多次机采血小板对献血员血常规的影响

目的：监测机采血小板献血者的血常规,评估多次机采血小板对献血者健康状况的影响。方法：分别检测献血者献血前和献血后1个月和6个月血常规,并进行对比分析。结果：白细胞计数、淋巴细胞比率、单核细胞比率、中性粒细胞比率、淋巴细胞计数、单核细胞计数和血小板计数等血液常规项目在机采血小板前后没有明显改变。结论：体检合格的血小板献血者,定期单采血小板对献血员的血常规和健康状况没有明显影响。     

治疗性血小板单采术在脾切除术后血小板异常增多患者中的应用

目的探讨治疗性血小板单采术对脾切除术后血小板异常增多患者的疗效。方法使用CS 3000 Plus血细胞分离机对12例脾切除术后血小板异常增多的患者进行治疗性血小板单采,同时配合抗血小板凝聚或抑制血小板生成治疗。治疗后查血常规,观察患者治疗前后血小板计数的变化情况及临床症状、体征缓解情况。结果血小板单采术后患者血小板计数由治疗前的(1704±546)×109/L下降至(499±77)×109/L(P<0.05);临床症状、体征得到明显改善,无1例患者出现出血或血栓形成。结论治疗性血小板单采术可安全、有效地清除患者异常增多的血小板,是治疗脾切除术后血小板异常增多患者的有效治疗方法之一。     

联合应用治疗性白细胞及血小板单采术治疗慢性粒细胞白血病的临床研究

目的 探讨对白细胞、血小板两系均异常增高的慢性粒细胞白血病(CML)患者联合应用治疗性白细胞、血小板单采术的可行性及方法 .方法使用CS 3000 plus血细胞分离机对10例CML患者用单套耗材进行白细胞及血小板单采,先进行一系细胞的单采,中途腾空产品袋,更换程序及更换相应的分离夹.治疗后查血常规,观察治疗前后白细胞、血小板变化情况及临床症状缓解情况.结果 用此法单次治疗,白细胞计数下降(55.2±21.2)%;血小板计数下降(47.8±10.2)%;临床症状、体征改善.结论 利用单套耗材联合应用治疗性白细胞及血小板单采术可同时安全、有效地清除白细胞及血小板,是治疗白细胞、血小板同时异常增高CML患者有效的综合治疗方法之一.     

急性血小板分离技术对深低温停循环主动脉手术患者凝血功能的影响

目的本研究通过血栓弹力图(TEG)观察急性血小板分离技术(APP)对深低温停循环(DHCA)的主动脉手术患者凝血功能的影响。方法选择A型主动脉夹层拟行主动脉根部替换(Bentall)及全弓替换加支架象鼻术的患者36例,男31例,女5例,年龄23~65岁,ASAⅡ~Ⅳ级。随机将患者分为研究组和对照组,每组18例。研究组手术同时进行APP分离,对照组仅进行术中血液回收和异体输血等常规血液保护措施。于诱导后(T1)、肝素化前(T2)、离开手术室前(T3)和术后24h(T4)采集血液标本,检测TEG的反应时间(TEG-R)、凝集时间(TEG-K)、凝集块形成速率(TEG-α)、HBG、大血小板比例(P-LCR)和即时振幅(TEG-A)、最大振幅(TEG-MA)、预测在MA值确定后30min内血凝块将要溶解的百分比(TEG-EPL)和凝血综合指数(TEG-CI);TEG行高岭土、肝素酶双检测。CPB停止后每小时监测血气,并根据术野出血情况检测血液常规(Hb、Plt、MPV、PLCR)和TEG以指导输血。结果与T1时比较,T4时研究组TEG-R、TEG-K明显缩短(P0.05),TEG-A、TEG-MA明显减小(P0.05),TEG-EPL、Plt明显降低(P0.05),TEG-CI、MPV、P-LCR明显升高(P0.05),两组Hb明显降低(P0.05)。T2时研究组TEG-A、TEG-MA、Plt明显高于对照组(P0.05),T3时研究组TEG-K明显短于对照组、TEG-EPL、Hb明显低于对照组(P0.05)。结论 TEG技术证明,APP对DHCA主动脉手术患者的凝血功能有保护作用。     

Comparison of plateletpheresis on the Fenwal Amicus,Fresenius COM.TEC,and Trima Accel Cell separators

