122例妇产科患者输注血小板的疗效分析

目的 通过对妇产科疾病患者输注血小板前后相应指标的测定,观察其输注效果.方法 对患者输注前、后1 h和24 h用细胞计数仪计数血小板,计算血小板的计数增值 (CCI) 和血小板回收率(PPR),并结合临床观察122例患者197次输注血小板后的疗效.结果 血小板计数大于50×109/L输注血小板的患者54次(27.41%),可见临床治疗中存在血小板滥用现象;输注血小板次数为1次、2～3次、4～5次、>5次的4组患者其临床有效率分别为:76.71%、70.37%、37.50%、31.58%,结果 还显示血小板输注有效率随着输血次数的增多而降低.结论 临床输注血小板存在不合理现象;输注血小板的治疗效果可能与输注次数呈正相关;要提高治疗效果应选择HLA配合的机采血小板,以提高血小板输注的效果.     

冰冻机采血小板临床疗效分析

目的探讨冰冻机采血小板在临床上的疗效.方法对预防性输注冰冻机采血小板病人,检测血小板输注前和输后1h及24h血小板计数,计算出血小板增值(CCI);治疗性急性出血输注冰冻机采血小板病人检测血小板输注前及输后1h出血时间.以输注新鲜机采血小板的患者作平行对照.结果预防性输注组中,测定1h CCI＞7.5×109/L的百分率,冰冻机采血小板组86.7%(13/15),新鲜机采血小板组90.9%(20/22),两组比较差别无显著性(P>0.05);24h CCI＞4.5×109/L的百分率,冰冻机采血小板组53.3%(8/15),新鲜机采血小板组86.4%(19/22),两组比较差别有显著性(P<0.05);治疗性急性出血组输注血小板前两组出血时间无显著性差别(t=0,P＞0.05),输注后1h两组出血时间差别有显著性(P＜0.05).结论冰冻血小板治疗急性出血患者效果优于新鲜血小板,预防性输注效果显著差于新鲜血小板.     

冰冻机采血小板临床疗效分析

目的探讨冰冻机采血小板在临床上的疗效。方法对预防性输注冰冻机采血小板病人,检测血小板输注前和输后1h及24h血小板计数,计算出血小板增值(CCI);治疗性急性出血输注冰冻机采血小板病人检测血小板输注前及输后1h出血时间。以输注新鲜机采血小板的患者作平行对照。结果预防性输注组中,测定1hCCI>7.5×109/L的百分率,冰冻机采血小板组86.7%(13/15),新鲜机采血小板组90.9%(20/22),两组比较差别无显著性(P>0.05);24hCCI>4.5×109/L的百分率,冰冻机采血小板组53.3%(8/15),新鲜机采血小板组86.4%(19/22),两组比较差别有显著性(P<0.05);治疗性急性出血组输注血小板前两组出血时间无显著性差别(t=0,P>0.05),输注后1h两组出血时间差别有显著性(P<0.05)。结论冰冻血小板治疗急性出血患者效果优于新鲜血小板,预防性输注效果显著差于新鲜血小板。     

机采血小板储存损伤对临床疗效的影响

目的探讨机采血小板储存损伤与血小板输注临床疗效的关系。方法检测64份机采血小板的血小板聚集功能和P-选择素,对56例血液病患者给予64治疗量机采血小板输注,输注后24h进行外周血血小板计数,根据血小板增高指数(CCI)、血小板回收率(PPR)和出血好转情况判定输注效果,分析血小板储存损伤对其影响的相关性。结果 64治疗量机采血小板输注后,40例输注有效的CCI值为(16.0±5.5),24例无效的CCI值为(3.4±1.0);输注血小板最大聚集率在有效期内第2天～第5天的平均值±标准差(Mean%±SD%)、最小值(min%)～最大值(max%)为48.1±4.7(41.1～56.2)、38.1±3.5(31.2～43.1)、17.4±2.4(14.5～20.9)、9.6±3.3(5.8～19.9);血浆可溶性P-选择素在有效期内第2天～第5天含量(Mean±SD)ng/mL为(11.4±5.8)、(28.9±7.5)、(55.5±8.4)、(89.2±5.6)ng/mL;血小板聚集功能与血小板输注疗效呈正相关(r=0.892,P 0.01),血浆可溶性P-选择素浓度与血小板输注疗效呈负相关(r=-0.836,P 0.01),均有统计学意义。结论机采血小板保存期内的血小板损伤会影响血小板输注无效的发生率,医疗机构可结合临床输注效果制定血小板功能标准和规范,提升本地区的输血水平。     

