恶性血液病患者机采血小板无效输注临床分析(1)
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[摘要] 目的：探讨恶性血液病患者血小板无效输注(PTR)的原因。方法：收集158例恶性血液病患者，随机分为两组，A组为输注机采血小板≤5次的患者80例，B组为输注机采血小板>5次的患者78例，观察输注1 h后的血小板数量，与输注前血小板数量进行比较分析。测定校正血小板计数增加值(CCI)评价PTR率，并对出血症状进行分级，分析PTR与免疫的关系。结果：A组通过CCI判断输注有效率为80%，判断PTR为20%，B组通过CCI判断输注有效率为51.3%，判断PTR为48.7%，A组PTR比例明显低于B组值，患者的出血程度与PTR呈正相关，输注血小板后症状改善。输注血小板>5次者更容易产生PTR。结论：在输注血小板引起PTR中，主要与输注血小板次数有关，输注血小板次数越多，越容易发生同种免疫，导致血小板输注无效。
[关键词] 血小板无效输注；机采血小板；恶性血液病
[中图分类号] R457.1[文献标识码]A [文章编号]1673-7210(2010)10(c)-046-02
Clinical analysis on hematologic m alignancies with apheresis platelet transfusion refractoriness
LI Haiwen1, LIN Yingbiao2, LIANG Xinquan2
(1.Chenzhou Central Blood Station, Hu′nan Province, Chenzhou 423000, China; 2.The First People′s Hospital of Chenzhou City, Hu′nan Province, Chenzhou 423000, China)
[Abstract] Objective: To study the reasons of platelet transfusion refractoriness (PTR) on hematologic m alignancies. Methods: 158 cases of patients with hematologic m alignancies were selected and divided into group A with 80 cases underwent ≤5 times platelet transfusion and group B with 78 cases underwent >5 times platelet transfusion. Compared the blood platelet number before and one hour after transfusion. Calculated modified platelet corrected count increament (CCI) as benchmark to judge ineffective platelet transfusion. Classified the bleeding symptom and analyzed the relationship of PTR and immune. Results: The transfusion curative effect rate was 80% in group A and 51.3% in group B. The PTR rate was 20% in group A and 48.7% in group B with significant statistical differences. Bleeding degree and PTR were positive correlation, the symptem improved after platelet transfusion. PTR usually happened in those cases with >5 times platelet transfusion. Conclusion: Hematologic m alignancies with PTR are concerned with the time of platelet transfusion. The more times of transfusion, the more likely to happen isoimmunization and induce PTR.
[Key words] Platelet transfusion refractoriness; Apheresis platelet; Hematologic m alignancie
输注机采血小板是临床治疗恶性血液病患者血小板减少最有效的治疗手段之一，但对于反复输注血小板恶性血液病患者，容易使体内产生血小板相关抗体(主要是HLA抗体)和血小板特异性抗体(主要是HPA抗体) ......
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