血液成分单采术在血液病中的应用及不良反应的观察

Application of Hemapheresis on Treatment of Hematology and Observation of the Adverse Reaction

目的 初步探讨血液成分单采术在血液病治疗中的应用并观察其不良反应.方法 对524例患者应用CS-3000 plus血细胞分离机进行916次治疗性血液成分单采,根据病人情况选择不同细胞收集程序,分析临床效果和实验室指标的改善情况,并分析其不良反应及处理措施.结果 行血细胞单采术后210例高白细胞患者白细胞由（230.1±48.5）×10^9/L降至（49.3±10.0）×10^9/L;123例真性红细胞患者血红蛋向由（216.0±23.0）g/L降至（150.0±12.0）g/L,红细胞由（7.1±0.5）×10^12/L降至（4.3±O.8）×10^12/L;158例高血小板患者血小板由（1 080.0±314.0）×10^9/L降至（341.0±82.0）×10^9/L,治疗前后差异均有统计学意义（P〈0.01）.32例血栓性血小板减少性紫癜患者行血浆置换后,90.6%患者临床症状、体征及实验室指标均明显改善.少部分患者出现枸橼酸盐中毒（3.0%）、低血容量休克（0.7%）、过敏反应（4.6%）等不良反应,经对症处理后均得以缓解.结论 利用血细胞分离机进行治疗性血液成分单采术和血浆置换术可迅速缓解临床症状,减少并发症的发生,疗效肯定且安全可靠,不良反应少,并对提高临床药物治疗效果有很大意义.

Objective To investigate the clinical effect of therapeutic hemapheresis and observe the adverse reaction. Methods CS-3000 plus blood cell separator was used for therapeutic hemapheresis in 524 patients. We selected the different cell collection procedures according to the patients＇ conditions and analyzed the clinical effects, the laboratory indexes, the adverse reactions and corresponding handlings. Results After therapeutic hemapheresis, the leucocyte counts was decreased from （230. 1±48. 5） × 10^9/L to （49. 3±10. 0） × 109/L in 210 patients with high white blood cell, the hemoglobin was decreased from （216.0±23.0） g/L to （150. 0 ± 12. 0） g/L and the erythrocyte counts was decreased from （7.1±0.5）× 1012/L to （4. 3±0. 8） X 10 12/L in 123 patients with polycythemia vera, the platelet counts was decreased from （1 080. 0±314. 0）×10^9/L to （341. 0 ± 82. 0） × 109/L in 158 patients with high platelet. There were significant differences （P 〈0. 01） before and after treatment. The significant improvement of clinical symptoms and laboratory indexes were gained in 90. 6% patients with TTP after therapeutic plasmatic exchange by CS-3000 plus blood cell separator. There were a few incidences of citrus salt poisoning （3. 0%）, hypovoletnic shock （0. 7%） and allergic reactions （4. 6%） as adverse reaction, but the complications were relieved after corresponding treatment. Conclusion Therapeutic hemapheresis is significant for rapidly improving clinical symptoms, reducing occurrence of complications and enhancing the curative effect of drugs.