两种血小板制剂应用于儿科血液病的临床观察

目的观察并比较机器单采法及手工法分离制备血小板制剂用于儿科血液病输注的效果。方法输注机器单采血小板患儿463例次为机采制剂组,输注手工分离血小板制剂患儿155例次为手工制剂组,分别在输注后24、48及72h作外周血血小板计数,观察临床止血效果、有无输血反应发生,计算血小板计数增加校正指数(CCI)、血小板回升率(PPR)、输注无效率、输血反应发生率等指标。结果输注后24、48、72h,机采制剂组:CCI分别为18.9、15.4、14.1,PPR分别为33.4%、27.8%、25.0%;手工制剂组:CCI分别为11.3、9.4、2.9,PPR分别为20.3%、10.3%、3.8%;机采法制剂组均明显高于手工制剂组(P<0.01)。机采制剂组输注无效率10.58%、输血反应发生率3.02%,手工制剂组相应为32.90%及11.61%,机采组虽都明显低于手工组,但两组均达到较好的临床止血目的,组间无差异。结论输注机器单采血小板制剂能更有效地提高血液病患儿的血小板值,减少其血小板输注无效及输血反应的发生。     

冰冻机采血小板用于急性严重失血患者的治疗性输注

目的探讨冰冻机采血小板在急性严重失血患者中输注的有效性。方法对45例急性严重失血患者采用冰冻机采血小板输注,测出患者输注冰冻机采血小板后1h、24h的血小板计数增高指数(CCI)值、出血时间及续用红细胞量,与21例输注新鲜机采血小板的患者作平行对照。结果急性严重失血患者输注冰冻机采血小板后,1h CCI值有效率非常显著低于新鲜机采血小板组,且患者出血时间和输注血小板后24h内人均续用红细胞量也显著小于新鲜机采血小板组,提示冰冻机采血小板被即时消耗起止血作用。结论冰冻机采血小板治疗急性严重出血患者即时止血效果优于新鲜血小板,血小板供应紧张地区对急性严重失血患者可推广应用冰冻机采血小板。     

2种血小板在血液病治疗中的疗效观察

目的了解并比较机采血小板和手工分离浓缩血小板对血液病的治疗效果。方法将45例血液病随机分为机采组:29例,输注机采血小板1个治疗量;手工组:16例,输注手工分离制备的浓缩血小板1个治疗量(机采和手工血小板均以10U为1个治疗量)。输注前复查患者及献血者ABO和Rh血型并作凝聚胺法交叉配血试验,输后1、24h计算2组患者的CC I及PPR。结果输注血小板后的疗效,2组均是输注次数少者好于输注次数多者;而输注机采血小板的疗效又好于手工制备的浓缩血小板。结论对于血液病患者而言,输注血小板的次数影响血小板输注疗效;输注机采血小板的疗效优于手工法制备的浓缩血小板。     

机采血小板输注疗效观察

目的 比较出血性血液病患者机采血小板与手工血小板榆注效果.方法 将42例血小板减少患者分别输注机采血小板和手工血小板后检测外周血小板计数,以校正血小板计数增值(CCI)判定输注效果.结果 机采组输注后1h,输注后24h,CCI高于手工采组,机采组输血无效率低于手工采组,均有统计学意义(p＜0.01).结论 机采血小板输注疗效优于手工血小板.     

冰冻血小板与新鲜血小板临床应用的效果比较

[目的]比较冰冻血小板与新鲜血小板在血液病及非血液病患者血小板减少、急性出血中应用的有效性与安全性.[方法]选择650例血小板减少症患者,330例患者输注冰冻机采血小板,320例患者输注新鲜机采血小板,输注前及输注后分别测定血小板计数(PLT),比较PLT增加值及临床出血症状改善情况.[结果]输注新鲜机采血小板和冰冻血小板后两组PLT均有显著增加( P ＜0.01),新鲜机采血小板增加优于冰冻血小板( P ＜0.01);止血有效率冰冻血小板优于新鲜机采血小板( P ＜0.01).[结论]输注冰冻血小板可提升血小板数量,止血效果显著,且较安全,临床急需时可用.     

