肝胆管结石病人血小板量及聚集性改变的临床研究

目的 探讨血小板在肝胆管结石病人中的病理作用及临床意义。方法 采用血小板聚集仪测定 40例肝胆管结石病人血小板量、血小板聚集率 (AGG) ,同时行肝活检术。结果 有胆道感染病史组血小板为 (6 4± 12 )× 10 9/L ,AGG为 (40 .8± 16 .4) % ,明显低于无胆道感染病史组 [分别为(2 17± 72 )× 10 9/L ,(76 .7± 17.2 ) % ,均P <0 .0 1]和正常对照组 [分别为 (2 39± 42 )× 10 9/L ,(77 8±13 0 ) % ,均P <0 0 1]。肝活检发现有胆道感染病史组有微聚物沉积于肝窦 ,部分肝细胞变性。结论 肝胆管结石病人血小板量及聚集性下降 ,可能与肝脏微聚物形成有关 ;临床测定血小板量及AGG对手术决策 ,预后估价具有重要的参考意义。

机采两个治疗量血小板的质量保证和献血者安全性探讨

机采血小板是一种全封闭式的采血方法,目前在血站比较普遍开展,随着血细胞分离机性能的提高,一次采集两个单位的血小板已成为现实.笔者就本站采集两个治疗量血小板,随机检测,分析血小板采集效果和献血者在采两个治疗量血小板前后血常规变化132例(264单位).检测结果表明,成品合格率达95.46%以上,献血者采集两个单位血小板后各项指标达100%以上在正常生理范围内.

富血小板血浆量、采血量与抗凝剂比例对血小板聚集检验结果的影响

目的分析富血小板血浆量(PRP)、采血量与抗凝剂比例对血小板聚集检验结果的影响。方法选取2019年1月至2019年5月本院64例健康体检人员静脉血为研究对象,其中枸橼酸钠抗凝比例为1∶9,贫血小板血浆(PPP)、离心分离富血小板血浆,主要采用比浊法检测分析血小板聚集状况。同量枸橼酸钠抗凝剂进行不同静脉血抗凝。结果不同剂量富血小板和血小板聚集结果间无较大差异,差异无统计学意义(P>0.05);当钙浓度0.08 mmol/L时聚集率降低,AA诱导时并未因钙离子浓度变化不聚,0.10 mmol/L和0.04~0.08 mmol/L差异有统计学意义(P<0.05)。结论富血小板血浆采用300μL进行血小板聚集时对聚集检验状况影响并不显著。Ca^2+离子浓度对血小板聚集检测有显著影响,且会随Ca^2+离子浓度降低而降低,正常状况下血小板聚集实验中Ca^2+离子浓度为0.09~0.11 mmol/L。

献血员血小板计数及其相关系数对单采血小板采集量的影响

目的通过对无偿献血机器单采血小板采集量的统计分析,探讨单采血小板采集量的影响因素。方法汇总统计全年所有单采血小板的采集量,以及献血员的血小板计数及相关的系数,对影响因素逐一分析,确定权重因素。结果单采血小板的采集量不仅与献血员的血小板计数(PLT)极其相关系数有一定相关性,而且献血员的血小板平均体积(MPV)和血小板体积分布宽度(PDW)也影响着采集量。结论单采血小板采集量的保证要从献血员的多项指标来综合分析,只有数量高,形态好,采集量才能达标。

应用MCS+LDP和UPP程序单采血小板的效果对比分析

目的应用MCS+全血细胞分离机LDP和UPP程序采集单采血小板,比较两者在采集血小板时的效率、时间、舒适度等。方法于2017年7月3日—7月23日来本中心的单采献血者111名,先用LDP程序采集。15—20 d后,该111名献血者再次用UPP程序采集,2次单、双份保持一致,对比2组的血小板采后计数、采集时间、采集率等,用SPSS统计软件进行分析。结果两种程序采集血小板采前、采后血小板计数、全血处理血量、血小板采集量比较,差异无统计学意义(P>0.05)。UPP无论单份还是双份血小板采血时间均少于LDP,每小时采集量均多于LDP,差异有统计学意义(P<0.05)。产品红细胞混入量、白细胞混入量、血小板含量均100%符合国家标准。2种程序采集过程中献血者没有出现献血反应,UPP舒适度优于LDP。结论使用UPP程序采集血小板,产品质量100%符合相关国家标准,且单双份采集时间都减少,每小时采集量增加,舒适度增加,值得在临床中推广使用。

