한달간 간헐적인 구토, 식욕부진과 침울을 보인 11살의 중성화하지 않은 수컷 요크셔 테리어견이 내원하였다. 혈액검사상 질소혈증과 빈혈을 나타내었으며, 만성신장질환과 이로 인한 빈혈 상태로 진단이 되었다. 임상 증상 및 질소혈증은 다소 감소하였으나 빈혈은 악화되었기 때문에 수혈을 실시하였다. 수혈 동안 환자의 상태는 양호하였으나, 수혈 후 10 시간째 환자는 급성 호흡곤란 증상을 보였다. 이 환자는 급성 호흡곤란의 임상 증상을 보인점, 수혈의 위험 요인들, 흉부 방사선사진에서 좌우 미만성의 폐포 침윤, 동맥혈 분석에서 200 미만의 $PO_2:FiO_2$ 비율을 바탕으로 수혈과 관련된 급성호흡곤란증후군으로 진단이 되었으며, 이 증상을 보인후 2시간후 폐사하였다.
한달간 간헐적인 구토, 식욕부진과 침울을 보인 11살의 중성화하지 않은 수컷 요크셔 테리어견이 내원하였다. 혈액검사상 질소혈증과 빈혈을 나타내었으며, 만성신장질환과 이로 인한 빈혈 상태로 진단이 되었다. 임상 증상 및 질소혈증은 다소 감소하였으나 빈혈은 악화되었기 때문에 수혈을 실시하였다. 수혈 동안 환자의 상태는 양호하였으나, 수혈 후 10 시간째 환자는 급성 호흡곤란 증상을 보였다. 이 환자는 급성 호흡곤란의 임상 증상을 보인점, 수혈의 위험 요인들, 흉부 방사선사진에서 좌우 미만성의 폐포 침윤, 동맥혈 분석에서 200 미만의 $PO_2:FiO_2$ 비율을 바탕으로 수혈과 관련된 급성호흡곤란증후군으로 진단이 되었으며, 이 증상을 보인후 2시간후 폐사하였다.
An 11-year-old intact male Yorkshire terrier had intermittent vomiting, anorexia and depression for a month. Clinical laboratory works showed azotemia and anemia. Chronic kidney disease with developing anemia was diagnosed clinically. Clinical signs were resolved but anemia was deteriorated and bloo...
An 11-year-old intact male Yorkshire terrier had intermittent vomiting, anorexia and depression for a month. Clinical laboratory works showed azotemia and anemia. Chronic kidney disease with developing anemia was diagnosed clinically. Clinical signs were resolved but anemia was deteriorated and blood transfusion was performed. On 10 hours after transfusion, the dog showed acute respiratory distress. Transfusion related acute respiratory distress syndrome (ARDS) was diagnosed based on acute clinical signs, risk factors of transfusion, bilateral alveolar infiltration on thoracic radiographs, and $PO_2:FiO_2$ ratio less than 200 on arterial blood analysis. The dog died within 2 hours after ARDS diagnosis.
An 11-year-old intact male Yorkshire terrier had intermittent vomiting, anorexia and depression for a month. Clinical laboratory works showed azotemia and anemia. Chronic kidney disease with developing anemia was diagnosed clinically. Clinical signs were resolved but anemia was deteriorated and blood transfusion was performed. On 10 hours after transfusion, the dog showed acute respiratory distress. Transfusion related acute respiratory distress syndrome (ARDS) was diagnosed based on acute clinical signs, risk factors of transfusion, bilateral alveolar infiltration on thoracic radiographs, and $PO_2:FiO_2$ ratio less than 200 on arterial blood analysis. The dog died within 2 hours after ARDS diagnosis.
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문제 정의
Among predisposing factors of ALI or ARDS, blood transfusion related ALI or ARDS is an uncommon but fatal syndrome characterized by the sudden onset of respiratory failure within hours of the blood transfusion (12,20). This case report describes the development and clinical characteristics of ARDS after transfusion in a dog with chronic kidney disease.
가설 설정
Antineutrophil antibodies react with pulmonary microvascular neutrophils and these lead to endothelial damage and vascular leakage into the alveolar space. Hypothesis of bioactive mediators suggests that lipids or other mediators, such as CD40L, activates neutrophils and contributes to endothelial damage, especially in patients with accumulation of neutrophils in the pulmonary microvasculature as result of preexisting systemic inflammation. These lead to vascular leaks and pulmonary edema (10,12,22).
대상 데이터
An 11-year-old intact male Yorkshire terrier with 2.52 kg was admitted with a history of intermittent vomiting and depression for over a month. The hematologic and clinical chemistry works showed increased WBC of 21200 × 103/µL (normal: 6000~17000 × 103/µL), blood urea nitrogen (BUN) level of 97 mg/dl (normal: 7~27 mg/dl), creatinine level of 3.
Blood transfusion was performed. Blood type of this dog was DEA 1.1. Transfusion with packed RBCs of canine DEA 1.
성능/효과
25 mg/kg bid) as a H2 receptor antagonist. For four days of hospitalization, vomiting was resolved and appetite was recovered and creatinine level was slightly decreased with 3.5 mg/dl. However anemia was deteriorated with manual PCV 18.
In conclusion, ARDS should be considered in cases showing clinical signs of acute respiratory distress by risk factors of primary or secondary lung insult. Thoracic radiographs of bilateral alveolar infiltration with central distribution helps to diagnose tentatively.
53 mg/dl. The analysis of arterial gas showed low PaO2 40 mmHg (normal: 90~100 mmHg), pH 7.27 (normal: 7.36~7.44), HCO3 21.7 mmol/L (normal: 24~26 mmol/L), tHb 7.4 (normal: 12~18), and SO2 60% (normal: 93~100%). PCO2 51 mmHg (normal: 36~44 mmHg), anion gap 31.
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