肿瘤患者血小板输注无效的临床分析

目的探讨本院患者血小板输注情况及临床疗效观察,了解血小板输注无效的原因,以便做好预防工作。方法 2010年1月-2012年12月对本院312名血小板减少的肿瘤患者输注机采血小板,并于输注前后检测血小板,以校正患者血小板计数增值(CCI)和24 h血小板回升率,判定输注效果并讨论影响因素。采用简易致敏红细胞血小板血清学技术(SEPSA)检测76名血小板输注无效的肿瘤患者血小板相关抗体,统计抗体分布。结果 75.6%(236/312)的患者输注后血小板数有不同程度的增高,血液病患者输注血小板有效率明显低于实体肿瘤患者(χ2=29.87,P0.05)和其他肿瘤患者(χ2=6.06,P0.05)。输注次数2次的患者(无效率为5.1%)输注血小板无效率明显低于输注次数7次患者(无效率为57.1%),也低于输注3-4次(无效率为39.5%)、5-7次患者(无效率为46.4%),血小板输注无效率随输注次数的增加而增加。分析76名肿瘤患者血小板输注无效原因,其中免疫因素占60.5%,非免疫因素占39.5%。结论反复输注产生血小板抗体是PTR发生的主要原因,多次输注者应进行血小板抗体的筛选,避免或减少造成血小板输注无效的原因,提高血小板输注的有效率。     

Febrile reactions after platelet transfusion: the effect of single versus multiple donors

Febrile reactions to platelet transfusions are a common problem. The platelet transfusion records from a 30-month period were analyzed to determine 1) when reactions occur in a transfusion sequence; 2) how frequently they recur; and 3) whether the choice of multiple-donor (pooled concentrates) or single-donor components (unmatched apheresis and HLA-compatible apheresis platelets) affected the reaction rate. Overall, 18.7 percent of all patients receiving platelets experienced reactions. A subset of 85 patients, who began platelet support with unmodified components during the study interval, were analyzed in detail. This group received 1204 unmodified transfusions (mean, 14.2/patient), which were associated with 171 reactions (per-transfusion reaction rate, 14.2%). Despite a higher mean white cell content, the transfusion of 438 unmatched single-donor platelets (10.84 x 10(8) white cells, 8.4% reaction rate) resulted in reactions significantly less often than did that of 583 pooled concentrates (8.53 x 10(8) white cells, 21.4% reaction rate) (p less than 0.001). The rate of reaction to HLA-compatible platelets (9/183 transfusions, 4.9%) was not significantly different from that to unmatched single-donor platelets. The use of platelet components from one donor, as opposed to multiple donors, may provide an effective means of reducing the incidence of febrile reactions.     

Platelet transfusions in children: results of a randomized,prospective, crossover trial of plasma removal and a prospective audit of WBC reduction

BACKGROUND: Febrile nonhemolytic transfusion reactions (FNHTRs) complicate 2 to 37 percent of platelet transfusions in adults, but the incidence of such reactions in children is not known. The effectiveness of plasma reduction after storage and WBC reduction of platelet concentrates before storage was studied in pediatric recipients of platelet transfusions. STUDY DESIGN AND METHODS: In the first study, a prospective randomized crossover design was used in which patients received either unmodified whole-blood-derived or apheresis platelets or platelets from which most of the plasma supernatant had been removed just before transfusion. The second study was a prospective audit of recipients of prestorage WBC-reduced platelets. Children between 3 months and 17 years of age were eligible for both studies. Patients were assessed for signs and symptoms that are characteristic of a reaction during, immediately after, and 2 hours following transfusion. RESULTS: There were 226 platelet transfusions administered to 66 children. One hundred and sixty transfusions were given to 35 children enrolled in the randomized study, and 66 transfusions were given to 33 children during the audit. In the randomized study, nine of the 75 transfusions of unmodified platelets (12%) and six of 85 transfusions of poststorage plasma-removed platelets (7%) were associated with an FNHTR (p=0.42). In the audit, three of 66 transfusions of prestorage WBC-reduced platelets (5%) were associated with an FNHTR. Allergic reactions occurred with 5 percent (4 of 75), 6 percent (5 of 85), and 6 percent (4 of 66) of platelet transfusions, respectively. CONCLUSION: FNHTRs appear to be less common among pediatric recipients of platelet transfusions than in adults. In our two studies, there was a trend toward a lower frequency of FNHTRs with poststorage plasma removal and prestorage WBC reduction than with standard platelets, but this was not significant.     

