血液病患者血小板输注无效分析及管理策略探讨

Exploration of the causes and management strategy of platelet transfusion refractoriness in patients with hematological diseases

目的探讨血液病患者血小板输注无效的原因及合理的管理策略,提高血小板有效输注。方法选择2015—2018年航天中心医院血液科收治的首次在我院输注单采血小板的血液病患者198例,应用血小板纠正计数指数(corrected count increment,CCI)评估患者血小板输注有效性,分析发热、脾大及化疗等非免疫因素以及血小板HLA-Ⅰ类抗体与血小板输注效果之间的相关性,探讨血液病患者反复输注血小板时合理有效的输注管理策略。结果198例患者共输注血小板1823次,有效输注1040次,总体输注有效率为57.0%。血小板输注有效性随血小板输注次数增加而降低(χ^(2)=45.840,P=0.000);发热、脾大、免疫抑制、化疗和移植因素可显著影响血小板输注效果(P<0.05)。患者血小板HLA-Ⅰ类抗体阳性率为22.2%。血小板输注无效率在HLA-Ⅰ类抗体阳性和阴性患者之间比较(62.3%比36.9%),差异有统计学意义(χ^(2)=87.281,P=0.000),抗体阳性者血小板输注有效率明显降低。HLA-Ⅰ类抗体产生在不同输注次数组间差异无统计学意义(χ^(2)=8.015,P=0.091),抗体的产生未伴随血小板输注次数增加而呈上升趋势,并且HLA-Ⅰ类抗体的产生在不同年龄、性别及血液病种类间差异均无统计学意义(P>0.05)。结论血液病患者在反复输注血小板的管理过程中,加强非免疫性因素监测及处理的同时,应在血小板输注前常规开展血小板HLA-Ⅰ类抗体检测。

Objective To explore the causes and management strategy of platelet transfusion refractoriness to improve the efficiency of platelet transfusion in patients with hematological diseases.Methods A total of 198 patients with hematological diseases who transfused apheresis platelets for the first time in department of hematology of Aerospace Center Hospital were selected from 2015 to 2018 years.The platelet corrected count increment(CCI)was used to evaluate the effectiveness of platelet transfusion in patients with hematological diseases.The correlation between the non-immune factors such as fever,splenomegaly,chemotherapy and HLA-I antibody with the effect of the platelet transfusion was analyzed.The reasonable and effective management strategy of platelet transfusion was explored-Results A total of 198 patients had platelets transfusion 1823 times,in which 1040 times were effectively.The total effective rate of platelets transfusion was 57.0%.The efficacy of platelet transfusion decreased with the increase of transfusion times(χ^(2)=45.840,P=0.000).Fever,splenomegaly,immunosuppression,chemotherapy and transplantation were correlated with the effect of platelet transfusion(P<0.05).The positive rate of platelet HLA-I antibody was 22.2%.There was a significant difference in platelet transfusion efficiency between HLA-I positive and negative patients(62.3%vs.36.9%,χ^(2)=87.281,P=0.000).The platelet transfusion efficiency of HLA-I positive patients was significantly lower than that of HLA-I negative patients.There was no correlation between the production of HLA-I antibody and the times of platelet transfusions(χ^(2)=8.015,P=0.091).The antibody production did not increase with the increase of platelet transfusion times.Conclusions During the management of platelet transfusion in patients with hematological diseases,monitoring and treatment of non-immune factors should be strengthened,and the HLA-I antibody should be screened routinely before platelet transfusion.