TEG用于新鲜血小板和冰冻血小板的功能分析

Application of TEG in functional analysis for fresh apheresis platelets and freezing platelets

目的通过血栓弹力图(thrombelastography,TEG)技术探讨新鲜血小板、冰冻血小板及两者混合后的功能差异,为制定血小板输血模式提供参考依据。方法选择2012年5月-2015年1月于日照市中心血站无偿捐献单采血小板为研究对象,随机选择20袋5%二甲基亚砜(DMSO)制备,-80℃保存冰冻血小板,20袋采集后72 h内新鲜血小板。临床输注血小板前取样,配制成4组标本:A组新鲜血小板标本,B组新鲜与冰冻(2∶1)混合血小板标本,C组新鲜与冰冻(1∶1)混合血小板标本,D组冰冻血小板标本,分别检测TEG参数,包括反应时间(R)、凝血时间(K)、ɑ角(Ang)和最大振幅(MA),血小板计数(Plt),平均血小板体积(MPV),血小板分布宽度(PDW),P选择素(CD62p),综合评价血小板功能情况。结果 1)新鲜与冰冻(1∶1)混合血小板标本R值最短,与新鲜血小板、冰冻血小板、新鲜与冰冻(2∶1)混合标本比较差异均有统计学意义(均为P<0.05);2)2种比例混合血小板标本的K值、α角和MA值差异均无统计学意义(均为P>0.05),但与未混合血小板比较差异均有统计学意义(均为P<0.05);30冰冻血小板与新鲜血小板比较,Plt、MPV、PDW和CD62p差异均有统计学意义(均为P<0.05);4)2种比例混合血小板的Plt和PDW差异有统计学意义(P<0.05),MPV和CD62p差异无统计学意义(P>0.05)。结论新鲜血小板和冰冻血小板按1∶1配合输注可以明显缩短血液凝固时间,对血块凝集强度影响不大,是一种理想的输血模式。

Objective To explore the differences in the function of fresh apheresis platelets, freezing platelets and their mixture through TEG, and to guide reasonable clinical usage of platelets.Methods From May 2012 to January 2015, the blood donors＂ blood preparation in Rizhao Blood Center were included into this study. Twenty bags of freezing platelets and twenty bags of fresh apheresis platelets were randomly selected. Freezing platelets were prepared through 5% DMSO and pre- served at -80 ℃. Fresh apheresis platelets were preserved at （22±2）℃ and were no more than 72 hours after preparation. All the platelets samples were taken before clinical usage and prepared into 4 groups ： a group of fresh apheresis platelet sam- ples, a group of fresh apheresis platelets and freezing platelets mixed in a 2 ： 1 ratio, a group of fresh apheresis platelets and freezing platelets mixed in an 1 ： 1 ratio, and a group of freezing platelet samples. All the platelet samples were used to detect the TEG parameters, including the reaction time （ R）, the prothrombin time （ K）, the ct angle （Ang） and the maximum am- plitude （MA）. At the same time, platelet count （Plt）, mean platelet volume （MPV）, platelet distribution width （PDW） and P-selectin （CD62p） were also detected. Results The parameter R value of fresh apheresis platelets and freezing plate- lets mixed by 1：1 samples was the shortest. Compared with the fresh apheresis platelets, the freezing platelets, the fresh a- pheresis platelets and freezing platelets mixed by 2：1 samples were significantly different （P〈0. 05 ）. Of the two types of mixed samples, there was no significant difference in the parameter K value, the ot angle and the MA value （P〉O. 05）. However, there was a significant difference in comparison with the non mixed platelets （P〈0. 05）. Compared with fresh a- pheresis platelets, the Plt, MPV, PDW and CD62p were significantly different in freezing platelets （P〈0. 05）. Between the two types of mixed platelets, there were significant differences （P〈O. 05） in Pit and PDW, but there was no significant difference in CD62p and MPV （P〉0.05）.Conclusion Fresh apheresis platelets and freezing platelets mixed by 1：1 trans- fusion is an ideal blood transfusion model. It has little influence on the strength of blood agglutination and can significantly shorten the time of blood coagulation.