血液病患儿血小板抗体筛查及交叉配型输注效果分析

The Analysis of Platelet Antibody Screening and Cross-matching Infusion in Children with Hematological Diseases

目的:分析血液病患儿血小板抗体筛查及交叉配型输注效果。方法:回顾性分析2016-01—2018-05在我院接受多次血小板输注治疗的血液病患儿78例,依据血小板抗体检测结果分为阳性组(n=28)和阴性组(n=50),阴性组直接输注ABO同型血小板,阳性组进行交叉配型,根据配型结果分为未配型组(n=13)和配型组(n=15),未配型组输注ABO同型血小板,配型组输注相同的血小板。所有患儿于输注血小板1h、24h后检测血小板计数,计算血小板增值指数(CCI),分析患者血小板抗体筛查结果、交叉配型及其血小板输注无效(PTR)和非溶血性输血反应(NHTR)情况。结果:阳性组患儿中HLA-I抗体阳性23例(82.14%),HLA-I+HPA抗体阳性4例(14.29%),HPA抗体阳性1例(3.57%)。其中配型组中有HLA-I抗体阳性者12例(80.00%),HLA-I+HPA抗体阳性2例(13.33%),HPA抗体阳性1例(6.67%);而未配型组中有HLA-I抗体阳性者11例(84.61%),HLA-I+HPA抗体阳性2例(15.39%)。阳性组患儿血小板输注后1h、24h的CCI值均低于阴性组(P<0.05),且阳性组PTR、NHTR发生率均明显高于阴性组患儿(P<0.05)。配型组血小板输注后1h、24h的CCI均高于同时点的未配型组,PTR和NHTR发生率均低于未配型组(P<0.05)。配型组血小板输注有效率也明显高于未配型组(P<0.01)。结论:多次血小板输注的血液病患儿,依据血小板交叉配型试验结果选择交叉配型相合的血小板进行输注,可提高血小板的输注效果。

Objective:To study the effect of platelet antibody screening and cross-matching in children with hematological diseases.Method:78 cases of children with hematologic diseases accept many platelets transfusion from 2016-01 to 2018-05 were restrospectively analyzed,on the basis of the platelet antibody test results they were divided into positive group(n=28)and negative group(n=50),negative groups direct infusion ABO type with platelets,positive group to cross over,according to the result of the match the positive group children were divided into unmatched group(n=13)and matched group(n=15).Platelet count was measured at 1h and 24h after platelet transfusion,platelet increment index(CCI)was calculated,and platelet antibody screening results,cross matching and platelet transfusion response(PTR)and non-hemolytic transfusion response(NHTR)were analyzed.Results:In the positive group,23 cases were positive for HLA-I antibody(82.14%),4 cases were positive for HLA-I+HPA antibody(14.29%),and 1 case was positive for HPA antibody(3.57%).In matched group,12 cases(80.00%)were positive for HLA-I antibody,2 cases(13.33%)were positive for HLA-I+HPA antibody,and 1 case(6.67%)were positive for HPA antibody.There were 11 cases(84.61%)were positive for HLA-I antibody,and 2 cases(15.39%)were positive for HLA-I+HPA antibody in unmatched group.CCI values at 1h and 24h after platelet transfusion in the positive and matched groups were significantly lower than those in the negative and unmatched groups(P<0.05),and the incidence of PTR and NHTR in the positive group were were significantly higher than the negative group(P<0.01).The efficiency of platelet transfusion in the matched group was significantly higher than that in the unmatched group(P<0.01).Conclusion:For multiple platelet transfusion in children with hematological disorders,selection of cross-matched platelets for transfusion based on the results of platelet cross-matching tests can improve platelet transfusion effects.