Heparin-induced thrombocytopenia(HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in cl...Heparin-induced thrombocytopenia(HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin(IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.展开更多
BACKGROUND Platelet transfusion in acute variceal bleeding(AVB)is recommended by few guidelines and is common in routine clinical practice,even though the effect of thrombocytopenia and platelet transfusion on the out...BACKGROUND Platelet transfusion in acute variceal bleeding(AVB)is recommended by few guidelines and is common in routine clinical practice,even though the effect of thrombocytopenia and platelet transfusion on the outcomes of AVB is unclear.AIM To determine how platelet counts,platelets transfusions,and fresh frozen plasma transfusions affect the outcomes of AVB in cirrhosis patients in terms of bleeding control,rebleeding,and mortality.METHODS Prospectively maintained database was used to analyze the outcomes of cirrhosis patients who presented with AVB.The outcomes were assessed as the risk of rebleeding at days 5 and 42,and risk of death at day 42,considering the platelet counts and platelet transfusion.Propensity score matching(PSM)was used to compare the outcomes in those who received platelet transfusion.Statistical comparisons were done using Kaplan-Meier curves with log-rank tests and Coxproportional hazard model for rebleeding and for 42-d mortality.RESULTS The study included 913 patients,with 83.5%men,median age 45 years,and Model for End-stage Liver Disease score 14.7.Platelet count<20×10^(9)/L,20-50×10^(9)/L,and>50×10^(9)/L were found in 23(2.5%),168(18.4%),and 722(79.1%)patients,respectively.Rebleeding rates were similar between the three platelet groups on days 5 and 42(13%,6.5%,and 4.7%,respectively,on days 5,P=0.150;and 21.7%,17.3%,and 14.4%,respectively,on days 42,P=0.433).At day 42,the mortality rates for the three platelet groups were also similar(13.0%,23.2%,and 17.2%,respectively,P=0.153).On PSM analysis patients receiving platelets transfusions(n=89)had significantly higher rebleeding rates on day 5(14.6%vs 4.5%;P=0.039)and day 42(32.6%vs 15.7%;P=0.014),compared to those who didn't.The mortality rates were also higher among patients receiving platelets(25.8%vs 23.6%;P=0.862),although the difference was not significant.On multivariate analysis,platelet transfusion and not platelet count,was independently associated with 42-d rebleeding.Hepatic encephalopathy was independently associated with 42-d mortality.CONCLUSION Thrombocytopenia had no effect on rebleeding rates or mortality in cirrhosis patients with AVB;however,platelet transfusion increased rebleeding on days 5 and 42,with a higher but nonsignificant effect on mortality.展开更多
BACKGROUND Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia.In recent years,with platelet tran...BACKGROUND Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia.In recent years,with platelet transfusion increasing,ineffective platelet transfusion has become increasingly prominent.Generally speaking,platelet antibodies can be produced after repeated transfusion,thus rendering subsequent platelet transfusion ineffective.We report a case of first platelet transfusion refractoriness(PTR)in a patient with acute myelocytic leukemia(AML).Due to the rarity of such cases in clinical practice,there have been no relevant case reports so far.CASE SUMMARY A 51-year-old female patient attended the hospital due to throat pain and abnormal blood cells for 4 d.Her diagnosis was acute myelocytic leukemia[M2 type Fms related receptor tyrosine kinase 3,Isocitrate Dehydrogenase 1,Nucleophosmin 1,Neuroblastoma RAS viral oncogene homolog(+)high-risk group].She was treated with"IA"(IDA 10 mg day 1-3 and Ara-C 0.2 g day 1-5)chemotherapy.When her condition improved,the patient was discharged from the hospital,instructed to take medicine as prescribed by the doctor after discharge,and returned to the hospital for further chemotherapy on time.CONCLUSION We report a rare case of first platelet transfusion failure in a patient with AML during induction chemotherapy,which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load.This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML.When platelet antibodies are produced,immunoglobulins can be used to block antibodies,thereby reducing platelet destruction.For patients with PTR,both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.展开更多