机器制备洗涤血小板的效果探讨

目的通过机器自动洗涤来制备洗涤血小板制品。方法采集ACD或CPDA抗凝的健康者全血,经离心获得白膜后汇集制成集量血小板制品,通过机器用生理盐水完成洗涤,最终制备成洗涤血小板制品供临床输用。结果洗涤血小板制品经检测,血小板回收率(%)、血浆蛋白清除率(%)、白细胞清除率(%)分别为82.21±2.58、99.10±0.17、99.97±0.01。结论洗涤血小板制品质量符合相关标准要求。

透析式洗涤冰冻红细胞去除白细胞和血小板的方法

目的:用低速离心的方法减少悬浮红细胞中白细胞和血小板的数量,使透析式洗涤机洗涤的冰冻红细胞中白细胞和血小板的残留量小于1%。方法:分别选用低速离心(700和500r/min)和常规离心(3800r/min)全血制备悬浮红细胞,计算白细胞和血小板的清除率;甘油低温冰冻保存,透析式冰冻红细胞洗涤机洗涤冰冻红细胞,对洗涤后的红细胞进行质量检测。结果:500r/min离心后白细胞和血小板的清除率(%)分别为53.82±6.83和85.23±4.21;洗涤后的冰冻红细胞中白细胞和血小板残留量(%)分别为0.843±0.058和0.903±0.035。700r/min离心后白细胞和血小板的清除率(%)分别为23.38±2.36和62.61±3.82;洗涤后的冰冻红细胞中白细胞和血小板残留量(%)分别为0.983±0.024和1.021±0.045。3800r/min离心后白细胞和血小板的清除率(%)分别为9.82±4.12和6.39±3.26;洗涤后的冰冻红细胞中白细胞和血小板残留量(%)分别为3.839±2.896和3.528±2.689。结论:用500r/min离心全血制备的悬浮红细胞,经甘油低温冻存,透析式洗涤机洗涤后,血小板和白细胞的残留量等各项指标均符合国家标准。

富血小板血浆量、采血量与抗凝剂比例对血小板聚集检验结果的影响

分析富血小板血浆量,采血量与抗凝剂比例对血小板聚集检验结果的影响。方法 选择共80例健康体检者的血液样本作为研究对象,分别进行富血小板血浆(PRP)和贫血小板血浆(PPP)的理性检验,不同剂量的枸橼酸钠(BD)对不同量静脉血按照比例进行抗凝,并且分离PRP、PPP,通过血浆比浊法实施血小板聚集率检测。结果 结果表明,300μl和0μl的PRP,采用花生四烯酸(AA)进行诱导,0μl的聚集率更高;采用二磷酸腺苷(ADP)进行诱导,300μl的聚集率更高。对于不同钙浓度来说,0.11—0.04mmol/L时,血小板聚集率在钙浓度降低的情况下也会降低,ADP诱导血小板聚集明显,当钙浓度达到0.08mmol/L时,聚集率开始明显下降。结论 对于富血小板血浆量来说,300μl测量聚集率对于结果的影响不大;钙浓度对于检验结果的影响较为明显,血小板聚集率会随着浓度的降低而降低,常规实验需要将钙浓度控制在0.09—0.11mmol/L间。

儿童免疫性血小板减少症生活质量

免疫性血小板减少症（ITP）是儿童常见的出血性疾病。因为血小板减少、出血、疾病预后、治疗的不良反应、活动受限等问题，常导致患儿及父母的生活质量显著降低。现就国内外儿童ITP的生活质量作一述评，以引起更多关注和重视。在ITP治疗抉择和管理时，应将健康相关的生活质量作为重要参考指标之一。

