血液病患者单采血小板输注无效的原因及对策

Reasons for apheresis platelet transfusion refractory on patients with blood disorder and its countermeasures

目的探讨血液病患者单采血小板输注无效(PTR)发生率及其影响因素,为临床正确应用血小板制剂提供指导。方法回顾性分析单采血小板输注的70例患者318例次输注资料,通过计算血小板计数增加指数和血小板恢复百分率结合患者出血状况有无改善,判断血小板输注有效性,并讨论其影响因素及处理措施。结果急性白血病、再生障碍性贫血、骨髓异常综合征和特发性血小板减少性紫癜患者PTR发生率分别为22.1%、25.5%、38.3%和51.2%,四种类型的血液病患者血小板PTR发生率差别有统计学意义(P均<0.05);同种疾病无并发症患者PTR发生率低于有并发症者(P<0.05);无并发症患者PTR发生率随着输注次数的增加而上升(P<0.05)。未过滤白细胞与过滤白细胞患者PTR发生率比较差异有统计学意义(P<0.05)。结论疾病类型、有无并发症等因素影响血液病患者血小板输注的治疗效果,减少并发症、过滤白细胞可提高血小板的输注效果。

Objective To explore incidence rate and influence factor of apheresis platelet transfusion refractory（ PTR） on patients with blood disorder. Methods The data of 318 infusions for 70 patients subject to apheresis platelet infusion were retrospectively analyzed,by calculating corrected Count increment（ CCI） and percent platelet recovery（ PPR） and combining hemorrhage improvement condition in patients,the effect of platelet transfusion were determined and influence factors and treatment measures were discussed. Results ①The PTR occurrence rate of acute leukemia（ AL）,aplastic anemia（ AA）,bone marrow abnormalities syndrome（ MDS） and idiopathic thrombocytopenic purpura（ ITP） in patients hit 22. 1%,25. 5%,38. 3% and 22. 1% respectively,the difference in platelet PTR rate in four types of blood diseases was statistically significant（ P〈0. 05）. ②The difference was statistically significant when the incidence rate of PTR of patients without complications was compared to that of patients with spices of diseases and complications（ P〈0. 05）. ③ The incidence rate of PTR in the group of patients without complications rose with the increase in the number of infusions（ P〈0. 05）. ④The difference was statistically significant when the incidence rate of PTR in the group of patients without the filtration of white blood cells was compared to that in the group of patients with the filtration of white blood cells（ P〈0.05）. Conclusions The disease type,number of infusions,fever,infection,spleen enlargement,DIC and other factors become critical factors affecting the transfusion effect of platelets on patients with blood diseases,and the decrease in the complications and filtration of groups of white blood cells can improve the transfusion efficacy of platelets.