免疫性血小板输注无效的解决方案

Solution strategy for ineffective platelet transfusion

目的观察免疫性血小板输注无效患者,经固相凝集法血小板配合实验予以配合性血小板输注后的临床疗效,探讨血小板输注无效的解决方案。方法对8例(共计19人次)血小板抗体筛选阳性的血小板输注无效患者,通过LABScreenMixed检测HLA抗体,并采用固相凝集法血小板配合实验予以配合性或适合性血小板输注,比较输注前后的血小板计数,计算输注后24 h内血小板计数增加值,同时追踪、观察患者出凝血方面的临床表现。结果8例患者血清中均含有HLA-Ⅰ抗体,阳性率100%。19人次患者输注配合型或适合型的血小板后,其中14人次临床出血情况好转,提示血小板输注有效,有效率为73.68%(14/19),有效的14人次中固相凝集实验结果为阴性者10人次,弱阳性者3人次,阳性者1人次。其余临床出血情况无好转的5人次中,4人次固相凝集实验结果为阳性或弱阳性,1人次为阴性。结论 HLA-Ⅰ抗体仍然是引起血小板无效输注的主要原因。经固相凝集法血小板配合实验配合的血小板输注可提高血小板输注无效患者的临床疗效,是免疫性血小板输注无效的有效解决措施。采供血机构应主动对所提供的配合性血小板的临床疗效进行观察,指导临床治疗。

Abstract：Objective To investigate the clinical efficacy of matched-platelet transfusions by solid-phase Coombs test and to discuss the solution for ineffective platelet transfusion patients. Methods Among 19 patients, eight ineffective platelet transfusion cases who were screened positive for platelet antibody were studied in the present research. The HLA antibodies of patients were detected by LABScreen Mixed assay. After matched-platelet transfusions by solid-phase Coombs test in subjects, the platelet counts of pre-infusion and post-infusion were used for comparative analysis. The corrected count incre- ment after infusion 24h was counted. The clinical manifestations of hemorrhage or coagulation were observed. Results The HLA- I antibody was tested in 8 patients, and the positive rate was 100%. The clinical hemorrhage of 14 patients was im- proved after matched-platelet transfusions or fitted-platelet transfusion in 19 patients at an improvement rate of 73.69% （ 14/ 19）. 10 patients were tested negative, 3 were weakly positive, and 1 was positive in solid-phase Coombs test in 14 effective cases. Among 5 patients with clinical hemorrhage that did not show marked recovery results, 4 were tested positive or weakly positive by solid-phase Coombs test, while 1 was negative. Conclusion HLA- I antibody remains to be the primary reason for ineffective platelet transfusion. Matched-platelet transfusions by solid-phase Coombs test could improve the clinical efficacy of platelet transfusion, and is identified as the main solution. Initial observation should be conducted on the clinical efficacy of matched-platelet transfusions in order to guide clinical treatment.