Blood component donations by apheresis have become more common in modern blood transfusion practices. We compared three apheresis instruments (Fenwal Amicus, Fresenius COM.TEC, and Trima Accel) with regard to platelet (PLT) yield, collection efficiency (CE), and collection rate (CR). The single‐needle or double‐needle plateletpheresis procedures of the three instruments were compared in a retrospective, randomized study in 270 donors. The blood volume processed was higher in the COM.TEC compared with the Amicus and Trima. Also there was a significantly higher median volume of ACD used in collections on the COM.TEC compared with the Amicus and Trima. The PLT yield was significantly lower with the COM.TEC compared with the Amicus and Trima. Additionally, the CE was significantly lower with the COM.TEC compared with the Amicus and Trima. There was no significant difference in median separation time and CR between the three groups. When procedures were compared regarding CE by using Amicus device, it was significantly higher in single‐needle than double‐needle plateletpheresis. When double‐needle Amicus system was compared with double‐needle COM.TEC system, CE and PLT yield were significantly higher with Amicus system. When single‐needle Amicus system was compared with single‐needle Trima system, CE and PLT yield were significantly higher with Trima system. All instruments collected PLTs efficiently. However, the CE was lower with the COM.TEC compared with the Amicus and Trima. Also, we found Amicus single‐needle system collected PLTs more efficiently compared with the double‐needle system. CE and PLT yields were significantly higher with the single‐needle Trima instrument compared with the single‐needle Amicus device. J. Clin. Apheresis 30:171–175, 2015. © 2014 Wiley Periodicals, Inc.     

机采血小板中使用两种收集夹采集效果比较

目的 比较在机采血小板中使用标准A-35收集夹和PLT-30收集夹血小板的采集效果。方法 选择100个合格健康献血者,Plat>150×109/L,随机分成两组,每组50人,应用Baxter CS-3000plus血细胞分离机进行血小板采集,对照组使用标准A-35收集夹,实验组使用PLT-30收集夹。结果 实验组血小板产量(3.3±0.3)×1011个/袋,平均采集时间(57±4)min,白细胞污染量(2.1±0.6)×106个/袋,发生枸橼酸盐过敏反应1例;对照组血小板产量(2.9±0.3)×1011个/袋,平均采集时间(69±5)min,白细胞污染量(5.0±0.6)×106个/袋,发生枸橼酸盐过敏反应3例。结论 使用PLT-30收集夹血小板采集效果明显优于使用标准收集夹,使用PLT-30收集夹不但血小板产量高,而且采集时间短,白细胞污染量小,枸橼酸盐过敏反应发生率低。     

血液病患者血小板输注效果评价及影响因素分析

目的探讨血小板输注在防治血液病患者出血中的有效性及其影响因素。方法对68例反复输血治疗的血液病患者给予机采血小板输注,输注后24h进行外周血血小板计数,根据血小板回收率(PPR)和血小板增高指数(CCI)判定输注效果并讨论其影响因素。结果(1)急性白血病(AL)、再生障碍性贫血(AA)、特发性血小板减少性紫癜(ITP)和骨髓异常增生综合征(MDS)患者血小板输注有效率分别为88·9%(153/172)、83·1%(59/71)、51·3%(19/37)和68·8%(11/16),4种类型的血液病患者血小板输注有效率间差别有显著性意义(P<0·05);(2)AL、AA、ITP无并发症患者血小板输注有效率与同病种有并发症患者比较,差别有显著性意义(P<0·05);(3)无并发症组患者血小板输注有效率随输注次数的增加而下降(P<0·05),而有并发症组患者血小板输注有效率与输注次数关系不大(P>0·05)。结论输注血小板是预防和治疗因血小板减少或血小板功能障碍而引起的出血的最有效措施,输注次数、发热、脾肿大、弥散性血管内凝血(DIC)等因素影响血小板的输注效果。     

Rationale for medical director acceptance or rejection of allogeneic plateletpheresis donors with underlying medical disorders

A survey was completed by 25 medical directors at different institutions performing plateletpheresis. The practices of these 25 physicians were analyzed regarding the acceptance/rejection of plateletpheresis donors with a history of cardiac disease/surgery, seizures/epilepsy, cancer, or autoimmune diseases. Although available medical literature documents little risk of these disorders either to donors (i.e., donation reactions) or to transfusion recipients (i.e., disease transmission), up to 24% of medical directors outright reject some of these potential donors while others accept patients/donors with these illnesses, providing they meet certain medical/health criteria. Acceptance/rejection of individuals with medical disorders has relevance for the availability of the blood supply and blood product shortages because several million Americans, diagnosed with these illnesses, represent a sizable pool of potential blood and platelet donors.