活化血浆凝固时间对血小板输注疗效评价的研究

本研究探讨活化血浆凝固时间(APCT)对评价血小板输注疗效的价值,用血小板聚集凝血因子分析仪检测了20例血液病患者血小板输注前后APCT的变化,并与血小板计数增加校正指数(CCI)和实际血小板回收率(PPR)进行了对比研究。结果表明:输注1小时、24小时后的APCT均明显缩短,APCT由血小板输注前的(103.7±11.3)秒分别缩短为输注后1小时、24小时的(60.0±9.7)秒、(68.5±9.8)秒,(P<0.01),而正常对照的APCT为(42.0±3.4)秒;按照CCI和PPR的判断标准(输注后1小时和24小时CCI分别为<7500和<5000,PPR分别为<30%和20%为输注无效),有2例为血小板输注无效,其输注1小时、24小时的CCI值分别为7415、2966和6913、4988,PPR值分别为28.0%、11.2%和25.2%、14.1%。1例PPR均达血小板输注无效标准,而CCI值均显示血小板输注有效;2例PPR均达血小板输注无效标准,而输注1小时的CCI值表示为血小板输注有效,24小时的CCI值表示为血小板输注无效。结论:APCT可以反映血小板数量和质量的变化,也能较全面的评估血小板的输注疗效。     

血小板凝血活性对预防性血小板输注的预示价值研究

目的探讨血小板凝血活性对预防性血小板输注的预示价值并确定血小板预防性输注的界值。方法采用活化血浆凝固时间(APCT)和血栓弹力图(TEG)检测血小板凝血活性。根据病人有无出血表现,将127例血小板计数(PLT)<50×109/L的患者分为两组,其中出血组37例,未出血组90例。抽取4.5ml静脉血,枸橼酸钠抗凝,进行PLT、TEG、APCT测定。结果出血组和未出血组的PLT和APCT分别为(7.9±3.6)×109/L、104.0±6.1s和(23.0±10.1)×109/L、68.4±9.4s,两者均有显著差异,P<0.01;PLT和APCT呈负相关,r=-0.7613。出血组病人(n=15)TEG的MA参数值(TEG-MA)为20.5±5.3mm,低于未出血组病人(n=20)的43.4±11.0mm,有显著差异,P<0.01。以APCT≥90s为界值,其预示血小板减少所致出血的敏感性为100%,特异性为98.9%;以MA≤30mm为界值,预示敏感性为100%,特异性为95.0%;以PLT≤20×109/L为界值,敏感性为100%,特异性为56.7%。结论血小板凝血活性是预示血小板减少所致出血的良好指标,其...     

活化血浆凝固时间试验及对白血病化疗后血小板降低所致出血的预示价值

白血病患者化疗后会引起血小板数量明显减少，从而诱发出血。临床上常通过输注血小板来预防出血。一般认为血小板输注阈值在20×10^9／L至10×10^9／L，如血小板降低至5×10^9／L应立即输注血小板。     

对腹主动脉瘤破裂患者预防性输注血小板和血浆：对输血策略一项变化的评估

背景：持续出血是导致大量输血患者死亡的主要原因，存活的患者较死亡患者血小板计数高、凝血酶原时间和活化部分凝血活酶时间（APTT）短。可考虑早期用血小板和新鲜冰冻血浆（FFP）预防凝血功能紊乱，从而提高存活率。研究设计与方法：将接受腹主动脉瘤破裂手术的患者分为两组比较存活率。一组为实施预防性输血方案：当可能发生主动脉破裂时，输注两份混合的白膜层血小板（PBPCs），     

血小板减少性紫癜激活的富血小板血浆凝固时间实验观察

目的研究激活的富血小板血浆凝固时间（APRPCT）测定对血小板减少性紫癜出血的预示作用及意义,探讨该实验方法与临床实验室常用的血小板计数、血浆凝血酶原时间、活化部分凝血活酶时间、血浆凝血酶时间、血浆纤维蛋白原测定间的相关性。方法制备激活富血小板血浆凝固时间激活试剂,检测健康对照组及血小板减少性紫癜组APRPCT,观察两组间差异。结果硅微粒激活的富血小板血浆凝固时间,健康对照组、血小板减少性紫癜组间差异有统计学意义（P〈0．05）。结论激活的富血小板血浆凝固时间可用于血小板减少性紫癜的出血预示。     

与输血不良反应有关的血浆抗-CD36对血小板输注反应的差异

背景和目的 抗-CD36具有重要的临床意义。输血或妊娠产生的血小板免疫球蛋白引起血小板激活，在非溶血性输血反应（NHTRs）中所起的作用已被证明，本文研究血小板对含抗CD36的血浆的体外反应。材料和方法将导致NHTRs和继后引起血小板减少症的含抗-CD36血浆与含CD36血小板一同孵育。血浆诱导的血小板活化是通过检测血小板凝集和RANTES（调节活化、正常、T细胞表达和分泌）释放来说明。结果20份CD36阳性标本只有4份血小板的活化是单独由血浆诱导的。7份受试者的血小板活化是肾上腺素和血浆的联合协同作用诱导的。剩下的9份受试者血小板对血浆无反应。     