Platelet transfusion is one of the most reliable strategies to cure patients suffering from thrombocytopenia or platelet dysfunction.With the increasing demand for transfusion,however,there is an undersupply of donors...Platelet transfusion is one of the most reliable strategies to cure patients suffering from thrombocytopenia or platelet dysfunction.With the increasing demand for transfusion,however,there is an undersupply of donors to provide the platelet source.Thus,scientists have sought to design methods for deriving clinical-scale platelets ex vivo.Although there has been considerable success ex vivo in the generation of transformative platelets produced by human stem cells(SCs),the platelet yields achieved using these strategies have not been adequate for clinical application.In this review,we provide an overview of the developmental process of megakaryocytes and the production of platelets in vivo and ex vivo,recapitulate the key advances in the production of SC-derived platelets using several SC sources,and discuss some strategies that apply three-dimensional bioreactor devices and biochemical factors synergistically to improve the generation of large-scale platelets for use in future biomedical and clinical settings.展开更多
The risk of blood-borne transmission of infectious diseases has led to an increasing awareness of the need for a safe and effective pathogen reduction technology. This study evaluated the efficacy of 2 pathogen reduct...The risk of blood-borne transmission of infectious diseases has led to an increasing awareness of the need for a safe and effective pathogen reduction technology. This study evaluated the efficacy of 2 pathogen reduction systems to inactivate dengue virus (DENV-2) and chikungunya virus (CHIKV) spiked into apheresis platelets (APLT) concentrates. Double-dose APLT collections (n = 3) were split evenly into two units and spiked with 107 infectious units of DENV-2 or CHIKV. APLTs samples were assayed for viral infectivity before and after Amotosalen photochemical treatment (PCT) or Riboflavin pathogen reduction treatment (PRT). Viral infectivity was determined by plaque assays. Platelet (PLT) count, pH and residual S-59 were measured during the storage of 5 days. Amotosalen PCT showed robust efficacy and complete inactivation of both viruses in APLTs, with up to 3.01 and 3.75 log reductions of DENV-2 and CHIKV respectively. At similar initial concentrations, Riboflavin PRT showed complete inactivation of CHIKV with up to 3.73 log reduction, much higher efficacy than against DENV-2 where a log reduction of up to 1.58 was observed. All post-treated APLTs maintained acceptable PLT yields and quality parameters. This parallel study of 2 pathogen reduction systems demonstrates their efficacy in inactivating or reducing DENV and CHIKV in APLTs and reaffirms the usefulness of pathogen inactivation systems to ensure the safety in PLTs transfusion.展开更多
Background： Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation （LT）, few studies described the influence of single-donor ...Background： Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation （LT）, few studies described the influence of single-donor platelet apheresis transfusion in living donor LT （LDLT）. This study aimed to assess the effect of blood products on outcomes for LDLT recipients, focusing on apheresis platelets. Methods： This retrospective study included 126 recipients who underwent their first adult-to-adult LDLT. Twenty-four variables including consumption of blood products of 126 LDLT recipients were assessed for their link to short-term outcomes and overall survival. Kaplan-Meier survival curve and the log-rank test were used for recipient survival analysis. A multivariate Cox proportional-hazard model and a propensity score analysis were applied to adjust confounders after potential risk factors were identified by a univariate Cox analysis. Results： Patients who received apheresis platelet transfusion had a lower 90-day cumulative survival （78.9% vs. 94.2%, P = 0.009）, but had no significant difference in overall survival in the Cox model, compared with those without apheresis platelet transfusion. Units of apheresis platelet transfusion（hazard ratio[HR]=3.103,95% confidence interval[CI]：1.720–5.600,P〈0.001）and preoperative platelet count（HR=0.170,95% CI：0.040–0.730,P=0.017）impacted 90-day survival independently.Multivariate Cox regression analysis also found that units of red blood cell（RBC）transfusion（HR=1.036,95% CI：1.006–1.067,P=0.018）,recipient＇s age（HR=1.045,95% CI：1.005–1.086,P=0.025）,and ABO blood group comparison（HR=2.990,95% CI：1.341–6.669,P=0.007）were independent risk factors for overall survival after LDLT. Conclusions： This study suggested that apheresis platelets were only associated with early mortality but had no impact on overall survival in LDLT. Units of RBC, recipient＇s age, and ABO group comparison were independent predictors of long-term outcomes.展开更多
