佛山地区血小板输注无效患者的血小板输注策略及应用

目的 建立一种适用于佛山地区临床客观情况的免疫抗体致血小板输注无效输血策略与技术路线.方法 采用PCR-SSP法对佛山地区无偿机采血小板捐献者600人进行HLA-1 （A,B位点）基因分型,其中100人进行HPA-1～15基因分型,建立HLA、HPA供者库.使用3种不同输血策略（HLA/HPA供者库配合输注、血小板交叉配血试验配合输注、随机输注血小板）为血小板输注无效患者提供血小板,并比较其输血效果.结果 HLA/HPA供者库配合输注策略和血小板交叉配血试验配合输注策略获得相合供者率分别为100.0％、80.0％,两者差异无统计学意义（P＞0.05）;HLA/HPA供者库配合输注策略、血小板交叉配血试验配合输注策略和随机输注血小板策略的输注有效率分别为100.0％、62.5％、10.0％,前两者间及前两者分别与后者比,差异均有统计学意义（P＜0.05）;HLA/HPA供者库配合输注策略和血小板交叉配血试验配合输注策略的平均实验时间分别为（7.5＆#177;1.6）h、（13.3＆#177;6.1）h,两者差异均有统计学意义（P＜0.05）;平均费用分别为（365＆#177;47）元、（696＆#177;343）元,两者差异均有统计学意义（P＜0.05）.结论 HLA/HPA供者库配合输注策略比血小板交叉配血试验配合输注策略更易寻找到相合的供者,平均实验时间更短,平均费用更少,输注有效率更高,输血效果良好,是为佛山地区血小板输注无效患者寻找相合血小板较为理想的输注策略,建议在临床输血中应用.

A Novel Platelet Transfusion Strategy in Patients with Refractoriness of Platelet Transfusions in Foshan Region

Objective To establish a transfusion strategy in Foshan region,in order to resolve the platelet transfu- sion refractoriness（PTR）.Methods HLA class I （A,B） of 600 and HPA-1 to-15 system of 100 regular apheresis platelet donors in Foshan region were genotyped by PCR-SSP, respectively. A voluntary apheresis platelet donor registry with HLA and HPA typing was established. The effectiveness of three different platelet transfusion strategy groups were com- pared in HLA/HPA specific matching, PLT cross-matching and random platelet transfusion for PTR patients. Results The agreement rates of the donors in the transfusion strategy group of HLA/HPA specific matching and PLT cross-match- ing were 100.0% and 80.0%, respectively. The two groups transfusion in the group of HLA/HPA specific matching, 100.0% ,62.5%,and 10.0% ,respectively. The effective rate had no statistical difference （P〉0. 05）. The effective rates of PLTcross-matching and random platelet transfusion were of transfusion between the first two groups had statistical sig- nificanee （P〈0.05）. There was a statistical significance （P〈0. 05） between the first two groups and the later. The aver- age experimental times of HLA/HPA specific matching and PLT cross-matching were （7.5±1.6） h and （13.3±6.1） h, the difference was statistically significant（P〈0.05）. The average costs were （365±47） RMB and （696±343）RMB,show- ing a significant difference（P〈0.05）. Conclusion Compared with PLT cross matching, it was easier to find out the suit- able donors by HLA/HPA specific matching, to save the experimental time and the average cost, and to improve the effe- cieney of transfusion. HLA/HPA specific matching was a promising transfusion strategy to resolve the PTR, and was worth of recommending to clinic practice.