118.2 📚 國考版醫垫國考 / PGY OSCE

118.2.0.1 📌 Cram Sheet

118.2.0.1.1 🔥 高 yield 12
  1. 5 倧 RBC system: ABO + Rh + Kell + Duffy + Kidd + MNS → 95% compat
  2. ABO natural Ab = IgM, complement-fixing嚎栌 cross-match
  3. D-negative 女童 / 兒童 → D + K compatible RBCC
  4. Restrictive Hb < 7 g/dL standard< 8 (cardiac/ortho), < 10 (ACS)
  5. Platelet< 10K (prophy), < 50K (procedure/active bleed), < 100K (neuro/CV/ECMO)
  6. TRALI = donor anti-HLA/HNA → 急性肺氎腫 < 6 hr; supportive (vent)䞍利尿
  7. TACO = volume overload; BNP ↑↑ + BP ↑ → 利尿
  8. TA-GVHD prevention = irradiate for HSCT, fludarabine, IUT, neonate, 芪屬茞血, Hodgkin
  9. MTP 1:1:1 RBC:Plasma:Platelet + TXA < 3 hr trauma + cryo if fibrinogen < 150
  10. Pathogen reduction (INTERCEPT) 22E 趚勢 → 取代 PC bacterial culture
  11. Bacterial contamination 倚圚 PCroom temperature 儲存
  12. PBM 䞉柱: optimize hematopoiesis (iron/EPO) + minimize loss (TXA, cell salvage) + 病人 anemia tolerance
118.2.0.1.2 🔢 必背敞字
項目 æ•žå­—
RBCC 容量 250–300 mL
1 RBCC unit → Hb ↑ +1 g/dL
PC platelet 敞量 ≥ 2×10¹¹
1 PC → platelet count ↑ +30K
Irradiation 劑量 25–35 Gy
Massive transfusion 定矩 > 10 unit RBC / 24 hr 或 > 4 / 1 hr
TXA timing in trauma < 3 hr
Fibrinogen replacement threshold < 150 (active bleed < 100)
TRALI 時間窗 < 6 hr
HIV transfusion risk 1 in 1.5 million
Anti-D alloimmunization rate (D-pos transfused to D-neg) 22%
FDA 死因 #1 (transfusion-related) TACO 32%
FDA 死因 #2 TRALI 21%

118.2.0.2 ⭐ 高 yield è¡š

118.2.0.2.1 Component Indication Quick
Component Threshold Note
RBCC Hb < 7 (general), < 8 (cardiac/ortho), < 10 (ACS) Restrictive
PC < 10K prophy / < 50K procedure / < 100K neuro/CV LR + ABO + Rh compat
Plasma INR > 1.5–2 + bleeding; MTP ABO compat
Cryo Fibrinogen < 150 (active bleed < 100); vWD; hemophilia A Concentrated fibrinogen + VIII + vWF
118.2.0.2.2 Reaction Differential
反應 機制 時間 Key feature
Acute hemolytic ABO incompat 急 寒顫 + 背痛 + hemoglobinuria + DIC + AKI
TRALI Donor anti-HLA/HNA < 6 hr Hypoxia + bilateral 浞最 + 倚 BP normal
TACO Volume 倚 < 6 hr BNP ↑ + BP ↑ + 心衰
Anaphylaxis IgA def → anti-IgA 急 Shock + bronchospasm
FNHTR Donor leukocyte cytokine < 1 hr T ↑ ≥ 1°C 無 hemolysis
Allergic urticaria Donor protein < 1 hr 蕁麻疹無 anaphylaxis
Bacterial contamination Mostly PC < 4 hr Septic + fever + hypotension
Delayed hemolytic Anamnestic anti-RBC 1-2 wk New alloAb + ↓ Hb + ↑ bili
TA-GVHD Donor T cells 1-4 wk Pancytopenia + rash + diarrhea, almost fatal
Iron overload Chronic 倚幎 Cardiac/Endo/Hepatic — chelation
118.2.0.2.3 TRALI vs TACO必考
TRALI TACO
Cause Anti-HLA/HNA Volume
BP ↓ / normal ↑
BNP normal ↑↑
Fever + −
JVD − +
CXR Bilateral 浞最 同 + cardiomegaly
Diuretic 䞍效 改善
Tx Vent supportive 利尿 + ↓ rate
118.2.0.2.4 TA-GVHD Prevention 適應症
必 irradiate Reason
HSCT recipient Profoundly immunosuppressed
Fludarabine + 其他 nucleoside analog T-cell defect
芪屬間茞血 HLA partial match
Premature / IUT / 新生兒 < 4 mo Immature immune
Hodgkin lymphoma T-cell defect
Severe congenital immunodeficiency —
侍需 routine HIV / CKD / 糖尿病 / 老人
118.2.0.2.5 MTPPROPPR-based
步驟 现節
Trigger > 10 RBC/24h or > 4/1h or hemodynamic instability
Ratio RBC : Plasma : PC = 1:1:1
加 TXA 1 g IV 早 (< 3 hr trauma); 1 g over 8 hr
Cryo Fibrinogen < 150
Calcium 監枬 + 補充 (citrate toxicity)
Avoid Hypothermia + acidosis + dilutional coag
Stop Source control + INR < 1.5 + plt > 50 + fib > 150

118.2.0.3 🎯 自我檢枬 12 題

  1. ABO natural Ab class? → IgM (complement-fixing)
  2. D-negative 女童茞 D-positive RBC alloimmunization rate? → ~ 22%
  3. Restrictive Hb threshold䞀般? → < 7 g/dL
  4. ACS Hb threshold? → < 10 g/dL
  5. Neurosurgery platelet threshold? → < 100K
  6. TRALI 時間窗? → < 6 hr
  7. TRALI 病因? → Donor anti-HLA / anti-HNA Ab
  8. TACO 鑑別 TRALI 䞻芁 lab? → BNPTACO ↑↑
  9. TA-GVHD 預防? → Irradiation 25-35 Gy
  10. 芪屬間茞血需芁 irradiate 嗎? → 是HLA partial match → engraftment
  11. MTP 比䟋? → 1:1:1 RBC:Plasma:PC
  12. Trauma TXA 時間窗? → < 3 hr

118.2.0.4 🩺 PGY OSCE 堎景

118.2.0.4.1 Scenario 1女 65 æ­² stable GI bleed Hb 6.8 + 血壓 stable
  • Workup + IV access + type-and-screen
  • Restrictive transfusion: RBC × 1 unit → reassess
  • 同時 PPI + GI consult
  • 䞍必 Hb > 7 unless 持續 active 出血
118.2.0.4.2 Scenario 2茞血 4 hr 埌 SOB + Sat 80 + 雙肺浞最
  • 鑑別 TRALI vs TACO
  • BNP normal + BP 100/60 + 沒 JVD → TRALI
  • Stop 茞血 + ICU + ventilation supportive
  • 䞍利尿劂 TACO 才利尿
  • 通報血庫 quarantine 該 donor
118.2.0.4.3 Scenario 3trauma 倧量出血
  • MTP activated → 1:1:1 packs
  • TXA 1 g IV bolus < 3 hr
  • 監枬 K + Ca + temperature + acidosis
  • Source control optimal goal

⚠ AI 草皿。