连续流动离心式血液成分分离机高量减除白细胞治疗对白血病患者凝血功能的影响

The influence of high proportion of white blood cell deduction therapy on blood coagulation function by continuous flow centrifuge for blood component separator

目的 探讨连续流动离心式血液成分分离机高量减除白细胞治疗对高白细胞性白血病患者综合性凝血指标及血浆纤维蛋白原浓度的影响.方法 采用COBE Spectra连续流动离心式血液成分分离机单个核细胞（MNC）采集程序,以ACD-A配方血液保存液作为抗凝剂,对高白细胞性白血病患者实施减除白细胞治疗,每次治疗运转2.523.0倍总血量,采集20％～25％总血容量的白细胞悬液,对39例患者共进行56次减除白细胞治疗.结果 单次治疗运行时间（233.63±27.41） min,运转血量（12 268.77±1 978.25）ml,ACD-A配方血液保存液用量（991.04±185.06）ml,采集白细胞悬液容量（922.89±213.26）ml,悬液中白细胞计数[中位数（四分位数间距）]为551.05×109/L（396.76×109/L,756.45 × 109/L）,单次治疗减除白细胞总数为491.52×109（341.53×109,754.51×109）;治疗前、后患者白细胞计数分别为233.30×109/L（163.62×109/L,367.05×109/L）、167.34×109/L（94.40×109/L.260.06×109/L） （s=765,P＜0.001）,凝血酶原时间（PT）分别为（15.69±2.82）s、（15.81 ±2.71）s（t=1.25,P＞0.05）,活化部分凝血活酶时间（aPTT）分别为（39.22±8.15）s、（39.87±7.97）s（t=1.96,P＞0.05）,凝血酶时间（TT）分别为（17.35±1.73）s、（17.48±1.57）s（t=1.77,P＞0.05）,纤维蛋白原浓度（Fbg）分别为（2.91±1.00）g/L、（2.61±0.81）g/L（t=7.49,P＜ 0.001）.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实施高量（20％～25％总血容量）减除白细胞治疗,可降低患者体内白细胞负荷,同时可降低患者血浆Fbg,但降低值在机体维持正常止血功能的代偿范围内,对反映患者内、外源性凝血活性的综合性凝血指标无明显影响.

Objective To explore the impact of high proportion of white blood cell （WBC） deduction therapy on comprehensive coagulation index and plasma fibrinogen concentration detected by continuous flow centrifuge （CFC） in blood component separator in patients with hyperleukocytic leukemia （HLL）.Methods With ACD-A preservation solution as blood anticoagulant,the WBC deduction therapy was performed in patients with HLL by the mononuclear cell （MNC） program of the COBE Spectra type of CFC.In each cycle of treatment,2.5-3.0 times of total blood volume （TBV） was circulated,and the WBC suspension with 20 %-25 % TBV was collected.56 times of WBC deduction treatment were performed in 39 patients with HLL.Results For a single treatment,（233.63±27.41） minutes was spent,（12 268.77±1 978.25） ml blood was circulated,（991.04±185.06） ml of ACD-A preservation solution was used,and （922.89±213.26） ml of WBC suspension were collected,in which WBC count was 551.05×109/L （396.76×109/L,756.45×109/L）,the total number of WBC was 491.52×109 （341.53×109,754.51×109）.Before treatment and after treatment,the WBC counts were 233.30× 109/L （163.62× 109/L,367.05 × 109/L） and 167.34× 109/L （94.40× 109/L,260.06× 109/L） （s =765,P〈 0.001）,PT were （15.69±2.82） s and （15.81±2.71） s （t =1.25,P〉 0.05）,aPTT were （39.22±8.15） s and （39.87±7.97） s （t =1.96,P 〉 0.05）,TT were （17.35±1.73） s and （17.48±1.57） s （t =1.77,P 〉 0.05）,Fbg concentration were （2.91±1.00） g/L and （2.61±0.81） g/L （t =7.49,P 〈 0.001）,respectively.Conclusions By high proportion（with 20 %-25 % TBV） of WBC depletion therapy for patients with HLL,the WBC load was significantly reduced,as well as the concentration of plasma fibrinogen was deceased,too,while the reduction level of plasma fibrinogen concentration is in the compensatory range of body normal hemostatic function.There is no significant influence on comprehensive coagulation indexes （including PT,aPTF and TT） of endogenous and exogenous coagulation activity by WBC depletion therapy for patients with HLL.