Evaluation of changes in hemoglobin levels associated with ABO- incompatible plasma in apheresis platelets

BACKGROUND: Hemolytic transfusion reaction is considered a rare complication of platelet transfusion. If minor ABO incompatibility exists (donor antibody directed against recipient's red cells [plasma- incompatible platelets]), however, the antibodies present in the plasma of platelets may cause acute hemolysis. A retrospective study was performed to identify possible hemolysis related to the transfusion of plasma-incompatible apheresis platelets. STUDY DESIGN AND METHODS: Acute hemolysis due to low-titer anti-A present in group O apheresis platelets transfused to a group A patient is reported. Pretransfusion and posttransfusion hemoglobin levels were evaluated in 16 non-group O autologous bone marrow transplant patients receiving apheresis platelets. All patients received, within 24 hours, both ABO-identical and plasma-incompatible platelet transfusions. No red cells were transfused during the time between the collection of the pretransfusion and posttransfusion hemoglobin samples. RESULTS: A total of 24 evaluable paired platelet transfusions in the 16 patients were compared. The mean change in hemoglobin following transfusion of the ABO-identical and plasma-incompatible platelets was -0.50 g per dL and - 0.11 g per dL, respectively (p = 0.193). CONCLUSION: There was no significant change in the hemoglobin concentration associated with the transfusion of plasma-incompatible apheresis platelets (minor ABO incompatibility) in our study group. The case reported here represents the only hemolytic transfusion reaction identified among 46,176 platelet transfusions performed at this hospital, despite approximately 21 percent of all platelet transfusions being plasma incompatible. The risk of such a reaction remains low.     

Monitoring for underutilization of RBC components and platelets

BACKGROUND: Monitoring blood transfusion for overutilization is standard practice at most institutions. STUDY DESIGN AND METHODS: This study monitored for underutilization of blood transfusion over a 14-month period, by evaluating patients who had Hb levels that were reported to be <5 g per dL or platelet counts <10 x 10(9) per L and who did not receive an RBC or platelet transfusion within 24 hours of the reported results. RESULTS: During the study period, 24,004 units of RBCs and 3,967 units of apheresis platelets were transfused. There were 148 patients who had a Hb level that was reported to be <5 g per dL or a platelet count reported to be <10 x 10(9) per L and who did not receive a transfusion during the 24 hours after the reporting of these results. In 5 cases, the patients died before the reporting of the low Hb or platelet counts, which precluded the low Hb or low platelet count reports from triggering transfusion therapy. In 8 cases, an underutilization review investigation could not be done, because of the unavailability of patient charts. Of the remaining 135 cases, investigation revealed justifiable reasons for withholding transfusion in 133. In 2 cases, the withholding of transfusion was deemed by peer review to be inappropriate, as the patients should have received a transfusion. Overall, there was one documented underutilization of RBC transfusion therapy during a period when 24,004 units were transfused and one underutilization of platelet transfusion therapy during a period when 3,967 units of apheresis platelets were transfused. CONCLUSION: Monitoring for underutilization of transfusion therapy fulfills the requirements of the Joint Commission on the Accreditation of Healthcare Organizations: While the underutilization of transfusion therapy did not appear to be a significant problem at this medical center, determining the reasons for withholding transfusions shed light on important patient care-related issues, including preexisting causes of falsely low platelet counts and Hb levels, delays in investigating critical laboratory values, and the need for policies for the treatment of patients who refuse transfusion for personal or religious reasons.     

The utility of platelet washing using an automated procedure for severe platelet allergic reactions

Increased use of platelets in patients requiring chronic platelet support has increased platelet transfusion reactions. The authors reviewed more than 300 platelet transfusion reactions, evaluated an automated platelet washing technique, and studied the effectiveness of washing platelets to reduce reactions. Febrile reactions (66%) were most frequently reported, followed by moderate and severe allergic reactions (15%), and urticaria alone (19%). Washed platelets were prepared by an automated technique (IBM/COBE 2991). In vitro studies indicated no apparent adverse effects to the platelets due to the wash procedure, and in vivo studies demonstrated good platelet increments in 10 thrombocytopenic patients. Twenty-two patients with histories of platelet transfusion reactions received a total of 554 washed platelet transfusions. Washed platelets were not effective in reducing febrile transfusion reactions in 16 patients receiving 347 washed products. The efficacy of washed platelets in reducing transfusion reactions was demonstrated in six patients with histories of severe allergic reactions who received 207 washed products. Severe allergic reactions were completely alleviated in this group. In conclusion, automated platelet washing is simple and efficacious in preventing or reducing the severity of allergic reactions to platelet transfusions.     

