造血干细胞移植与血小板输注

背景:血小板输注被认为是对致死性出血最为有效的治疗措施,已成为治疗造血干细胞移植后血小板减少的标准方法。关于血小板输注临床应用的相关研究资料相对缺乏,各医院间实际情况变化较大。目的:对52例造血干细胞移植患者移植期间血小板输注的情况进行回顾性分析。方法:将出现活动性出血所进行的血小板输注归为治疗性输注,在没有出血表现的情况下进行的血小板输注定义为预防性输注。根据24h血小板回收率和出血改善情况来评价不同血小板输注性质、自体或异基因移植类型等因素对血小板输注疗效的影响。结果与结论:预防性和治疗性血小板输注有效率分别为63.6%和55.6%;接受造血干细胞移植患者血小板输注有效率和平均血小板升高值分别为60.9%和26.8×109L-1。而自体造血干细胞移植组和异基因造血干细胞移植组间预防性和治疗性输注的疗效无差别。回归分析中,凝血功能异常被认为是影响血小板输注疗效的独立风险因素。

Hematopoietic stem cell transplantation and platelet transfusion

BACKGROUND:Platelet transfusions were shown to reduce mortality from hemorrhage in patients with acute leukemia in the 1950s,and the use of the therapy has steadily grown since then.The procedure has become an essential part of hematopoietic stem cell transplantation(HSCT) treatment.However,there are rare studies about the current transfusion practices.OBJECTIVE:To retrospectively analyze the effects of platelet transfusion in 52 patients undergoing HSCT.METHODS:Prophylactic versus therapeutic platelet transfusion was grouped according to platelet counts and bleeding manifestation.The factors potentially influencing platelet transfusion efficacy after HSCT were evaluated.RESULTS AND CONCLUSION:The effective rates of prophylactic and therapeutic platelet transfusion groups were 63.6% and 55.6%,respectively.The effective rates and mean platelet increment in patients undergoing HSCT were 60.9% and 26.8×109/L.Meanwhile,the efficacy of prophylactic and therapeutic platelet transfusion in patients who received autologous transplants was similar in the group of allogeneic HSCT.Coagulation disorder as a independent factor identified by binary Logistic Regression showed influencing the efficacy of platelet transfusion.The platelet transfusion is an effectively therapeutic method for thrombocytopenic patients undergoing HSCT.The effect of prophylactic platelet transfusion is better than therapeutic platelet transfusion in these patients.The difference was not seen between the groups of autologous and allogeneic transplants.The curative effect of platelet transfusion can be influenced by coagulation disorder.