连续流动离心式高量减除血小板治疗对患者凝血功能指标的影响  

Effects of high-volume platelet-lowering therapy on patients’ coagulation indices using a continuous-flow cell separator

作　　者：吴远军 吴勇 李惠森 陈宝婵 刘艳 梁美琪 吴月勤 梁思远 Wu Yuanjun;Wu Yong;Li Huisen;Chen Baochan;Liu Yan;Liang Meiqi;Wu Yueqin;Liang Siyuan(Department of Blood Transfusion,Dongguan Maternal and Child Health Care Hospital;Department of Blood Transfusion,Affiliated Donghua Hospital,Sun Yat-sen University)

机构地区：[1]东莞市妇幼保健院输血科,东莞523120 [2]中山大学附属东华医院输血科,东莞523110

出　　处：《重庆医科大学学报》2020年第2期274-277,共4页Journal of Chongqing Medical University

摘　　要：目的:探讨连续流动离心式血液成分分离机高量减除血小板治疗对血小板增多症患者综合性凝血指标及血浆纤维蛋白原浓度的影响。方法:采用COBE Spectra连续流动离心式血液成分分离机ELP或MNC程序,以ACD-A配方血液保存液为抗凝剂,对血小板增多症患者实施减除血小板治疗,每次治疗设置处理血量为2.5~3.0倍总血容量(total blood volume,TBV),采集血小板悬液容量为20%~25%TBV,对21例患者共进行32次减除血小板治疗,观察血小板减除效果及治疗前、后凝血指标和血浆纤维蛋白原浓度的差异。结果:单次治疗运行时间(212.53±41.54)min,处理血量(8812.63±2087.15)mL,采集血小板悬液容量(798.84±190.77)mL;治疗前、后患者循环血液血小板计数(platelet count,Plt)分别为(1426.46±530.23)×10^9个/L、(778.83±247.25)×10^9个/L(t=10.808,P=0.000),凝血酶原时间(prothrombin time,PT)分别为(12.82±1.53)s、(13.28±1.51)s(t=3.921,P=0.000),活化部分凝血活酶时间(activated partial thromboplastin time,aPTT)分别为35.75(29.43,37.55)s、35.40(31.20,38.20)s(Z=3.021,P=0.003),凝血酶时间(thrombin time,TT)分别为(17.46±1.30)s、(17.88±1.41)s(t=2.783,P=0.009),纤维蛋白原浓度(fibrinogen concentration,Fbg)分别为(2.96±1.18)g/L、(2.81±1.11)g/L(t=3.433,P=0.002)。结论:采用连续流动离心式血液成分分离机对血小板增多症患者实施高量减除血小板治疗,可显著降低患者体内血小板负荷;对患者PT、aPTT、TT、Fbg的影响在机体正常代偿范围内。Objective:To explore the effects of high-volume platelet-lowering therapy on the comprehensive coagulation indices and fibrinogen concentration of patients with thrombocytosis using a continuous-flow cell separator(CFCS). Methods:Patients with thrombocytosis underwent a platelet-lowering therapy administered by the ELP/MNC program of a COBE Spectra CFCS using ACD-A as an anticoagulant. A total of 32 platelet-lowering treatments were performed for 21 patients with the treated blood volume for each treatment set as 2.5 to 3.0 times the total blood volume(TBV) and the collected platelet suspension volume as 20% to 25% of TBV.The effect of platelet-lowering therapy and the changes in coagulation indices and fibrinogen concentration after treatment were evaluated. Results:A single treatment had a run time of(212.53±41.54) minutes with a treated blood volume of(8 812.63±2 087.15) mL and a collected platelet suspension volume of(798.84±190.77) mL. The patients’ coagulation indices in circulating blood before and after treatment were as follows:platelet count:(1426.46±530.23)×10^9 cells/L vs.(778.83±247.25) ×10^9 cells/L(t=10.808,P=0.000),prothrombin time(PT):(12.82±1.53) s vs.(13.28±1.51) s(t=3.921,P=0.000),activated partial thromboplastin time(aPTT):35.75(29.43,37.55) s vs. 35.40(31.20,38.20) s(Z=3.021,P=0.003),thrombin time(TT):(17.46±1.30) s vs.(17.88±1.41) s(t=2.783,P =0.009),fibrinogen concentration(Fbg):(2.96 ±1.18) g/L vs.(2.81 ±1.11) g/L(t =3.433,P =0.002). Conclusion:High-volume platelet-lowering therapy using a CFCS can significantly reduce the platelet load within the body of patients with thrombocytosis,and its effects on PT,aPTT,TT,and Fbg are within the normal range of body compensation.

关 键 词：血液成分分离机 血小板增多症 血小板单采 凝血 

分 类 号：R457.1[医药卫生—治疗学] R733.71[医药卫生—临床医学]