高量减除白细胞治疗对患者血红蛋白水平及血小板计数的影响

Influence of High Proportion of White Blood Cell Deduction Therapy on Patient＇s Hemoglobin Level and Platelet Count

目的 探讨采用连续流动离心式血液成分分离机,对高白细胞性白血病患者进行高量减除白细胞治疗时,对患者血红蛋白（Hb）水平及血小板计数的影响.方法 选取2008年1月至2013年12月,于中山大学附属东华医院收治的高白细胞性白细胞病患者39例为研究对象.采用COBE Spectra连续流动离心式血液成分分离机MNC程序,以ACD-A配方血液保存液作为抗凝剂,对39例高白细胞性白血病患者进行高量减除白细胞治疗共计56次.每次高量减除白细胞治疗运转该患者2.5～3.0倍总血容量（TBV）血液,采集其1/5～1/4 TBV的白细胞悬液.本研究遵循的程序符合中山大学附属东华医院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意.结果 本研究单次高量减除白细胞治疗的运行时间为（233.6±27.4） min;运转血量为（12 268.8±1 978.3） mL;采集白细胞悬液容量为（922.9±213.3） mL,悬液中白细胞计数为（600.4±321.1）×109/L,白细胞总数为（554.1±281.3）×10 9,Hb水平为（27.3±10.0） g/L,Hb总量为（25.2±12.3）g,血小板计数为240.5×109/L[（90.0～640.0）×109/L],血小板总数为230.2×109[（83.7～593.0）×109];本组高白细胞性白血病患者治疗前、后白细胞计数分别为（261.0±121.4）×109/L与（185.5±111.1）×109/L,二者比较,差异有统计学意义（t=8.50,P＜0.001）;Hb水平分别为（94.7±20.9） g/L与（89.4±20.0） g/L,二者比较,差异有统计学意义（t=4.21,P＜0.001）;血小板计数分别为123.7×109/L[（55.2～283.8）×109/L]与96.40×109/L[（4.0～254.5）×109/L],二者比较,差异有统计学意义（s=662.50,P＜0.001）,其中,12次减除白细胞治疗前血小板计数＜50×109/L的高白细胞性白血病患者治疗前、后血小板计数分别为（29.8±9.7）×109/L与（24.3±12.6）×109/L,二者比较,差异无统计学意义（t=1.29,P＞0.05）.结论 采用连续流动离心式血液成分分离机对高白细胞性白血病患者进行高量减除白细胞治疗安全、有效,其虽可导致患者Hb水平及血小板计数有所下降,但Hb水平下降在机体代偿范围内;对血小板计数＜50×109/L患者进行高量减除白细胞治疗,也不会导致其血小板进一步减少而增加出血风险.

Objective To explore the effect on hemoglobin （Hb） level and platelet count of high proportion of white blood cell deduction therapy for patients with hyperleukocytic leukemia by continuous flow centrifuge for blood component separator.Methods From January 2008 to December 2013,a total of 39 cases with hyperleukocytic leukemia who hospitalized in Affiliated Donghua Hospital,Sun Yet-sen University were enrolled into this study.By using ACD-A preservation solution as blood anticoagulant,56 times of white blood cell deduction treatment were performed on 39 patients with hyperleukocytic leukemia in MNC program performed by COBE Spectra type of continuous flow centrifuge for blood component separator.In each treatment,2.5-3.0 times of total blood volume （TBV） was circulated,and 20 ％-25 ％ TBV white blood cell suspension was collected.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Donghua Hospital,Sun Yet-sen University.Informed consent was obtained from all participants.Results For a single white blood cell deduction treatment,（233.6±27.4）min was took,（12 268.8±1 978.3）mL blood was circulated,and （922.9±213.3） mL white blood cell suspension was collected,in which white blood cell count was （600.4 ±321.1）×109/L,the total number of white blood cell was （554.1±281.3）×109,Hb level was （27.3±10.0） g/L,the amount of Hb was （25.2±12.3） g,platelet count was 240.5× 109/L（90.0× 109/L-640.0× 109/L）,and the total number of platelet was 230.2 × 109 （83.7 ×× 109-593.0 ×× 109）.For patients before and after treatment,white blood cell count were （261.0 ± 121.4） ×× 109/L and （185.5 ± 111.1） ×109/L,respectively,and the differences were statistically significant between before and after treatment （t=8.50,P＜0.001）; Hblevels were （94.7±20.9） g/L and （89.4±-20.0） g/L,respectively,and the difference were statistically significant between before and after treatment （t=4.21,P＜0.001）; platelet count were 123.7×× 109/L（55.2 × 109/L-283.8 × 109/L） and 96.4 ×× 109/L（41.0×× 109/L-254.5×× 109/L）,respectively,and the differences were statistically significant between before and after treatment （s =662.50,P＜0.001）.In 12 times of white blood cell deduction therapy for patients with platelet count ＜50× 109/L,platelet counts in patients before and after treatment were （29.8±9.7）×× 109/L and （24.3±12.6）× 109/L,respectively,and there were no significant differences between before and after treatment （t=1.29,P＞ 0.05）.Conclusions It is safe and efficient to use continuous flow centrifuge for blood component separator for high proportion of white blood cell depletion therapy for patients with hyperleukocytic leukemia.Though it can make Hb level and platelet count decreased,the reduction of Hb is within the ability of body compensation.And white blood cell deduction therapy for hyperleukocytic leukemia patients with platelet count ＜50×× 109/L will not lead to further reduction of platelet or increase the risk of hemorrhage.