单采2个治疗量血小板的安全性分析

目的探讨献血者单采2个治疗量的血小板（PLT）的安全性及个体影响因素，以建立科学、合理、安全的献血者筛选标准。方法选择2011年6月至2012年6月，于本站行单采2个治疗量PLT的389例献血者为研究对象。按献血者献血前PLT计数（PLT0）不同，将其分为3组：A组（PLT前〈250×10^9，n=118）；B组PUT前为（250299）×10^8，n=1503；C组（PLT∞≥300×10^9，n=121）。以1个治疗量PLT产品的PLT，红细胞（RBC），白细胞（WBC）计数作为产品质量目标；献血者采血后PLT，红细胞比容（HCT），处理全血量作为献血者安全性评价指标，考察献血者献血前PLT高低对PLT产品质量和献血者安全性指标的影响。结果本研究389例献血者中安全性指标达标率为97．17％；各组安全性评价指标之间差异，有统计学意义（P值均〈0．05）。采血后，献血者的PLT，HCT，RBC显著下降（P值均〈0．05），但仍在安全范围内。12例献血者发生献血反应，发生率为3．08oA。2个治疗剂量PLT产品中，383袋合格，合格率为98．46％。结论选择体重≥60kg，PLT前≥220×10^9，HCT前为0．40～0．48的献血者，采用智能化血细胞分离机，1位供者单采2个治疗量血小板安全可行。

注射用血凝酶体内外止血作用的研究

出血在临床上相当常见,约占血液病门诊的1/3,除血液科外,临床各科也都有出血问题。引起出血的最主要原因为血小板量或质的异常和凝血障碍,先天性或获得性血管异常、纤溶亢进以及循环中抗凝物质增多等因素也可导致出血。在有严重出血时,需要给予止血药帮助止血。临床上有效的止血药不多,并且都有一定的局限性。维生素K只对维生素K依赖性凝血因子减少的出血有效。

肝移植及腹部多器官移植手术的成分输血

背景:肝移植及腹部多器官移植手术复杂,失血多,输血需求大。目的:探讨肝移植及腹部多器官移植的失血及输血特点和移植后生存率。方法:回顾性分析192例患者,研究比较移植开始后24 h内输血数据和移植后存活期。结果与结论:(1)192例患者中,其中肝移植177例,肝肾联合移植2例,腹部多器官移植13例。每例移植患者移植中平均失血量为(2 401.5±3 239.5)mL;移植开始后24 h内的平均红细胞输注量为(11.3±11.9)U;平均血小板输注量为(0.8±0.9)U;平均冷沉淀输注量为(10.7±11.7)U;平均血浆输注量为(2 805.5±1 393.1)m L。(2)肝癌组的红细胞、血小板、冷沉淀、血浆输注量明显少于肝衰竭组;肝硬化组的冷沉淀、血浆输注量明显少于肝衰竭组;肝癌组的血小板输注量明显少于肝硬化组;2013年7月至2015年6月期间移植的红细胞输注量明显少于2012年7月至2013年6月;肝硬化患者的肝移植出血量、红细胞、血浆输注量均明显多于肝硬化患者的多器官移植(均为P<0.05)。(3)肝病诊断类别和手术操作技术及熟练程度影响肝移植患者的出血量和输血量。肝移植及腹部多器官移植的不断改良,移植失血量和输血量均有所下降;与单纯肝移植相比,腹部多器官移植并未增加失血量和输血量。

卡-梅综合征:干扰素的危险性和应用己酮可可碱的成功治疗

A girl aged 3 months presented with thrombocytopenia and bruising around a large vascular malformation of her posterior abdominal wall. Treatment was started with corticosteroids and platelet replacement, but with no improvement and a platelet count persistently less than 10×109/L over 3 weeks, α-interferon was added. There was an immediate increase in bruising, a fall in platelet count, and an increase in platelet transfusion requirement until interferon was discontinued 11 days later. After a further week, the platelet count returned to the levels before interferon, but the patient did not develop any further symptoms. The platelet count remained low with no clinical change until pentoxifylline was start ed at the age of 15 months. The platelet count rose to 117×109/L within 4 days and remai- ned more than 100×109/L thereafter. The patient is now 7 years old and has had no recurrence since stopping the pentoxifylline at the age of 5 years. Although thrombocytopenia is a recognized side effect of interferon therapy, this very dangerous complication has not been previously reported using interferon for the Kasabach-Merritt syndrome.

