反复输注血小板的血液病患者输血疗效的分析

The impact of repeated transfusion of platelets on patients with hematopoietic disease

目的探讨血小板输注无效（PTR）的原因,以做好预防PTR的工作。方法收集2017年1月—2017年5月本院血液科178名住院患者输注滤除白细胞机采血小板（滤白单采血小板）612例次的临床资料,包括急性白血病（AL）38例、再生障碍性贫血（AA）40例、骨髓增生异常综合征（MDS）42例、特发性血小板减少性紫癜（ITP）58例,其血小板输注效果评价依据血小板纠正增加指数（CCI）,采用简易致敏红细胞血小板学技术（SEPSA）检测PTR患者的血小板相关抗体,并分析影响PTR的因素。结果本组输注滤白单采血小板的血液病患者PTR率29.9%（183/612）,其中ITP、AA、MDS和AL患者PTR率分别为53.9%（69/128）、27.9%（38/136）、25.9%（29/112）、19.9%（47/236）（P〈0.05）;输注血小板次数≤2次、〉2—5次、〉5—8次及〉8次患者的PTR率分别为24.5%（58/236）、30.3（60 198）、34.7%（32/92）及38.4%（33/86）（P〈0.05）。对发生PTR的82名患者的血小板相关抗体检测：抗体检出率39.1%（32/82）,其中抗-HLA占62.5%（20/32）、抗-HPA占6.25%（2/32）、自身抗体占31.25%（10/32）;余下60.9%（50/82）PTR为非免疫因素所致。有、无发热感染者的PTR率分别为35.1%（138/393）和20.1%（44/219）（P〈0.05）;脾大与脾正常者的PRTR率分别为47.2%（84/178）、22.5%（98/434）（P〈0.05）。结论输注滤白机采血小板的血液病患者中,ITP患者PTR率最高;发热、脾大、输注次数、血小板抗体等对血液病患者血小板输注效果有较为明显影响;多次输注血小板的患者,作血小板抗体筛查,采用血小板配合输注,有助于减少PTR的发生。

Objective To explore the causes of Platelet transfusion refractoriness（ PTR） and seek potential approaches to prevent PTR. Methods The clinical data of 612 patients ranging from January 2017 to May 2017 were collected from the hematology department of the hospital,including： Acute leukemia（ AL） 38; aplastic anemia（ AA） 40; myelodysplastic syndrome（ MDS） 42; idiopathic thrombocytopenic purpura（ ITP） 58. The evaluation of platelet transfusion was based on the increase index of platelet correction（ CCI）. The platelet related antibodies in PTR patients were detected by simple sensitized erythrocyte platelet technique（ SEPSA）. The factors affecting PTR were analyzed. Results The rate of PTR in the transfusion group was 29. 9%（ 183/612）. Among them,PTR rates of ITP,AA,MDS and AL were 53. 9%（ 69/128）,27. 9%（ 38/136）,25. 9%（ 29/112） and 19. 9%（ 47/236）（ P〈0. 05）,respectively. The PTR rates of the patients were 24. 5%（ 58/236）,30. 3%（ 60/198）,34. 7%（ 32/92） and 38. 4%（ 33/86）（ P〈0. 05）,respectively. Platelet related antibody detection in the 82 patients with PTR was performed： The antibody detection rate was 39. 1%（ 32/82）,among which,antihla was 62. 5%（ 20/32）,anti-hpa was 6. 25%（ 2/32）,and self-antibody was 31. 25%（ 10/32）. The remaining 60. 9%（ 50/82） PTR was caused by non-immune factors. The PTR rates of patients with and without fever were 35. 1%（ 138/393）and 20. 1%（ 44/219）（ P〈0. 05）. The PRTR rate of splenomegaly and normal people was 47. 2%（ 84/178） and 22. 5%（ 98/434）（ P〈0. 05）. Conclusion The PTR rate was the highest among the patients with hematopoietic disease. The effects of fever,splenomegaly,infusion frequency and platelet antibody on platelet transfusion in patients with hematological diseases were significantly affected. Platelet antibody screening for platelet antibody screening in patients with multiple platelet transfusion may help to reduce PTR.