输血支持在造血干细胞移植中的应用

背景:接受造血干细胞移植的患者经常需要血液制品输注支持,而患者对红细胞和血小板输注的需求差异非常大,这主要依赖于造血干细胞移植的类型和患者本身的疾病性质。目的:评价中山大学附属中山医院接受造血干细胞移植患者移植期间输血的需求和数量。方法:收集中山大学附属中山医院2004-01/2010-06接受造血干细胞移植患者的资料,包括移植的适应证、移植的类型、CD34+细胞的数量、红细胞和血小板的输注数量、费用、脱离输注时间以及中性粒细胞和血小板植入时间;红细胞输注的阈值是血红蛋白计数为70g/L,而血小板的输注阈值是计数为20×109L-1。研究分析了患者移植期间红细胞和血小板输注的需求、输注量、输血费用,以及患者的生存情况。结果与结论:自体造血干细胞移植组中有14例(93%)患者,而异基因造血干细胞移植组中有35例(90%)患者显示了造血细胞植入和脱离输注证据。自体造血干细胞移植组取得脱离红细胞输注天数为14.6d,明显短于异基因造血干细胞移植组。与异基因造血干细胞移植组比较,自体造血干细胞移植组红细胞输注单位明显减少;而异基因造血干细胞移植组的红细胞输注费用明显高于自体造血干细胞移植组。输血花费昂贵,但却是造血干细胞移植中必不可少的一部分,异基因造血干细胞移植组需要更多的输血支持。脱离输注时间有望成为评估造血干细胞移植成功的指标。

Transfusion support therapy for patients undergoing hematopoietic stem cell transplantation

BACKGROUND: Transfusion of blood products is often necessary for patients undergoing hematopoietic stem cell transplantation (HSCT).The need for red cell and platelet transfusion may vary significantly depending on the type of transplantation and underlying disease.OBJECTIVE: To evaluate the need and volume of transfusions in patients undergoing HSCT in Zhongshan Hospital of Sun Yat-sen University.METHODS: Retrospective data were collected on all patients under?going autologous and allogeneic transplantation in our hospital during January 2004 to June 2010,regarding indications for transplantation,type of HSCT,CD34+ stem cell dose,total number of red cell and platelet units transfused,cost,and times to achieve freedom from transfusion (FFT) and engraftment for white blood cell and platelet.The trigger for red cell transfusion was hemoglobin lower than 70 g/L.Platelet count less than 20×109/L was the trigger for platelet transfusion.We evaluated the needs,doses as well as cost for red cell and platelet transfusion for patients undergoing HSCT.Also,overall and disease free survival were analyzed as clinical outcomes.RESULTS AND CONCLUSION: A total of 14 (93%) out of 15 patients undergoing autologous HSCT and 35 (90%) out of 39 patients with allogeneic HSCT exhibited total hematopoietic engraftment and FFT.Time to achieve FFT (median;range) for red blood cell units for autologous HSCT (14.6,0-62) was significantly shorter compared with allogeneic HSCT (11.8,0-108.5).Number of red blood cell units (median;range) transfused were significantly less in patients undergoing autologous HSCT (5.8,0-35.5) compared to patients undergoing allogeneic HSCT (11.8,0-108.5).The median cost of RBC transfusion was significantly higher in patients undergoing allogeneic HSCT compared to patients undergoing autologous HSCT.Transfusion of blood products is an expensive but integral part of HSCT,the more transfusion requirements for allogeneic HSCT than for patients undergoing autologous HSCT.FFT is a desirable long-term goal of successful HSCT.