恶性血液病患者骨髓抑制期血小板无效输注的研究  

Study on the ineffective platelet transfusion in patients with hematologic malignancies during myelosuppression

作　　者：华晓莹[1] 王彪[1] 吴炜[1] 上官志敏 唐亮 Hua Xiaoying;Wang Biao;Wu Wei;Shangguan Zhimin;Tang Liang(Department of Blood Transfusion,the First People's Hospital of Changzhou,the Third Affiliated Hospital of Soochow University,Changzhou 213003,China)

机构地区：[1]苏州大学附属第三医院江苏省常州市第一人民医院输血科,213003

出　　处：《白血病．淋巴瘤》2020年第1期41-44,共4页Journal of Leukemia & Lymphoma

摘　　要：目的 探讨恶性血液病患者骨髓抑制期血小板无效输注的发生情况及利妥昔单抗治疗效果。方法 选择2017年1月至2018年12月常州市第一人民医院收治的180例不同类型恶性血液病患者,观察骨髓抑制期血小板无效输注的发生率,并比较血小板抗体阳性的急性白血病患者接受利妥昔单抗治疗前后T、B淋巴细胞亚群和血小板计数的变化,以及不同类型血小板悬液无效输注的发生率。结果 180例患者骨髓抑制期发生血小板无效输注45例(25.0%),其中108例急性白血病患者发生血小板无效输注30例(27.8%),43例骨髓增生异常综合征患者发生无效输注10例(23.3%),15例恶性淋巴瘤患者发生无效输注2例(13.3%),14例多发性骨髓瘤患者发生血小板无效输注3例(21.4%)。辐照单采去白血小板无效输注发生率(17.0%,16/94)低于单采血小板(33.7%,29/86),差异有统计学意义(χ2=6.68,P= 0.01)。对8例血小板抗体阳性的急性白血病血小板无效输注患者予利妥昔单抗治疗后,5例血小板输注后血小板计数改善。利妥昔单抗治疗前后CD19、CD20、CD4和血小板计数水平比较,差异均有统计学意义(均P<0.05)。结论 急性白血病患者血小板无效输注发生率最高,行血小板配型输注可提高疗效。利妥昔单抗对因免疫因素导致的血小板无效输注有效。辐照单采去白血小板的无效输注发生率低于单采血小板。Objective To investigate the causes of ineffective platelet transfusion in patients with hematologic malignancies during myelosuppression and the therapeutic effect of rituximab.Methods A total of 180 patients with different hematologic malignancies in the First People's Hospital of Changzhou from January 2017 to December 2018 were selected.And the incidence of ineffective platelet transfusion during myelosuppression was observed.The changes of T and B lymphocyte subgroups and platelet counts before and after rituximab therapy in acute leukemia patients with platelet antibody-positive were compared,and the incidence of ineffective platelet transfusion with different platelet suspensions was analyzed.Results The ineffective platelet transfusion was observed in 45 of 180 patients(25.0%)during myelosuppression,including 30(27.8%)of 108 patients with acute leukemia,10(23.3%)of 43 patients with myelodysplastic syndrome,2(13.3%)of 15 patients with malignant lymphoma,and 3(21.4%)of 14 patients with multiple myeloma.The incidence of ineffective platelet transfusion in patients transfused with irradiated leukocyte depleted apheresis platelets(17.0%,16/94)was lower than that in those with apheresis platelets(33.7%,29/86),and the difference was statistically significant(χ2=6.68,P=0.01).In 8 acute leukemia patients with platelet antibody-positive and the ineffective platelet transfusion after rituximab therapy,the increase of platelet count was observed in 5 patients.The differences of levels of CD19,CD20,CD4 and platelet count before and after treatment with rituximab were statistically significant(all P<0.05).Conclusions The incidence of ineffective platelet transfusion is the highest in acute leukemia patients.Transfusion of human leukocyte antigen-matched platelets can improve the effect of platelet transfusion.Rituximab is effective in the ineffective platelets transfusion caused by immune factors.The incidence of ineffective platelet transfusion in irradiated leukocyte depleted apheresis platelets is lower compared wi

关 键 词：血液肿瘤 骨髓抑制 血小板输注 医疗无效 

分 类 号：R733[医药卫生—肿瘤]