单抗固相微孔板法用于血小板交叉配合及抗体检测分析

目的:为了进一步提高血小板输注的疗效,减少血小板输注无效症(PTR)和输血后紫癜症(PTP)的发生率,避免宝贵血源的浪费.方法:应用单抗固相微孔板(MASPAT)法和简易致敏红细胞血小板血清学试验SEPSA法,检测患者血清中的血小板抗体,再进行血小板供者与患者之间的交叉配合试验.结果:2004年6月～2006年6月70名患者,其14名患者检出血小板(阳性率20%),其余均为阴性(80%为其他因素),χ=54.02,P=0.0000＜0.05,K=0.5664.结论:经Kappa检验,MASPAT和SEPSA 2种检测方法具有良好的一致性,MASPAT法在重复性,特异性,敏感性方面均优于SEPSA法,且快速,可靠,易判断;操作规范,程序化,标准化;MASPAT法可用于临床血小板抗体的检测和交叉配合试验.     

血小板输注效果的临床分析

目的:观察血小板的输注疗效,探讨血小板抗体以及年龄因素对临床血小板输注所产生的影响。方法:搜集2013-04-2013-10进行机采血小板输注的92例患者的血清或血浆标本及临床资料,采用固相凝集法对血小板抗体进行筛查,计算血小板回收率和血小板计数增高指数评价血小板输注效果,分析血小板输注无效的影响因素。结果:92例患者血小板输注无效率为44.56%,血小板抗体阳性率为27.17%;血小板抗体阳性组的输注无效率为68%,明显高于抗体阴性组的输注无效率35.82%,两者比较差异有统计学意义(P0.05);以年龄段分组的4组患者输注无效率分别为16.67%、45.45%、48.39%、80.00%,比较差异有统计学意义(P0.05);4组患者抗体阳性率分别为29.17%、27.27%、21.88%、35.71%,比较差异无统计学意义(P0.05)。结论:血小板抗体可引起血小板输注无效;血小板输注无效率随年龄的增高而增加;暂无法确定年龄因素对血小板抗体阳性的影响。     

血小板输注与HLA抗体的临床意义

血小板输注与ＨＬＡ抗体的临床意义李敬兰金宗骧赵纯平杨杰坤曹金霓我们检测６６例长期输血小板的急性白血病（ＡＬ），再生障碍性贫血（ＡＡ）的同种抗体（ＨＬＡ抗体），并观察部分抗体阳性患者血小板交叉配型输血的临床效果。一、材料与方法１．观察对象、血小板来源与...     

血小板输注患者的血小板抗体检测意义

临床发现,一些血液病患者因血小板减少引起的出血倾向,在给予血小板浓缩液输注治疗后,出血倾向可好转,但随着血小板输注次数输注量的增加,出血倾向又复出现,甚至更加严重。为了解其中可能的原因,我们对采用血小板输注治疗的４７例血液病患者,进行了血小板抗体检测...     

血小板输注无效

血小板是血液系统中维持血管完整性的“卫士”，参与出血性疾病和血栓性疾病的发生、发展。在某些血液病和肿瘤疾病的患者，即使多次给予足量的血小板，其出血症状依然没有改善，而血液中血小板计数水平仍很低，这称为血小板输注无效（platelet transfusion refractory，PTR）。PTR是临床上十分棘手的问题，本文从PTR的定义、病因、实验室诊断及其预防和治疗作一简要综述。     

122例单采血小板输注的临床观察

目的：对122例血小板减少症患者输注1单位单采血小板效果的实验室观察。方法：按血小板输血史将患者分为3组,A组（首次输血者,41例）;B组（重复输血者,69例）;C组（频繁输血者,12例）。血小板输注1h和24h后,比较患者校正血小板计数增加值（CCI）和血小板回收率（PPR）。结果：A组、B组、C组间CCI、PPR差异有统计学意义（P〈0．05）;血小板减少症组血小板输注无效率低于血液病组。结论：单采血小板输注是临床控制出血重要方法,尤其对首次输血者及一般重复输血者（2～10次）有效,可起到更好的预防及治疗效果;频繁输血者（≥11次）输注血小板后疗效较低,可能与患者输血前血小板基数较低及频繁输血导致血小板输注无效有关,未来的研究需要收集患者临床资料以更好地把握此类患者血小板输注效果。     

HLA-Ⅰ抗体及血小板膜糖蛋白CD41a的表达与血小板输注无效的相关性及影响因素分析

目的:分析HLA-工抗体及血小板膜糖蛋白CD41a的表达与血小板输注无效(PTR)相关性及影响因素.方法:将2019年7月-2020年10月收治的50例PTR患者作为观察组,50例行血小板输注治疗有效患者作为对照组;采集患者临床资料,检测患者血小板HLA-Ⅰ抗体和CD41a表达水平.绘制受试者工作特征(ROC)曲线,分...     