特发性血小板减少性紫癜患者激活的富血小板血浆凝固时间测定及临床意义

目的研究激活的富血小板血浆凝固时间（activated platelet rich plasma coagulation time，简称APRPCT）对特发性血小板减少性紫癜（idiopathic thrombocytopenic purpura，ITP）出血的预示作用及意义，探讨该实验方法与临床实验室常用的血小板计数（PLT）、血浆凝血酶原时间测定（PT）、活化部分凝血活酶时间测定（APTT）、血浆凝血酶时间测定（TT）、血浆纤维蛋白原测定（Fib）间的相关性。方法根据APRPCT实验原理，优选浓度为2g／L的硅微粒作为APRPCT激活试剂，制备质控血浆监测APRPCT实验的过程和质量，以2g／L的硅微粒检测正常对照组及ITP组的APRPCT，统计分析两组间的APRPCT有无显著性差异。结果浓度为2g／L的硅微粒测定APRPCT，正常对照组较ITP组明显延长，两组之间差异有统计学意义（P〈0．05）。结论APRPCT能同时反映血小板数量和质量的变化，其预示出血倾向的特异性明显优于血小板计数，可作为ITP患者的出血预示指标。     

血小板抗体对血小板输注的疗效观察

目的 探讨血小板抗体对血小板输注效果的影响.方法 把57例血小板减少的患者分为无抗体组和有抗体组,分别在输注前1h内和输注后24h检测血小板数,并进行血小板输注效果评价.结果 无抗体组输注后比输注前血小板计数有高度显著性增多,有抗体组输注后比输注前血小板计数仅显著性增多;CCI评价血小板输注效果,无抗体组有效率为77.4%,有抗体组有效率为26.9%,两组血小板输注效果有高度显著性差别.结论 血小板输注无效与血小板抗体的存在有关,预先进行血小板抗体检测分析,选择合适的血小板输注,可大大提高血小板输注效果.     

血小板抗体对血小板输注的疗效观察

[目的]探讨血小板抗体对血小板输注效果的影响。[方法]把57例血小板减少的患者分为无抗体组和有抗体组，分别在输注前1h内和输注后24h检测血小板数，并进行血小板输注效果评价。[结果]无抗体组输注后比输注前血小板计数有高度显著性增多，有抗体组输注后比输注前血小板计数只显著性增多；CCI评价血小板输注效果，无抗体组有效率为77.4％，有抗体组有效率为26.9％，两组血小板输注效果有高度显著性差别。[结论]血小板输注无效与血小板抗体的存在有关，预先进行血小板抗体检测分析，选择合适的血小板输注，可大大提高血小板输注效果。     

血小板抗体对血小板输注的疗效观察

目的探讨血小板抗体对血小板输注效果的影响。方法把57例血小板减少的患者分为无抗体组和有抗体组，分别在输注前1h内和输注后24h检测血小板数．并进行血小板输注效果评价。结果无抗体组输注后比输注前血小板计数有高度显著性增多，有抗体组输注后比输注前血小板计数仅显著性增多；CCI评价血小板输注效果，无抗体组有效率为77．4％，有抗体组有效率为26．9％．两组血小板输注效果有高度显著性差别。结论血小板输注无效与血小板抗体的存在有关，预先进行血小板抗体检测分析．选择合适的血小板输注，可大大提高血小板输注效果。     

Compliance with prophylactic platelet transfusion trigger in haematological patients

The aim of prophylactic platelet transfusions in haemato-oncologic patients with thrombocytopenia is to prevent bleeding. Currently, a platelet transfusion trigger of 10 x 10(9) L(- 1) is considered to be safe. Transfusion compliance with this trigger can save costs. To investigate the compliance with this trigger of 10 x 10(9) L(- 1), we have evaluated 1447 platelet transfusions given during a period of 1 year to haematological patients. In half of the transfusions, there had been compliance with the trigger of 10 x 10(9) L(- 1). About three-quarters of all platelet transfusions were given at platelet counts < or =20 x 10(9) L(- 1). Transfusions at levels >20 x 10(9) L(- 1) were usually performed because of bleeding, scheduled interventions or concurrent anticoagulant therapy. We conclude that compliance with the prophylactic platelet transfusion trigger of 10 x 10(9) L(- 1) was about 50%; however, deviation from the trigger was partly explained by risk factors that justify a higher transfusion trigger.     

Comparison of efficacy of low and high dose prophylactic platelet transfusion therapy in thrombocytopenic haemato-oncology patients

IntroductionTo determine an optimal platelet dose in thrombocytopenic patients is important for their judicious use. Transfusing platelets in different doses and comparing their post transfusion response can achieve this.AimTo compare the efficacy of low and high dose single donor apheresis platelets (SDAP) with standard dose transfusions in terms of Corrected Count Increment (CCI), Percent Platelet Recovery (PPR) and transfusion free interval.MethodIt was a prospective case control study done from January 2016 to April 2017. Twenty-eight hemato-oncology patients with CCI ≥5000 at 20–24 hours after standard dose (3 × 10¹¹/unit), received low dose (1.5 × 10¹¹ platelets/unit) and high dose (>4 × 10¹¹ platelets/unit) SDAP. CCI and PPR were calculated after 20 to 24 hours of transfusion. Transfusion free interval and bleeding episodes were also noted. Grading was done according to WHO bleeding scale.ResultThere was no statistical difference in CCI and PPR when standard dose was compared with low dose (CCI: p = 0.92, PPR: p = 0.89). When standard and high dose was compared, standard dose gave better results than the high dose in terms of CCI (p = 0.006) and PPR (p = 0.008) although the post transfusion increments were comparable (p = 0.938). High dose gave better (p = 0.005) platelet count increments than low dose but CCI (p = 0.04) and PPR (p = 0.05) was significantly less than the low dose. The difference in transfusion free intervals after three doses was not significant. Donor exposure to the patients was significantly (p = 0.000) reduced to 17.5%.ConclusionPossibility of low dose as an alternative to standard dose can be considered in view of comparable platelet response indicators and significantly reduced donor exposure.