单采血小板输注引发输血不良反应相关因素分析

Analysis on factors associated with adverse reactions after transfusion of apheresis platelets

目的调查输注单采血小板发生输血不良反应相关因素,为制定预防措施提供依据。方法收集广东省东莞市某医院2012年5～6月间,输注单采血小板后引发输血不良反应临床病例13例作为研究组,同时随机选择同期输注单采血小板未发生输血不良反应的临床病例16例作为对照组,根据受血者和献血者的基本信息设计调查方案。受血者基本信息包括:性别、年龄、输血史、药物史及外周血细胞变化(包括输血前后白细胞、嗜酸细胞、嗜碱细胞、单核细胞的绝对值之差以及血小板回收率和输血后血浆球蛋白含量);献血者基本信息包括:性别、年龄、献血次数、血小板输注前保存时间、血小板采集机型、循环量、献血前白细胞计数、献血过程中有无献血不良反应。对收集数据进行统计学分析。结果研究组输注单采血小板发生输血不良反应的受血者的年龄、性别、输血史、药物史、血小板回收率、输血前后白细胞、嗜酸细胞、嗜碱细胞、单核细胞的绝对值之差、输血后血浆球蛋白含量与对照组比较,差异均无统计学意义(P>0.05);研究组血小板输注前保存时间、献血者性别、年龄、献血次数、血小板采集机型、循环量、献血前白细胞计数与对照组比较,差异均无统计学意义(P>0.05)。结论输注单采血小板发生输血不良反应与受血者和献血者自身因素、受血者外周血细胞数量变化及血浆球蛋白含量无关。推测导致输注单采血小板而发生输血不良反应的主要因素为异源血浆蛋白的输入,推荐临床对已发生输血不良反应需再次输注血小板的患者应选择洗涤血小板。

Objective To investigate the factors associated with the adverse reactions after transfusion of apheresis platelets and provide a basis for the development of preventive measures.Methods Thirteen cases of adverse reaction after transfusion of apheresis platelets were collected from May to June,2013 in a hospital in Dongguan City,Guangdong Province,China,serving 16 cases without adverse reaction after transfusion as control.The investigation protocol was designed based on the basic information of recipients and donors,and the data were collected for statistical analysis.The basic information of recipients included sex,age,blood transfusion history,medication history and changes of peripheral blood cells [differences between absolute values of leukocytes,eosinophils,basophils,monocytes before and after transfusion as well as platelet recovery（PR） and globulin content in plasma after transfusion],while that of donors included sex,age,times of donating,time for storage of platelets before transfusion,the type and circulation capacity of platelet collector,leukocyte counts before donating and presence or absence of adverse reaction during donating.Results The age,sex,blood transfusion history,medication history,PR as well as the differences between absolute values of leukocytes,eosinophils,basophils,monocytes before and after transfusion,globulin content in plasma after transfusion of recipients in test group showed no significant difference with those in control group（P 0.05）.However,the time for storage of platelets before transfusion,the sex,age,times of donating of donors,the type and circulation capacity of platelet collector and leukocyte counts before donating in test groups showed no significant difference with those in control group.Conclusion The adverse reactions after transfusion of apheresis platelets showed no relationship to the basic information of recipients and donors as well as peripheral blood cell count and plasma globulin of recipients.It indicated that the allogeneic plasma protein was the major cause for the adverse reaction after transfusion of apheresis platelets. Washing platelets was recommended to the recipients with history of adverse reaction after transfusion.