血液病患者血小板抗体检测及血小板输注疗效评估

Detection of platelet antibody and evaluation of platelet transfusion efficacy in patients with hematologic disease

目的 探讨影响血小板抗体产生的因素及其对临床血小板输注效果的影响。方法 本研究为1项单中心的前瞻性观察性研究,收集了四川大学华西医院2018年10月1日~2019年9月30日血液病患者输注血小板前的血浆标本,对血小板抗体进行检测(均采用固相凝集法),根据血小板抗体筛查结果将患者分为血小板抗体阳性组和阴性组,采用t检验及非参数Mann-Whitney U检验比较2组的输注疗效。从HIS6.2.0和临床用血全过程管理系统3.0收集患者的人口学与临床信息、用血数据,包括患者年龄与性别、病种、输注血小板与红细胞量,分析患者年龄及性别、所患疾病(种)对血小板抗体阳性率的影响,以及不同疾病患者的血小板抗体分布情况、血小板抗体阳性率与输血(血小板)史的相关性。同时现场观察血小板输注过程。结果 本组共纳入316名血液病患者,以急性髓细胞白血病为主[59.5%(188/316)];所有患者住院期间共输注血小板1 671 U、[1~17(5.3±3.1)]U/人,红细胞1 896 U、[0~38(7.8±4.6)]U/人;血小板抗体检出(阳性)率26.9%(85/316),不同性别和年龄的血液病患者输注血小板后的血小板抗体阳性率无明显差异(P>0.05),不同疾病的患者血小板抗体分布不同(P<0.05),其中骨髓增生异常综合症最高(57.1%),其次是再生障碍性贫血(36.4%),髓系白血病(27.7%);血小板抗体阳性率与患者既往输注血小板次数呈正相关(P<0.05)。血小板抗体阳性组和阴性组整体输注效果分别为:阳性组输注血小板后的绝对血小板计数增量(8×10~9/L vs 17×10~9/L,P<0.01)及校正血小板计数增量(5.2×10~9/L vs 11.5×10~9/L,P<0.01)比阴性组低;阳性组平均每周输注的血小板单位数(1.7U vs 1.2U,P<0.01)和红细胞单位数(1.5 U vs 1.1 U,P<0.05)比阴性组多,血小板输注间隔比阴性组短(3.1 d vs 3.6 d,P<0.05),2组间红细胞输注间隔无明显差异(3.1 d vs 3.8 d,P>0.05);阳性组住院期间最低Plt(5×10~9/L vs 9×10~9/L,P<0.01)、平均Plt(27×10~9/L vs 40×10~9/L,P<0.01)及平均Hb(71 g/L vs 77 g/L,P<0.05)比阴性组低,最低Hb之间无明显差异(56 g/L vs 59 g/L,P>0.05)。此外,本次研究共现场观察到1 291例次血小板输注过程,共169例次输血小板不良反应,发生率为13%(169/1291)。结论 血小板抗体在血液病患者中分布频率较高,且血小板抗体阳性的患者输血效果比阴性者差。血液病患者输注血小板前常规做血小板抗体检测,输注配合型血小板,有助于提高输注疗效。

Objective To investigate the factors influencing the production of platelet antibody and its effect on clinical platelet transfusion.Methods This is a single-center prospective observational study. The research subjects were patients with hematological diseases in West China Hospital of Sichuan University from October 1, 2018 to September 30, 2019, and their plasma were collected before platelet transfusion to detect platelet antibodies using solid-phase agglutination method. According to the results of platelet antibody screening, the patients were divided into platelet antibody positive group and negative group. The t test and nonparametric Mann-Whitney U test were used to compare the transfusion efficacy of two groups. Patients’ demographic and clinical information, including age, gender, diagnosis, the units of platelets and RBC transfused, were collected via HIS6.2.0 and whole process management system of blood in clinical(version 3.0) to analyze the influence of age, gender and the disease on the positive rate of platelet antibodies, as well as the profile of platelet antibodies in patients with different diseases, the correlation between the positive rate of platelet antibodies and the history of blood/platelets transfusion. In additional, the platelet transfusion process was observed on site.Results A total of 316 patients with hematologic diseases were included in this study, mainly with acute myeloid leukemia(188/316, 59.5%). All patients were transfused 1671 U platelet [1~17(5.3±3.1)U each person] and 1896 U RBC products [0~38(7.8±4.6)U each person] during the treatment. Out of the 316 patients, platelet antibodies were found in 85(26.9%) of them. No significant differences in the positive rates of platelet antibody after transfusion were notice by genders or ages(P>0.05). The incidence of platelet antibody was related to diseases(P<0.05), with MDS as the highest(57.1%), followed by aplastic anemia(36.4%) and myeloid leukemia(27.7%).In additional, the positive rate of platelet antibody increased with the number of previous platelet transfusions(P<0.05).The 316 patients were divided into positive group and negative group according to the results of platelet antibody screening. The corrected count of increment(5.2×10~9/L vs 11.5×10~9/L,P<0.01) and absolute platelet increase(8×10~9/L vs 17×10~9/L,P<0.01)in positive group were lower than those in negative group. The positive group were transfused more units of platelets(1.7 U vs 1.2 U,P<0.01)and red blood cells(1.5 U vs 1.1 U,P<0.05)per week than negative group. The platelet transfusion interval was shorter in positive group than negative group(3.1 days vs 3.6 days, P<0.05), but there was no significant difference in red blood cell transfusion interval(3.1 days vs 3.8 days, P>0.05) between two groups. The minimum PLT count(5×10~9/L vs 9×10~9/L, P<0.01), average PLT count(27×10~9/L vs 40×10~9/L,P<0.01)and average Hb(71 g/L vs 77 g/L,P<0.05)in positive group were lower than those in negative group during hospitalization, but there was no significant difference in the minimum Hb(56 g/L vs 59 g/L,P>0.05)between two groups. According to transfusion events on site, the incidence of acute adverse reactions to transfusion was 13%(169/1 291). Conclusions The positive rates of platelet antibodies in patients with hematologic diseases were relatively high. In addition, the efficacy of platelet transfusion in positive group were worse than that in the negative group. It is recommended that platelet antibody testing should be routinely performed before transfusion in hematologic disease patients to select crossmatch-compatible platelets in order to improve the effectiveness of platelet transfusion.