血小板配型输注效果及影响因素分析

Analysis of factors influence and posttransfusion effectiveness in matched-type of platelet transfusion

目的比较血小板配型相合与随机输注的效果,并分析相关影响因素,探求提高血小板输注效果的方法。方法通过分析该院2013年7月至2014年6月申请血小板输注的住院患者进行血小板抗体筛查及特殊配型试验结果,比较不同影响因素对输注效果的影响,并评估血小板输注效果。分析性别、输血史、怀孕史对血小板抗体产生的影响。分析性别、输血次数、怀孕次数、输注类型、保存天数及联合其他成分输注对输注效果的影响。应用该院临床输血智能管理与评估系统评估血小板输注效果。结果 812例患者进行血小板抗体筛查试验,随机抽取抗体筛查阳性的87例患者,共1 247U血小板输注,抗筛阳性输注特殊配型血小板、抗筛阳性随机输注血小板、抗体筛查阴性随机输注血小板3种方式输注效果比较,差异有统计学意义(P<0.05)。应用多因素Logistics回归分析,发现有输血史是血小板抗体产生的独立危险因素(P<0.05,OR=13.104,95%CI:7.784~22.061)。性别(P<0.05,OR=1.629,95%CI:1.236~2.148)、输血史、输注血小板类型(机采、去白、辐照)、血小板保存天数、同时输注红细胞(P<0.05,OR=2.464,95%CI:1.053~5.765)、输注方式(特配)(P<0.05,OR=0.576,95%CI:0.389~0.854)是血小板输注效果的危险因素。结论血小板抗体筛查阳性时,需配型输注,提高有效率;输血史影响抗体的产生;性别、输血次数、输注类型、保存天数、联合其他成分输注、血小板配型输注均影响血小板输注效果。

Objective To analysis the related influencing factors and explore the approach of improving the effect of platelet transfusion through compared the posttransfusion effect of matched-type with random platelet transfusion.Methods Analysis the results of platelet antibody screening test and matched-type test in our hospital′s inpatients during July 2013 to June 2014,who applied for platelet transfusion.The influence of sex,blood transfusion history,pregnant history on the antibody were analyzed.The factors of sex,times of blood transfusion,pregnant times,platelet component sorts,storage time,combined with other components,platelet antibody（positive or negative）and transfusion matched-type platelet on the effect of platelet transfusion were analyzed.Application in our clinical blood transfusion intelligent management and evaluation system to evaluate the effect of platelet transfusion.Results Totally 812patients′platelet antibody were screened.Then we randomly selected 87 antibody positive inpatients were selected and 1 247 Uplateletswere transfused,which including matched-type platelet transfusion for antibody screening positive patients,random platelet transfusion for antibody screening positive patients,random platelet transfusion for antibody screening negative patients,there were statistical difference（P〈0.05）.With Logistics regresion analysis,the history of blood transfusion was an independent risk factor for platelet antibody production（P〈0.05,OR=13.104,95%CI：7.784-22.061）.Sex（P〈0.05,OR=1.629,95%CI：1.236-2.148）,transfusion times,different platelet component sorts（leukocyte-reduced platelets aphaeresis and irradiation leukocyte-reduced platelets aphaeresis）,different storage time,transfusion combined with other components（RBC）（P〈0.05,OR=2.464,95%CI：1.053-5.765）,transfusion matched-type platelet（P〈0.05,OR=0.576,95%CI：0.389-0.854）were the risk factors for platelet transfusion.Conclusion Matched-type test should be done to improve efficiency when the platelet antibody screening were positive.Sex,times of blood transfusion,platelet component sorts,storage time,combine with other components,transfusion matched-type platelet couldinfluence the effect of platelet transfusion.