Mechanism and dose-effect of Ginkgolide B on severe acute pancreatitis of rats

AIM:To determine the optimal dosage and mechanism of Ginkgolide B(BN52021) on severe acute pancreatitis(SAP) of rats.METHODS:Seventy male Wistar rats were randomly divided into seven groups(10 for each group).Shamoperation group(SO),SAP model group(SAP),dimethyl sulfoxide(DMSO) contrast group(DMSO),and groups treated with 2.5 mg/kg BN52021(BN1),5 mg/kg BN52021(BN2),10 mg/kg BN52021(BN3),and 20 μg/kg Sandostatin(SS).The SAP model was established in Wistar rats by injecting 5% sodium taurocholate retrogradely into the common bilio-pancreatic duct.The rats of SO,DMSO and BN52021 were injected with 0.9% NaCl,0.5% DMSO and BN52021 through femoral vein 15 min after the operation.The SS group was injected with Sandostatin subcutaneously.All rats were anaesthetized at 6 h after operation,and venous blood was collected to determine the levels of serum amylase and phospholipase A2(PLA2),and pancreas tissue was harvested and stained.RESULTS:There was no significant difference between the SAP and DMSO groups in serum amylase level,PLA2,ascites and pathologic score,but significant difference was found in SAP/DMSO groups compared with those in SO group(P < 0.05) and the levels of serum amylase,PLA2,ascites,and pathologic score were lower in the BN1,BN2,BN3 and SS groups than in the SAP and DMSO groups(P < 0.05).However,among BN1,BN2,BN3 and SS groups,BN2 had the best effect in decreasing the levels of serum amylase and PLA2(P < 0.05).Expression of platelet activating factor(PAF) receptor(PAFR) mRNA and protein showed no significant difference between the SAP and DMSO groups,or among BN1,BN2,BN3 and SS groups,but there was remarkable difference between SAP/DMSO group and SO group(P < 0.05),and expression of PAFR mRNA and protein was higher in the BN1,BN2,BN3 and SS groups than in the SAP and DMSO groups(P < 0.05).PAFR expression was observed in the nucleus and cytoplasm of pancreatic islet cells in Wistar rats by immunohistochemistry.CONCLUSION:By iv injection,5 mg/kg of BN52021 is the optimal dosage for SAP rats.BN52021 may inhibit the interaction/binding of PAF with PAFR.

Effect of ageing temperature on precipitation of A1-Cu-Li-Mn-Zr alloy

The precipitation behaviors of an A1-Cu-Li-Mn-Zr alloy at different ageing temperatures （120, 160 and 200 ~C） were investigated using Vickers hardness measurements and transmission electron microscopy （TEM） characterization. Age hardening curves show an increase in precipitation kinetics with increasing ageing temperature. The results of TEM show that for the samples peak aged at 120 ~C, the amount of g＇ （A13Li）, GP zones/0＇ （A12Cu） and Z （A15Cu6Li2） phases is obviously higher than that of T1 （A12CuLi） precipitates; while the samples peak aged at 160 and 200 ~C are usually dominated by T1 phase with a minor fraction of GP zones/0＇ and g＇, and the Z phase almost does not form. In addition, quantitative analysis on the T1 platelets demonstrates that the samples peak aged at 200 ~C have larger plate diameter and smaller area fraction of T1, as compared to the samples peak aged at 160 ~C. Correspondingly, the possible reasons for such phenomena are discussed.

