血小板输注无效的原因与对策的研究进展

Research Progress in Reasons and Countermeasures of Platelet Transfusion Refractoriness

血小板的主要生理作用是参与正常的止血,防止损伤后血液丢失。在临床治疗中,血小板的输注频率仅次于红细胞,是现代成分输血的一个重要组成部分,适用于预防和治疗血小板减少和/或血小板功能缺陷患者的出血,并且已成为各种血液病及肿瘤患者放、化疗的有效支持疗法[1],可以降低血液病患者及肿瘤患者放、化疗后因血小板减少而导致出血致死的死亡率。但是随着血小板的大量使用,血小板输血反应日渐增多,特别是血小板输注无效(refractoriness to platelet transfusion,RPT)是临床面临的一大难题。据文献报道,其发生率为30%-70%。产生原因包括免疫性因素和非免疫性因素。处理措施主要是分析血小板输注无效的主要原因,尽量减少输血次数,控制感染和发热,开展血小板组织配型为患者选择适用的血小板,提高输注疗效。

The main physiological role of platelets is its participation in normal hemostasis and blood loss prevention after injury.During clinical therapy,the frequency of platelet transfusion is just second to that of red blood cell transfusion.Platelet transfusion becomes important component in modern blood transfusion.It is applied to treatment of thrombocytopenia and/or platelet function defect caused bleeding.It has become an effective supporting therapy for it can reduce the mortality of patients caused by thrombocytopenia after chemotherapy and/or radiotherapy.However,with the extensive use of platelet transfusion,platelet transfusion refractoriness beco-mes a major issue.According to literature,the incidence is 30%-70%.The reasons include immunological factors and non-immun-ological factors.Countermeasures to treat platelet transfusion refractoriness mainly are to analyze its reasons,reduce frequency of blood transfusion,control infection and fever,and check HLA and HPA specificity.