyme-cofactor complexes driving blood coagulation.27Swapan Kumar Dasgupta, PhDBaylor College of MedicineSignaling Cascade Leading to Phosphatidylserine Exposure in Stored Platelets儲存血小板中導致磷脂酰絲氨酸暴露的信號級聯(lián)反應Stored platelets und

15、ergo changes collectively referred to as the platelet storage lesion. One of the changes is the exposure of the anionic phospholipid phosphatidylserine, or PS, on the cell surface, a hallmark of apoptosis (cell death). Platelets exposing PS are rapidly cleared from circulation, suggesting that this

16、exposure is a signal that prompts macrophages to rid the body of these cells. Dasgupta and colleagues propose that inhibiting PS exposure may help increase the storage time and in vivo recovery of stored platelets. 28Eldad A. Hod, MDColumbia University Medical CenterEffect of Repeat Blood Donation o

17、n Atherosclerosis and Cancer Risk in Murine Models重復獻血對大鼠模型中動脈粥樣硬化形成和癌癥危險的影響 The long-term effects of blood donation on certain disease processes are unknown; however, some researchers have suggested that donation may be cardioprotective and others have proposed that it may reduce the risk of develo

18、pment of certain cancers. Hod will use a mouse model of blood donation that he previously developed to further investigate whether there may be benefits of phlebotomy over time. Hod and colleagues propose to test two hypotheses: that frequent donation is protective, the apoE-knockout mouse model of

19、atherosclerosis and the p53 heterozygous mutant mice that are prone to develop tumors.29Katherine C. MacNamara, PhDAlbany Medical CollegeIFN-Mediated Control of Hematopoietic Stem and Progenitor Cell Differentiation造血干細胞和多能干細胞分化過程中干擾素介導的調(diào)控作用Interferon-gamma, or IFN-gamma, is a cytokine known for bei

20、ng a suppressor of hematopoiesis. However, recent studies suggest that its roles in the blood system are more complex. Based on her earlier research, MacNamara postulates that IFN-gamma acts differently in less differentiated cells hematopoietic stem cells and progenitor cells than in more mature ce

21、lls, where most previous research on its activity has been conducted. With this NBF grant, MacNamara and colleagues propose to determine the molecular mechanisms that regulate IFN-gamma signaling in distinct populations of HSCs and progenitor cells.30Nilam S. Mangalmurti, MDUniversity of PennsylvaniaRole of Red Cell Advanced Glycation End products in Endothelial Dysfunction內(nèi)皮功能失衡過程中紅細胞嚴重糖化終未產(chǎn)物的作用Observational studies have found that transfusion of stored r