低剂量单采血小板预防性输注在血液病中的疗效分析

Efficacy of low dose apheresis platelet prophylactic infusion in hematological diseases:a retrospective study

目的回顾性分析低剂量单采血小板预防性输注疗效,探索低剂量单采血小板预防性输注的可行性。方法选取2020年11月至2021年9月本院输注血小板的住院患者392名,输注常规剂量(1治疗量)单采血小板为对照组,输注低剂量(0.5治疗量)单采血小板为试验组。以输注前后血小板计数、血小板增高值(△PLT)以及24 h血小板计数纠正增加指数(CCI)为观测指标,按病种和性别分析低剂量血小板输注疗效。结果对照组血小板△PLT值和24 h CCI有效输注率均高于试验组(16±16)×10^(9)vs(7±10)×10^(9),71.94%vs 60.46%(P<0.05)。对照组△PLT值约为试验组1.4~3.5倍,有效率约为1~1.4倍。对照组,血小板增高值△PLT为AML(20±14)>AA(14±14)>ALL(13±12)>NHL(9±8)>MDS(7±6);试验组,血小板增高值△PLT(×10^(9))为AA(11±18)>AML(8±8)>ALL(5±7)>NHL(5±7)>MDS(5±16)。24 h CCI,对照组,AML(163/188,86.70%)>AA(23/32,71.88%)>ALL(65/98,66.33%)>MDS(9/17,52.94%)>NHL(12/22,51.55%);试验组,AML(133/188,70.74%)>AA(19/32,59.38%)>NHL(12/22,51.55%)>ALL(47/98,47.96%)>MDS(8/17,47.06%)。AML和ALL 2种疾病的试验组有效输注率分别为70.74%(133/188)、47.96%(47/98),明显低于对照组86.7%(163/188)、66.33%(65/98),差异有统计学意义(P<0.05);其它病种试验组与对照组有效输注率间的差异无统计学意义(P>0.05)。结论低剂量单采血小板预防性输注可缓解供需矛盾,能达到60.46%(237/392)的有效输注率,具有一定的临床应用价值。推荐临床在应用低剂量血小板时,优先选择AML、AA或ALL的患者,尽量避免MDS、NHL患者。

Objective To retrospectively analyze the efficacy of low dose apheresis platelet prophylactic infusion and ex-plore its feasibility.Methods A total of 392 inpatients with platelet transfusion in our hospital from November 2020 to September 2021 were selected.The conventional dose(1 therapeutic dose)of apheresis platelet transfusion was set as the control group,and the low dose(0.5 therapeutic dose)as the experimental group.Platelet count before and after infusion,platelet elevation value(△PLT)and 24 h platelet count correction increase index(CCI)were observed,and the efficacy of low-dose platelet infusion was analyzed by disease type and gender.Results The △PLT value and 24h CCI effective infusion rate in control group were higher than those in experimental group:(16±16)×10^(9) vs(7±10)×10^(9),71.94%vs 60.46%,P<0.05.The △PLT value of the control group was about 1.2-3.5 times that of the experimental group,and the effective rate was about 1-1.4 times.In control group,the △PLT(×10^(9))was AML(20±14)>AA(14±14)>ALL(13±12)>NHL(9±8)>MDS(7±6).In the experimental group,the △PLT(×10^(9))was AA(11±18)>AML(8±8)>ALL(5±7)>NHL(5±7)>MDS(6±16).The 24h CCI was AML(163/188,86.70%)>AA(23/32,71.88%)>ALL(65/98,66.33%)>MDS(9/17,52.94%)>NHL(12/22,51.55%)in the control group,and AML(133/188,70.74%)>AA(19/32,59.38%)>NHL(12/22,51.55%)>ALL(47/98,47.96%)>MDS(8/17,47.06%)in the experimental group.The effective infusion rates of AML and ALL2 in the experimental groups were 70.74%(133/188)and 47.96%(47/98),respectively,significantly lower than 86.7%(163/188)and 66.33%(65/98)in the control group(P<0.05).No significant difference was noticed in the effective infusion rate between the experimental group and the control group for other diseases(P>0.05).Conclusion Low-dose apheresis platelet prophylactic infusion can alleviate the between supply shortage,with an effective infusion rate of 60.46%(236/392),which has certain clinical application value.Patients with AML,AA or ALL were recommended with low dose platelets,while patients with MDS and NHL were not recommended.