恶性血液病患者血小板输注无效与淋巴细胞毒试验同种免疫的关系

目的　探讨恶性血液病患者血小板输注无效与淋巴细胞毒试验 (LCT)同种免疫的关系。方法　对1997- 12～ 2 0 0 2 - 12广东省人民医院 5 9例恶性血液病患者经多次血小板输注后进行淋巴细胞毒试验 ,进行血小板校正增加值测定 (CCI) ,探讨LCT与血小板输注无效之间的关系。结果　患者中 ,LCT阳性率 38 6 % ;其中 ,急性淋巴细胞白血病 (ALL)LCT阳性率 4 6 1% ;急性非淋巴细胞白血病 (AML)LCT阳性率 34 8% ;ALL与AML之间LCT阳性率差异无显著性意义 (χ2 =0 4 5 2 ,P >0 0 5 )。CCI无效组 32 2 % ,其中LCT阳性者 5 7 9% ;CCI有效组 6 7 8% ,其中LCT阳性者 12 5 %。CCI无效组与CCI有效组LCT阳性率差异有显著性 (χ2 =13 4 3,P <0 0 1)。结论　发现大多数患者LCT滴度越高 ,发生血小板输注无效的可能性就越大。     

新乡地区临床患者的血小板抗体检测及配型的疗效分析

目的:调查新乡地区临床反复输血和输注血小板的患者血小板抗体阳性率及血小板交叉配合性输注的输注效果。方法:设86例3次以上输血史的随机血小板输注患者为实验组,80名≤3次输血史的随机住院患者为对照组,采用固相凝集法检测实验组及对照组中患者的血小板抗体阳性率,对46例产生血小板抗体的临床患者,通过配合性输注24h后血小板计数增高指数(CCI)来观察患者血小板输注效果。结果:实验组和对照组血小板抗体阳性率分别为43.02%和11.25%,实验组明显高于对照组;临床患者输注ABO同型随机机采血小板不同输注次数相比较,≤3次、4~6次、6次以上有效率分别为70.00%、66.67%、37.14%,差异均有统计学意义(均P0.05);46例产生血小板抗体的临床患者经配合性血小板输注,计算24h后CCI、血小板回收率,输注次数≤3次、4~6次的临床患者输注效果明显高于6次以上。结论:对于≥5次输血的患者及反复血小板输注无效的患者,对其检测血小板抗体筛检,对产生血小板抗体的患者进行交叉配型,配合性输注,提高输注疗效,真正做到安全有效输血,减少血液的浪费。     

急性白血病患者血小板无效输注的原因分析

目的：探讨急性白血病（AL）血小板输注无效的原因。方法：观察106例AL患者的263例次单采血小板输注效果并检测血小板抗体,分析讨论血小板无效输注的影响因素。结果：①AL血小板无效输注率为43．35％;②血小板抗体阳性检出率为32．32％;③血小板输注有效组与无效组的抗体阳性检出率的差异有统计学意义（P〈0．01）。④AL发热组输注无效率高于未发热组（P〈0．01）;脾脏肿大与无肿大组无效输注率差异有统计学意义（P〈0．01）。结论：引起血小板输注无效的病因复杂。血小板输注前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。     

The role of ABO matching in platelet transfusion

Abstract: A prospective controlled trial was performed to determine whether the use of ABO-identical platelets from the start of treatment might provide higher post-transfusion platelet increments, reduce the number of platelet transfusions and ultimately delay the onset of refractoriness. Forty newly diagnosed patients with haematological diseases were randomized to receive either pooled ABO-identical platelets or pooled platelets unmatched for ABO group throughout their course. The corrected platelet count increments (CCI) were calculated for the first 25 transfusions of each patient and non-immune factors present at the time of each platelet transfusion were documented. The mean CCI for the first 25 transfusions in the ABO-identical group was significantly higher (6600 ±: 7900 SD) than that achieved with ABO unmatched platelets (5200 ±: 7900; p<0.01). The effect was most marked for the first 10 transfusions for each patient where the CCI was 64% higher in the ABO-identical group (8200 ±: 7500 vs 5000 ±: 8100; p<0.0002). Patients given ABO-identical platelets required only about half as many transfusions in the first 30 days (10 versus 17, p<0.05) or during the first admission (11 versus 21 p<0.01) as patients in the ABO-unmatched group. A smaller percentage of patients in the ABO-identical group became refractory (36% vs 75% p<0.03). The data suggest that patients requiring long-term platelet support should be transfused with ABO-identical platelets.     

