肿瘤患者血小板输注无效的临床分析  

Clinical analysis on platelet transfusion refractoriness in cancer patients

作　　者：张学慧[1] 王晨[1] 康晓宁[1] 樊晶[2] 

机构地区：[1]天津医科大学肿瘤医院国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室,天津300060 [2]天津市血液中心

出　　处：《中国输血杂志》2015年第4期407-409,共3页Chinese Journal of Blood Transfusion

摘　　要：目的探讨本院患者血小板输注情况及临床疗效观察,了解血小板输注无效的原因,以便做好预防工作。方法 2010年1月-2012年12月对本院312名血小板减少的肿瘤患者输注机采血小板,并于输注前后检测血小板,以校正患者血小板计数增值(CCI)和24 h血小板回升率,判定输注效果并讨论影响因素。采用简易致敏红细胞血小板血清学技术(SEPSA)检测76名血小板输注无效的肿瘤患者血小板相关抗体,统计抗体分布。结果 75.6%(236/312)的患者输注后血小板数有不同程度的增高,血液病患者输注血小板有效率明显低于实体肿瘤患者(χ2=29.87,P<0.05)和其他肿瘤患者(χ2=6.06,P<0.05)。输注次数<2次的患者(无效率为5.1%)输注血小板无效率明显低于输注次数>7次患者(无效率为57.1%),也低于输注3-4次(无效率为39.5%)、5-7次患者(无效率为46.4%),血小板输注无效率随输注次数的增加而增加。分析76名肿瘤患者血小板输注无效原因,其中免疫因素占60.5%,非免疫因素占39.5%。结论反复输注产生血小板抗体是PTR发生的主要原因,多次输注者应进行血小板抗体的筛选,避免或减少造成血小板输注无效的原因,提高血小板输注的有效率。Objective To study the transfusion of platelet transfusion and its clinical efficacy on patients in our hospital,and to investigate the reasons behind platelet transfusion refractoriness( PTR) for future prevention work. Methods 312 cases of cancer patients with reduced platelet number were transfused with apheresis platelet during the period of January 2010 to December 2012. In these cases,the platelet numbers before and after transfusion were detected respectively,in order to modify the platelet count increment( CCI) and platelet rebound rate in 24 hours. The clinical effect of platelet transfusion was assessed and the relevant factors were explored. The platelet-associated antibodies in 76 PTR tumor patients were examined by SEPSA assay,and then,followed by the measurement of the antibody distribution. Results In 75. 6%(236 /312)patients,the platelet number increased after transfusion. The rate of curative effect of transfusion in hematologic patients was certainly lower than that of tumor patients( χ^2= 29. 87,P<0. 05) and other patients( χ^2= 6. 06,P<0. 05). The PTR rate of the patients with <2 times platelet transfusion( PTR rate is 5. 1%) was lower than that of patients with >7 times platelet transfusion( PTR rate is 57. 1%),and was also lower than that of patients with 3-4 times transfusion( PTR rate is39. 5%) and those that received 5-7 times transfusion( PTR rate is 46. 4%). The more numbers of transfusion,the more likely PTR was induced. Among the reasons for PTR found in 76 tumor patients,immune factors accounted for 60. 5% and non-immune factors accounted for 39. 5%. Conclusion Multiple blood transfusion constitutes a major cause for platelet antibodies production,which may lead to PTR. Patients with multiple transfusions should be screened for platelet antibodies to avoid or reduce the incidence of PTR and to enhance the curative rate of transfusion.

关 键 词：单采血小板 血小板输注无效 血小板抗体 

分 类 号：R457.1[医药卫生—治疗学] R331.143[医药卫生—临床医学]