Haploidentical stem cell transplantation (haplo-SCT) has been an alternative source of bone marrow for patients without human leukocyte antigen (HLA)-matched donors. The aim of this study was to investigate the relati...Haploidentical stem cell transplantation (haplo-SCT) has been an alternative source of bone marrow for patients without human leukocyte antigen (HLA)-matched donors. The aim of this study was to investigate the relationships between platelet transfusion refractoriness (PTR) and clinical outcomes in the setting of haplo-SCT. Between May 2012 and March 2014, 345 patients who underwent unmanipulated haplo-SCT were retrospectively enrolled. PTR occurred in 20.6% of all patients. Patients in the PTR group experienced higher transplant-related mortality (TRM, 43.7% vs. 13.5%, P<0.001), lower overall survival (OS, 47.9%vs. 76.3%, P<0.001) and lower leukemia-free survival (LFS, 47.9% vs. 72.3%, P<0.001) compared to patients in the non-PTR group. The multivariate analysis showed that PTR was associated with TRM (P=0.002), LFS (P<0.001), and OS (P<0.001).The cumulative incidences of PTR in patients receiving >12 platelet (PLT) transfusions (third quartile of PLT transfusions) were higher than in patients receiving either >6 (second quartile) or >3 (first quartile) PLT transfusions (56.1% vs. 41.6% vs. 28.2%,respectively; P<0.001). The multivariate analysis also showed that PTR was associated with the number of PLT transfusions(P<0.001). PTR could predict poor transplant outcomes in patients who underwent haploidentical SCT.展开更多
目的观察血小板自身抗体与同种抗体对血小板交叉配型难易程度及输注效果的影响。方法选择2021年7月—2023年9月在本实验室完成血小板抗体鉴定的106例血小板输注无效(PTR)患者,根据血小板抗体类型将患者分为两组,20例自身抗体阳性患者为...目的观察血小板自身抗体与同种抗体对血小板交叉配型难易程度及输注效果的影响。方法选择2021年7月—2023年9月在本实验室完成血小板抗体鉴定的106例血小板输注无效(PTR)患者,根据血小板抗体类型将患者分为两组,20例自身抗体阳性患者为观察组,86例同种抗体阳性患者为对照组。比较两组患者配型相合次数百分率、配型相合供者百分率、输注交叉配型相合血小板及随机血小板的24 h血小板计数增加指数(CCI)值及输注有效率的差异,并对观察组自身抗体变化情况进行追踪。结果观察组的配型相合次数百分率及配型相合供者百分率均高于对照组(P<0.05)。观察组患者输注交叉配型相合血小板与随机血小板的24 h CCI值及输注有效率均无显著性差异(P>0.05),对照组患者输注交叉配型相合血小板的24 h CCI值及输注有效率均高于输注随机血小板(P<0.001),对照组患者输注交叉配型相合血小板后24 h CCI值及输注有效率比观察组高(P<0.05),对照组和观察组输注随机血小板后24 h CCI值及输注有效率无显著性差异(P>0.05)。观察组多数患者的自身抗体强度呈下降趋势。结论血小板自身抗体对血小板交叉配型难易程度及输注效果的影响比同种抗体小。血小板自身抗体强度随时间推移呈现逐渐下降乃至消失的规律。在临床实践中,对于自身抗体患者的治疗,应当首先查找病因,并进行针对性治疗,如果需要输注血小板,可以选择输注随机血小板。展开更多
文摘Heparin-induced thrombocytopenia(HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin(IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.
文摘BACKGROUND Platelet transfusion in acute variceal bleeding(AVB)is recommended by few guidelines and is common in routine clinical practice,even though the effect of thrombocytopenia and platelet transfusion on the outcomes of AVB is unclear.AIM To determine how platelet counts,platelets transfusions,and fresh frozen plasma transfusions affect the outcomes of AVB in cirrhosis patients in terms of bleeding control,rebleeding,and mortality.METHODS Prospectively maintained database was used to analyze the outcomes of cirrhosis patients who presented with AVB.The outcomes were assessed as the risk of rebleeding at days 5 and 42,and risk of death at day 42,considering the platelet counts and platelet transfusion.Propensity score matching(PSM)was used to compare the outcomes in those who received platelet transfusion.Statistical comparisons were done using Kaplan-Meier curves with log-rank tests and Coxproportional hazard model for rebleeding and for 42-d mortality.RESULTS The study included 913 patients,with 83.5%men,median age 45 years,and Model for End-stage Liver Disease score 14.7.Platelet count<20×10^(9)/L,20-50×10^(9)/L,and>50×10^(9)/L were found in 23(2.5%),168(18.4%),and 722(79.1%)patients,respectively.Rebleeding rates were similar between the three platelet groups on days 5 and 42(13%,6.5%,and 4.7%,respectively,on days 5,P=0.150;and 21.7%,17.3%,and 14.4%,respectively,on days 42,P=0.433).At day 42,the mortality rates for the three platelet groups were also similar(13.0%,23.2%,and 17.2%,respectively,P=0.153).On PSM analysis patients receiving platelets transfusions(n=89)had significantly higher rebleeding rates on day 5(14.6%vs 4.5%;P=0.039)and day 42(32.6%vs 15.7%;P=0.014),compared to those who didn't.The mortality rates were also higher among patients receiving platelets(25.8%vs 23.6%;P=0.862),although the difference was not significant.On multivariate analysis,platelet transfusion and not platelet count,was independently associated with 42-d rebleeding.Hepatic encephalopathy was independently associated with 42-d mortality.CONCLUSION Thrombocytopenia had no effect on rebleeding rates or mortality in cirrhosis patients with AVB;however,platelet transfusion increased rebleeding on days 5 and 42,with a higher but nonsignificant effect on mortality.
