血小板抗体阳性患者联合输注丙种球蛋白和血小板效果的临床研究

Clinical study on effect of combination infusion of gamma globulin and platelet in patients with positive platelet antibody

目的:比较分析血小板抗体阳性的血液病患者联合输注丙种球蛋白和单采血小板与只输注单采血小板的治疗效果,以探索基层医疗机构中临床血液病患者血小板输注无效的输血策略。方法:选取2017-01—2019-10血液科409例血液病患者标本,采用固相凝集法进行血小板抗体检测,并对64例血小板减少且血小板抗体检测阳性的患者输注单采血小板前随机分组,其中32例联合静脉输注丙种球蛋白和单采血小板(联合输注组),另外32例只输注单采血小板(血小板输注组);并通过计算输注1 h和24 h后血小板计数增加校正指数来判定输注效果。结果:联合输注组输注有效率53.1%,血小板输注组输注有效率18.8%,组间差异有统计学意义(P<0.01)。结论:血小板抗体阳性的血液病患者联合静脉输注丙种球蛋白和血小板,可以提高血小板输注的有效率,避免或减少因血小板输注无效造成的血液资源浪费。

Objective:To compare the therapeutic effect of apheresis platelet transfusion in patients with positive platelet antibodies combined with or without immunoglobulin infusion,and explore the solution strategies of ineffective platelet transfusion for patients with blood diseases in primary medical institutions.Method:From January 2017 to October 2019,409 samples of patients with hematological diseases were tested for platelet antibodies by solid-phase agglutination method.64 patients with thrombocytopenia and positive platelet antibodies were divided into two groups randomly before platelet transfusion.Among them,32 patients received combined intravenous infusion of gamma globulin and apheresis platelet(combined infusion group),the others transfused the apheresis platelet only(platelet infusion group).The effect of transfusion was determined by calculating the platelet count increase correction index after 1 and 24 hours of transfusion.Result:The effective rate was 53.1%in the combined infusion group and 18.8%in the platelet infusion group,and there was significant difference between the two groups(P<0.01).Conclusion:The efficiency of platelet transfusion could be improved by intravenous infusion of immunoglobulin and platelet in patients who were suffering from hematonosis and having platelet antibodies,in order to avoid or reduce the waste of blood resources caused by ineffective platelet transfusion.