高量减除白细胞治疗对高白细胞性白血病患者血液学指标的影响  

Effect of High-Volume Leukapheresis on Hematological Indexes of Patients with Hyperleukocytic Leukemia

作　　者：吴勇 吴远军 李惠森 陈宝婵 刘艳 吴月勤 梁思远 WU Yong;WU Yuan-Jun;LI Hui-Sen;CHEN Bao-Chan;LIU Yan;WU Yue-Qin;LIANG Si-Yuan(Department of Blood Transfusion,Dongguan Tungwah Hospital,Dongguan 523110,Guangdong Province,China;Department of Blood Transfusion,Dongguan Maternal and Child Health Care Hospital,Dongguan 523120,Guangdong Province,China)

机构地区：[1]东莞东华医院输血科,广东东莞523110 [2]东莞市妇幼保健院输血科,广东东莞523120

出　　处：《中国实验血液学杂志》2022年第5期1331-1336,共6页Journal of Experimental Hematology

基　　金：2019年东莞市社会科技发展重点项目(201950715046181)。

摘　　要：目的:提高减除白细胞治疗的采集效率,探讨相对科学、客观的采集效果评价指标,观察高量减除白细胞治疗对患者血液细胞和凝血功能的影响。方法:采用连续流动离心式血液成分分离机,对93例高白细胞性白血病患者共进行158次高量减除白细胞治疗(以患者总血容量1/5-1/4作为单次减除白细胞治疗采集白细胞悬液的目标值),采用减除白细胞总数、白细胞减除值、白细胞减除率、白细胞数减低值、白细胞数减低率、血红蛋白丢失量、血红蛋白丢失值、血红蛋白下降值、血小板丢失总数、血小板丢失值、血小板数下降值,综合评价减除白细胞治疗的采集效果及对患者血红蛋白水平、血小板数的影响;检测患者治疗前后凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、纤维蛋白原浓度,观察减除白细胞治疗对患者凝血功能的影响。结果:单次治疗采集白细胞悬液容量为793.01±214.23ml,减除白细胞总数为353.25(241.99-547.28)×10^(9),白细胞减除值为86.98(63.05-143.43)×10^(9)/L,白细胞减除率为44.24(28.37-70.48)%,白细胞数减低值为65.73(37.17-103.97)×10^(9)/L,白细胞数减低率为(35.67±23.08)%,血红蛋白丢失量为17.36(12.12-24.94)g,血红蛋白丢失值为4.31(3.01-6.12)g/L,血红蛋白下降值为4.80(-1.25-9.33)g/L,血小板丢失总数为222.79(67.03-578.31)×10^(9),血小板丢失值为54.45(17.29-139.08)×10^(9)/L,血小板数下降值为26.00(8.38-62.50)×10^(9)/L。单次治疗前后凝血酶原时间分别为14.80(13.20-16.98)s、15.20(13.08-16.90)s(z=-1.520,P>0.05),活化部分凝血活酶时间分别为35.20(28.68-39.75)s、35.40(28.00-39.75)s(z=-2.058,P<0.05),凝血酶时间分别为17.50(16.30-18.80)s、17.70(16.70-19.10)s(z=-3.928,P<0.001),纤维蛋白原浓度分别为2.87±1.13 g/L、2.64±1.03 g/L(t=7.151,P<0.001)。结论:高量减除白细胞治疗可在保持患者循环血容量相对稳定的前提下提高减除白细胞治疗的效率Objective:To improve the collection efficiency of leukapheresis,explore relatively scientific and objective evaluation indicators for collection effect,and observe the effect of high-volume leukapheresis on blood cells and coagulation function.Methods:A total of 158 times of high-volume leukapheresis were performed on 93patients with hyperleukocytic leukemia by using continuous flow centrifugal blood component separator.1/5-1/4of total blood volume of the patients was taken as the target value of leukocyte suspension for single treatment.In addition,the total number of white blood cells (WBCs) subtracted,value of WBCs reduction,rate of WBCs reduction,decrease value of WBCs count,decrease rate of WBCs count,amount of hemoglobin (Hb) lost,value of Hb lost,decreased value of Hb,total number of platelet (PLT) lost,the value of PLT loss,and decrease value of PLT count were used to comprehensively evaluate the collection effect of leukapheresis and influence on Hb level and PLT count of the patients.The prothrombin time (PT),activated partial thromboplastin time (a PTT),thrombin time (TT),and fibrinogen (Fib) concentration were detected before and after treatment,and the effect of leukapheresis on coagulation function of the patients was observed.Results:The volume of leukocyte suspension collected in a single treatment was 793.01±214.23 ml,the total number of WBCs subtracted was 353.25 (241.99-547.28)×10^(9),the value of WBCs reduction was 86.98 (63.05-143.43)×10^(9)/L,the rate of WBCs reduction was 44.24 (28.37-70.48)%,decrease value of WBCs count was 65.73 (37.17-103.97)×10^(9)/L,decrease rate of WBCs count was (35.67±23.08)%,the amount of Hb lost was 17.36 (12.12-24.94) g,the value of Hb lost was 4.31 (3.01-6.12) g/L,decreased value of Hb was 4.80(-1.25-9.33) g/L,total number of PLT lost was 222.79 (67.03-578.31)×10^(9),the value of PLT loss was 54.45 (17.29-139.08)×10^(9)/L,and decrease value of PLT count was 26.00 (8.38-62.50)×10^(9)/L.Before and after a single treatment,the PT was 14.80 (13.20-16.98) s a

关 键 词：白血病 白细胞单采术 血红蛋白 血小板 纤维蛋白原 凝血 

分 类 号：R733.7[医药卫生—肿瘤]