Random donor platelet crossmatching: comparison of four platelet antibody detection methods

The standard lymphocytotoxicity assay (LCT), a biotin-avidin enzyme immunoassay (ELISA), platelet suspension immunofluorescence test (PSIFT), and platelet radioactive antiglobulin test (PRAT) were examined in prospective crossmatching for selection of compatible random donor platelets for refractory patients. One hundred seven episodes of pooled random donor platelet transfusions were evaluated in 26 patients. There was good reproducibility of results by individual techniques. Concordance of results by the different methods was 40-60%. One-hour and 24 hr posttransfusion corrected count increments (CCI) were compared as parameters for assessing success or failure of the transfusion. Using a rank scoring system, the relative efficiency of predictiveness for all transfusions was PRAT greater than LCT greater than PSIFT greater than ELISA. Combination of PRAT and LCT afforded the best predictability and sensitivity was higher than for either PRAT or LCT alone (93 vs. 79 and 62%, respectively). Mean posttransfusion CCI (x 10(9)/L) following PRAT-compatible platelets was 13.9 +/- 12.7 at 1 hr and 7.3 +/- 6.9 at 24 hr; following PRAT-incompatible platelets, 5.7 +/- 7.8 (1 hr) and 2.1 +/- 4.1 (24 hr). Results were similar for LCT-tested platelets. A radioimmunofiltration modification of the PRAT developed and used in selected cases was simple, fast, efficient, and inexpensive. The study indicated that the techniques evaluated are practical and feasible for routine use in the provision of compatible random donor platelets to the refractory patient who has no other cause for increased platelet destruction.     

Primary refractoriness to platelet transfusion caused by Nak(a) antibody alone

BACKGROUND AND OBJECTIVES: Anti-Nak(a), a platelet-specific antibody, occasionally causes platelet-transfusion refractoriness (PTR) together with human leucocyte antigen (HLA) antibodies. Anti-Nak(a) usually appears after frequent platelet transfusions or pregnancy. We report the first case of PTR caused by anti-Nak(a) alone. MATERIALS AND METHODS: A 19-year-old male patient with testicular tumour showed PTR when receiving his first transfusion of platelets. Screening for platelet antigens and platelet antibodies revealed that he had type I CD36 (Nak(a)) deficiency and that anti-Nak(a), but not anti-HLA, was present before he received his first transfusion. RESULTS: The transfusion of Nak(a)-negative, but HLA non-selected, platelets was effective in raising the platelet count. CONCLUSION: Clinically significant Nak(a) antibody was present as naturally occurring antibody in a platelet glycoprotein IV (CD36)-negative non-transfused male patient.     

Successful treatment of platelet transfusion refractoriness: the use of platelet transfusions matched for both human leucocyte antigens (HLA) and human platelet alloantigens (HPA) in alloimmunized patients with leukaemia

Six patients, 4 with acute myeloid leukaemia and 2 with a myelodysplasia syndrome who were refractory to random donor platelet transfusions and alloimmunized to human leucocyte antigens (HLA) and human platelet alloantigens (HPA), were treated with HLA-and HPA-matched platelet transfusions. In all the patients refractoriness and alloantibodies to HLA as well as HPA-1b or HPA-5b were detected simultaneously. Sixty-seven transfusions (445 units) of HLA-and HPA-matched platelets were given and responses to them were, in general, satisfactory in all the patients. No major spontaneous bleeding occurred. Four patients underwent bone marrow transplantation despite alloimmunization. The percentages of platelet transfusion days with a platelet nadir below 20×10⁹/l were 88% for the last 3 random donor platelet transfusions and 39% for the first 3 HLA-and HPA-matched platelet transfusions, respectively (p=0.009, Fisher's exact test). Four patients received also HLA-matched platelets, but responses to them were poor. The small number of transfusions with HLA-matched platelets precluded comparisons to either the random donor or HLA-and HPA-matched platelet transfusions. It seems that HLA-and HPA-alloimmunized patients can be successfully supported with HLA-and HPA-matched platelet concentrates.     

Successful use of rituximab in platelet transfusion refractoriness in a multi-transfused patient with myelodysplastic syndrome

A 61-year-old man with newly diagnosed INT-1 risk myelodysplastic syndrome – refractory cytopenia with multilineage dysplasia (MDS-RCMD) was not responsive to treatment, such as androgen, thalidomide, granulocyte – colony stimulating factor (G-CSF) combined with erythropoietin (EPO), interleukin-11 (IL-11) and thrombopoietin (TPO), and became transfusion dependent. Due to repeated blood transfusions, he developed platelet transfusion refractoriness (PTR) to platelets from cross-matched donors as well as random donors. Anti-HLA class I antibodies were positive with enzyme-linked immunosorbent assay; however, HLA-compatible platelet products were unavailable. PTR was unresponsive to high-dose immunoglobulin and plasma exchange. The patient was then treated with rituximab 375?mg/m² on days 1 and 8, and 100?mg total dose on days 15 and 22. Already after the first dose of rituximab, the patient was able to received successful platelet transfusion from all donors. Therefore rituximab may be considered as a potential therapy for PTR.     

血小板交叉配型改善血液病患儿血小板输注疗效的观察

目的：探讨血小板配合性输注对血液病患儿的血小板输注疗效。方法：选择20例血小板输注无效的血液病患儿,当再次输注血小板应用单克隆抗体固相血小板抗体试验（MASPAT）进行血小板交叉配合试验,并于输注前及输注后1h和24h检测血小板计数,以血小板校正计数增值（CCI）,判定输注效果。结果：输注配合性血小板后1hCCI,24hCCI显著高于之前未配型输注（P〈0．01）。结论：经MASPAT进行血小板交叉配合试验,能显著提高血小板临床输注效果,有效改善血液病患儿血小板输注无效状态。