Mechanism Study of Endothelial Protection and Inhibits Platelet Activation of Low Molecular Weight Fucoidan from Laminaria japonica

Several studies have indicated that fucoidan fractions with low molecular weight and different sulfate content from Laminaria japonica could inhibit the activation of platelets directly by reducing the platelet aggregation. To explore the direct effect of LMW fucoidan on the platelet system furthermore and examine the possible mechanism, the endothelial protection and inhibits platelet activation effects of two LMW fucoidan were investigated. In the present study, Endothelial injury model of rats was made by injection of adrenaline(0.4 mg kg-1) and human umbilical vein endothelial cells were cultured. v WF level was be investigated in vivo and in vitro as an important index of endothelial injury. LMW fucoidan could significantly reduce v WF level in vascular endothelial injury rats and also significantly reduce v WF level in vitro. The number of EMPs was be detected as another important index of endothelial injury. The results showed that LMW fucoidan reduced EMPs stimulated by tumor necrosis factor. In this study, it was found that by inhibiting platelet adhesion, LMW fucoidan played a role in anti-thrombosis and the specific mechanism of action is to inhibit the flow of extracellular Ca2+. All in a word, LMW fucoidan could inhibit the activation of platelets indirectly by reducing the concentration of EMPs and v WF, at the same time; LMW fucoidan inhibited the activation of platelets directly by inhibiting the flow of extracellular Ca2+.

Study on Antithrombotic and Antiplatelet Activities of Low Molecular Weight Fucoidan from Laminaria japonica

The antithrombotic and antiplatelet effects of two fucoidan fractions with low molecular weight and different sulfate content from Laminaria japonica were compared in order to examine the influence of chemical character on their antithrombotic activity and the possible mechanism. Both LMW fucoidan fractions exhibited favorable antithrombotic activity in an Fecl3-induced arterial thrombosis. The antithrombotic activity of LMW fucoidan was related with decrease of TXB2 and whole blood viscosity and hematocrit. LMW fucoidan showed a correlation between anticoagulant, antiaggregant and antithrombotic effects in vivo. For LMW fucoidan, antithrombotic activity required high dose of 5-10 nmol kg-1, concomitantly with increase in anticoagulant activity and inhibition of platelet aggregation. Administration of LMW fucoidan significantly promoted the 6-keto-PGF1α content and decreased the TXB2 content, indicating its inhibition of tissue factor pathway and regulation of metabolism of arachidonic acid. By comparison, highly sulfated fucoidan LF2 with Mw 3900 seemed to be a more suitable choice for antithrombotic drug for its antithrombotic activity accompanied with specific inhibitory activity on platelet aggregation, low anticoagulant activity and low hemorrhagic risk in vivo.

Incidence of pocket hematoma after electrophysiological device placement：dual antiplatelet therapy versus low-molecular-weight heparin regimen

Background Given the increasing number of patients who require dual antiplatelet （DAP） therapy and electrophysiological device （EPD） placement, perioperative antiplatelet management is a current challenge. In this study, we investigated the incidence of pocket hema-toma formation after EPD placement in patients undergoing DAP therapy or an alternative low-molecular-weight heparin （LMWH） regimen. Methods This clinical observational study was performed from July 2010 to July 2012. In total, 171 patients were enrolled in the analysis after meeting the inclusion criteria. These patients were divided into two groups： 86 patients were treated with DAP therapy at the time of device implantation, and the DAP therapy was discontinued for 5 to 7 days and replaced with enoxaparin before device implantation in the other 85 patients. Adenosine phosphate （ADP）-mediated platelet aggregation and arachidonic acid-induced platelet aggregation were tested preoperatively. We compared the incidence of pocket hematoma between the two groups and the association of pocket hematoma develop-ment with ADP-mediated platelet aggregation and arachidonic acid-induced platelet aggregation.Results The incidence of pocket hema-toma in the patients who continued DAP was lower than that in the patients who replaced the dual antiplatelet regimen with LMWH （3.49%vs. 16.47%, respectively;X2 = 6.66,P 〈 0.01）. Among the patients who continued DAP therapies, the rate of ADP-mediated platelet aggre-gation inhibition in patients with pocket hematomas was higher than that in patients without pocket hematomas. None of the patients under-going DAP or enoxaparin therapy developed pocket infection, thromboembolic events, or other serious complications. Multiple logistic re-gression analysis revealed that LMWH therapy was an independent risk factor for the development of pocket hematoma （RR = 0.054, 95%CI = 0.012-0.251）. Furthermore, patients undergoing LMWH therapy were 5.1-fold more likely to develop pocket hematomas than were DAP-treated individuals.Conclusion Continuance of DAP therapy does not increase the risk of pocket hematoma formation after EPD placement.