Effects of nitric oxide on platelet activation during plateletpheresis and in vivo tracking of biotinylated platelets in humans

BACKGROUND: The use of platelet transfusions has risen considerably over the last few years, which leads to the collection and transfusion of a greater number of donor plateletpheresis units. Plateletpheresis activates platelets in platelet concentrates, which determines the degree of the storage lesion subsequently observed. STUDY DESIGN AND METHODS: As nitric oxide (NO) is a potent inhibitor of platelet aggregation and activation, a placebo-controlled crossover trial was performed in healthy young male volunteers to determine whether the NO-donating compound, sodium nitroprusside (SNP), decreases platelet activation during apheresis and whether activated (p-selectin+) platelets circulate in vivo after transfusion. The study also investigated whether nonradioactive biotin labeling of apheresis platelets is feasible for the study of platelet recovery after transfusion in humans. RESULTS: Platelet activation increased after plateletpheresis in the platelet components, but SNP did not inhibit platelet activation during apheresis, as measured by the percentage of p-selectin expression and the secretion of soluble p-selectin and RANTES. Only a minor increase in p-selectin+ platelets was seen in peripheral blood at 60 minutes after transfusion of the platelets, a rise that was considerably less than that calculated in p-selectin+ platelets if they all were recovered as activated platelets after transfusion. Biotin-labeled platelets averaged 1.5 percent at 10 minutes after transfusion and increased slowly to 2.6 and 3.4 percent after 60 minutes and 24 hours, respectively (p<0.05). CONCLUSION: SNP does not decrease platelet activation during apheresis and subsequent storage, and only a minor proportion of activated (p-selectin+) platelets circulate after transfusion in men. Moreover, biotin labeling of PCs can safely be used in humans for the study of platelet recovery after transfusion, and measuring recovery at 1 hour may lead to an underestimation of the true recovery when activated platelets are transfused.     

冰冻血小板与新鲜血小板的疗效比较

目的比较冰冻血小板和新制备的血小板的在临床上的应用效果。方法选268例新制备的血小板与296例冰冻的血小板输注病例,观察两组输注血小板前后的临床表现并进行血小板的计数。结果在564例病案中,输注新制备血小板后的患者外周血血小板上升的程度和总有效率明显高于输注冰冻血小板的患者,两者之间差异有显著性(P<0.05)。结论输注新鲜血小板或冰冻血小板均能达到控制及预防出血的治疗作用,并且提升机体血小板数值,虽然新鲜血小板的疗效优于冰冻血小板,但冰冻血小板可以在抢救危重患者时代替机采新鲜血小板。     

临床727例次单采血小板输注效果分析

为分析临床单采血小板输注效果及其影响因素,回顾性分析湘雅第三医院2010年9月至2011年5月进行单采血小板输注的254名患者的727例次输注资料,计算血小板计数增高指数(CCI)和血小板回收率(PPR)评价血小板输注效果,统计输注有效率,根据患者病症、输血次数、血型和脾肿大与否分组进行统计学比较。结果表明,727例次输注单采血小板有效456例次,占62.72%,以急性失血性贫血和慢性系统性疾病患者输注效果较为明显,尤其是慢性肾疾病(有效率为94.12%);脾脏肿大影响血小板输注效果(有效率仅为40.35%);血小板输注次数与输注效果呈负相关。结论:脾脏肿大和血小板输注次数是影响输注效果的因素。     

少白细胞汇集浓缩血小板的临床应用

目的观察少白细胞汇集浓缩血小板的临床效果。方法将88例血小板输注患者分为2组,A组包括血液病及肿瘤放化疗患者38例;B组包括产妇及外科术中出血患者50例。均于输注前及输注后1h和24h检测血小板计数,并计算CCI值,观察其有效率和不良反应发生率。结果 88例患者输注少白细胞汇集浓缩血小板总有效率94.32%。其中A组有效率为86.84%,不良反应发生率为10.53%。B组有效率为100.00%,不良反应发生率为2.00%。A组不良反应发生率高于B组。结论少白细胞汇集浓缩血小板临床输注安全有效,可作为单采血小板用量不足的补充,对临床术中出血患者的抢救治疗有重要应用价值。