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ACD-A에 아나필락시스를 보인 환자에서 UFH을 단독으로 사용한 혈장교환술 2례

Two Cases of Successful Plasma Exchange with Unfractionated Heparin Anticoagulation in Patients Exhibiting Anaphylaxis to Acid-citrate-dextrose Formula A

대한수혈학회지 2020년 31권 1호 p.55 ~ 60
강혜인 ( Kang Hye-In ) - Keimyung University Dongsan Hospital Department of Laboratory Medicine

김도훈 ( Kim Do-Hoon ) - Keimyung University Dongsan Hospital Department of Laboratory Medicine
 ( Jeon Dong-Seok ) - Keimyung University Dongsan Hospital Department of Laboratory Medicine
이원목 ( Lee Won-Mok ) - Keimyung University Dongsan Hospital Department of Laboratory Medicine
류남희 ( Ryoo Nam-Hee ) - Keimyung University Dongsan Hospital Department of Laboratory Medicine
하정숙 ( Ha Jung-Sook ) - Keimyung University Dongsan Hospital Department of Laboratory Medicine

Abstract


Plasma exchange performed with the aid of acid-citrate-dextrose formula A (ACD-A) is generally regarded as safe. However, unfractionated heparin (UFH) can serve as an anticoagulant for patients experiencing serious side effects such as anaphylaxis. No guidelines have currently been defined for the stand-alone UFH dosing during plasma exchange. We describe here two patients who developed anaphylaxis to ACD-A during plasma exchange, and we successfully used UFH as a standalone anticoagulant. The first patient was a 55-year-old man who required plasma exchange before ABO-incompatible kidney transplantation. During plasma exchange, he developed an allergic reaction. Thereafter, UFH was used as a standalone anticoagulant during four sessions of plasma exchange; the UFH (5,000 units) was added to a 500 mL normal saline bag and the UFH:whole blood ratio was maintained at 1:28. The second patient was an 80-year-old woman with steroid pulse-resistant neuromyelitis optica. She developed an allergic reaction during the first session of plasma exchange. The patient subsequently underwent five successful sessions of plasma exchange using UFH as a standalone anticoagulant. These findings may be useful when establishing a protocol for UFH as a standalone anticoagulant during plasma exchange in patients who develop an allergic reaction to citrate.

키워드

Plasma exchange; Heparin; Anticoagulation
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