基金Supported by Innovation Platform and Talent Program of Hunan Province,No.2021SK4050.
文摘BACKGROUND Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia.In recent years,with platelet transfusion increasing,ineffective platelet transfusion has become increasingly prominent.Generally speaking,platelet antibodies can be produced after repeated transfusion,thus rendering subsequent platelet transfusion ineffective.We report a case of first platelet transfusion refractoriness(PTR)in a patient with acute myelocytic leukemia(AML).Due to the rarity of such cases in clinical practice,there have been no relevant case reports so far.CASE SUMMARY A 51-year-old female patient attended the hospital due to throat pain and abnormal blood cells for 4 d.Her diagnosis was acute myelocytic leukemia[M2 type Fms related receptor tyrosine kinase 3,Isocitrate Dehydrogenase 1,Nucleophosmin 1,Neuroblastoma RAS viral oncogene homolog(+)high-risk group].She was treated with"IA"(IDA 10 mg day 1-3 and Ara-C 0.2 g day 1-5)chemotherapy.When her condition improved,the patient was discharged from the hospital,instructed to take medicine as prescribed by the doctor after discharge,and returned to the hospital for further chemotherapy on time.CONCLUSION We report a rare case of first platelet transfusion failure in a patient with AML during induction chemotherapy,which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load.This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML.When platelet antibodies are produced,immunoglobulins can be used to block antibodies,thereby reducing platelet destruction.For patients with PTR,both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.
基金Supported by the National Natural Science Foundation of China Grants,No.31600683 and No.U1738103Strategic Priority Research Program of the Chinese Academy of Sciences,No.XDA15014000
文摘Platelet transfusion is one of the most reliable strategies to cure patients suffering from thrombocytopenia or platelet dysfunction.With the increasing demand for transfusion,however,there is an undersupply of donors to provide the platelet source.Thus,scientists have sought to design methods for deriving clinical-scale platelets ex vivo.Although there has been considerable success ex vivo in the generation of transformative platelets produced by human stem cells(SCs),the platelet yields achieved using these strategies have not been adequate for clinical application.In this review,we provide an overview of the developmental process of megakaryocytes and the production of platelets in vivo and ex vivo,recapitulate the key advances in the production of SC-derived platelets using several SC sources,and discuss some strategies that apply three-dimensional bioreactor devices and biochemical factors synergistically to improve the generation of large-scale platelets for use in future biomedical and clinical settings.
文摘The risk of blood-borne transmission of infectious diseases has led to an increasing awareness of the need for a safe and effective pathogen reduction technology. This study evaluated the efficacy of 2 pathogen reduction systems to inactivate dengue virus (DENV-2) and chikungunya virus (CHIKV) spiked into apheresis platelets (APLT) concentrates. Double-dose APLT collections (n = 3) were split evenly into two units and spiked with 107 infectious units of DENV-2 or CHIKV. APLTs samples were assayed for viral infectivity before and after Amotosalen photochemical treatment (PCT) or Riboflavin pathogen reduction treatment (PRT). Viral infectivity was determined by plaque assays. Platelet (PLT) count, pH and residual S-59 were measured during the storage of 5 days. Amotosalen PCT showed robust efficacy and complete inactivation of both viruses in APLTs, with up to 3.01 and 3.75 log reductions of DENV-2 and CHIKV respectively. At similar initial concentrations, Riboflavin PRT showed complete inactivation of CHIKV with up to 3.73 log reduction, much higher efficacy than against DENV-2 where a log reduction of up to 1.58 was observed. All post-treated APLTs maintained acceptable PLT yields and quality parameters. This parallel study of 2 pathogen reduction systems demonstrates their efficacy in inactivating or reducing DENV and CHIKV in APLTs and reaffirms the usefulness of pathogen inactivation systems to ensure the safety in PLTs transfusion.
