血小板输注无效患者的抗体监测及血小板配型的疗效评估  

Evaluation of platelet cross-matching in the management of patients with platelet transfusion refractoriness and monitoring of platelet-specific antibodies

作　　者：王嘉励[1] 叶欣[1] 邓晶[1] 徐秀章[1] 夏文杰[1] 陈扬凯[1] 丁浩强[1] 邵媛[1] 付涌水[1] 

机构地区：[1]广州血液中心输血研究所,广东广州510095

出　　处：《中国输血杂志》2015年第10期1238-1241,共4页Chinese Journal of Blood Transfusion

摘　　要：目的回顾性分析配型血小板对于血小板输注无效患者的长期疗效评估,以及对血小板特异性抗体进行监测。方法 2014年5月-12月共登记49名血小板输注无效患者的临床医疗记录,患者连续≥2次输注随机单采血小板24 h后的CCI值<4 500,即定义为血小板输注无效。血小板配型采用商品化的单克隆抗体固相法试剂盒,血小板特异性抗体检测采用酶联免疫吸附试验(ELISA)。结果 49名患者平均输注配型血小板4 U(2-11U不等),共输注了ABO同型的配型单采血小板194 U,24 h后CCI值显示:配型相合的血小板输注效果(7800±7000)明显优于输注随机单采血小板(1500±2100)(P<0.01)。每例患者初次及末次交叉配型的平均反应性分别为36.64%及29.01%(P>0.05),表示长期输注配型血小板的患者其免疫反应性无进一步增加的倾向。88.46%不相合配型是由抗-HLA引起,其中,单独引起的占57.69%,合并抗-HPA的占30.77%。结论 HLA和/或HPA同种免疫反应是临床引起血小板输注无效的重要因素,对于绝大多数患者而言,输注配型血小板可成为血小板输注无效的1项快速、有效的治疗措施。Objective To evaluate the efficacy of crossmatch-compatible platelet transfusions in patients with platclet transfusion refractoriness and to monitor platelet-specific antibodies. Methods 49 refractory patients, who were characterized by 〈 4 500 following two consecutive platelet transfusions in 24-hour corrected count increment （CC1）, were enrolled between May and December 2014. A commercial solid-phase adherence kit was used for crossmatching and Enzyme-linked immunosorbent （ELISA） was used to detect platelet-specific antibodies. Results A total of 194 crossmatched ABO compat- ible platelet units were given to refractory patients. A median of 4 unit crosssmatch platelets were transfused per patients （ range, 2 - 11 ）. The 24-hour CCI （ mean ± SD） was significantly higher for crossmatch-compatible platelets （7800±7000） than for randomly selected platelets （ 1500 ±2100） （P 〈0.001 ）. The mean percentage reactivity in initial （36.64%） versus last （29. 01% ） crossmatch assay for each patient demonstrated no trend toward progressive alloimmunization （P 〉 0. 05 ）. 88.46% incompatible crossmatches were due to anti-HLA antibodies, alone （57. 69% of cases） or together with anti-HPA antibodies （30. 77% ）. Conclusion HLA and/or HPA alloimmunization is an important factor to cause refractoriness in platelet transfusions. For most patients, transfusion support with crossmatched platelets offers an effective and rapid approach to the management of patients with platelet transfusion refractoriness.

关 键 词：血小板输注无效 血小板配型 CCI 血小板特异性抗体 

分 类 号：R457.11[医药卫生—治疗学]