文摘Background： Although many previous studies have confirmed that perioperative blood transfusion is associated with poor outcomes after liver transplantation （LT）, few studies described the influence of single-donor platelet apheresis transfusion in living donor LT （LDLT）. This study aimed to assess the effect of blood products on outcomes for LDLT recipients, focusing on apheresis platelets. Methods： This retrospective study included 126 recipients who underwent their first adult-to-adult LDLT. Twenty-four variables including consumption of blood products of 126 LDLT recipients were assessed for their link to short-term outcomes and overall survival. Kaplan-Meier survival curve and the log-rank test were used for recipient survival analysis. A multivariate Cox proportional-hazard model and a propensity score analysis were applied to adjust confounders after potential risk factors were identified by a univariate Cox analysis. Results： Patients who received apheresis platelet transfusion had a lower 90-day cumulative survival （78.9% vs. 94.2%, P = 0.009）, but had no significant difference in overall survival in the Cox model, compared with those without apheresis platelet transfusion. Units of apheresis platelet transfusion（hazard ratio[HR]=3.103,95% confidence interval[CI]：1.720–5.600,P〈0.001）and preoperative platelet count（HR=0.170,95% CI：0.040–0.730,P=0.017）impacted 90-day survival independently.Multivariate Cox regression analysis also found that units of red blood cell（RBC）transfusion（HR=1.036,95% CI：1.006–1.067,P=0.018）,recipient＇s age（HR=1.045,95% CI：1.005–1.086,P=0.025）,and ABO blood group comparison（HR=2.990,95% CI：1.341–6.669,P=0.007）were independent risk factors for overall survival after LDLT. Conclusions： This study suggested that apheresis platelets were only associated with early mortality but had no impact on overall survival in LDLT. Units of RBC, recipient＇s age, and ABO group comparison were independent predictors of long-term outcomes.
基金supported by the National High Technology Research and Development Program of China (2013AA020401)the National Natural Science Foundation of China (81470342)
文摘Haploidentical stem cell transplantation (haplo-SCT) has been an alternative source of bone marrow for patients without human leukocyte antigen (HLA)-matched donors. The aim of this study was to investigate the relationships between platelet transfusion refractoriness (PTR) and clinical outcomes in the setting of haplo-SCT. Between May 2012 and March 2014, 345 patients who underwent unmanipulated haplo-SCT were retrospectively enrolled. PTR occurred in 20.6% of all patients. Patients in the PTR group experienced higher transplant-related mortality (TRM, 43.7% vs. 13.5%, P<0.001), lower overall survival (OS, 47.9%vs. 76.3%, P<0.001) and lower leukemia-free survival (LFS, 47.9% vs. 72.3%, P<0.001) compared to patients in the non-PTR group. The multivariate analysis showed that PTR was associated with TRM (P=0.002), LFS (P<0.001), and OS (P<0.001).The cumulative incidences of PTR in patients receiving >12 platelet (PLT) transfusions (third quartile of PLT transfusions) were higher than in patients receiving either >6 (second quartile) or >3 (first quartile) PLT transfusions (56.1% vs. 41.6% vs. 28.2%,respectively; P<0.001). The multivariate analysis also showed that PTR was associated with the number of PLT transfusions(P<0.001). PTR could predict poor transplant outcomes in patients who underwent haploidentical SCT.
文摘目的观察血小板自身抗体与同种抗体对血小板交叉配型难易程度及输注效果的影响。方法选择2021年7月—2023年9月在本实验室完成血小板抗体鉴定的106例血小板输注无效(PTR)患者,根据血小板抗体类型将患者分为两组,20例自身抗体阳性患者为观察组,86例同种抗体阳性患者为对照组。比较两组患者配型相合次数百分率、配型相合供者百分率、输注交叉配型相合血小板及随机血小板的24 h血小板计数增加指数(CCI)值及输注有效率的差异,并对观察组自身抗体变化情况进行追踪。结果观察组的配型相合次数百分率及配型相合供者百分率均高于对照组(P<0.05)。观察组患者输注交叉配型相合血小板与随机血小板的24 h CCI值及输注有效率均无显著性差异(P>0.05),对照组患者输注交叉配型相合血小板的24 h CCI值及输注有效率均高于输注随机血小板(P<0.001),对照组患者输注交叉配型相合血小板后24 h CCI值及输注有效率比观察组高(P<0.05),对照组和观察组输注随机血小板后24 h CCI值及输注有效率无显著性差异(P>0.05)。观察组多数患者的自身抗体强度呈下降趋势。结论血小板自身抗体对血小板交叉配型难易程度及输注效果的影响比同种抗体小。血小板自身抗体强度随时间推移呈现逐渐下降乃至消失的规律。在临床实践中,对于自身抗体患者的治疗,应当首先查找病因,并进行针对性治疗,如果需要输注血小板,可以选择输注随机血小板。
