恶性血液病患者机采血小板无效输注临床分析

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1、恶性血液病患者机采血小板无效输注临床分析［摘耍］冃的：探讨恶性血液病患者血小板无效输注(PTR)的原因。方法：收集158例恶性血液病患者，随机分为两纟R,A组为输注机采血小板W5次的患者80例，B组为输注机采血小板>5次的患者78例，观察输注lh后的血小板数量，与输注前血小板数量进行比较分析。测定校正血小板计数增加值(CCI)评价PTR率，并对出血症状进行分级，分析PTR与免疫的关系。结果：A组通过CCI判断输注有效率为80%,判断PTR为20%,B组通过CCT判断输注有效率为51.3%,判断PTR为48.7%,A组PTR比例明显低于B组值，患者的出血程度与PT

2、R呈正相关，输注血小板后症状改善。输注血小板>5次者更容易产生PTR。结论：在输注血小板引起PTR中，主要与输注血小板次数冇关，输注血小板次数越多，越容易发生同种免疫，导致血小板输注无效。［关键词］血小板无效输注；机采血小板；恶性血液病［中图分类号］R457.1［文献标识码］A［文章编号11673-7210(2010)10(c)-046-02ClinicalanalysisonhematologicmalignancieswithapheresisplatelettransfusionrefractorinessLIHaiwenl,LINYingbiao2,LI

3、ANGXinquan2(1・ChenzhouCentralBloodStation,Hu"nanProvince,Chenzhou423000,China;2.TheFirstPoop1ersHospitaiofChenzhouCity,HuznanProvince,Chenzhou423000,China)［Abstract］Objective:Tostudythereasonsofplatelettransfusionrefractoriness(PTR)onhematologicmalignancies.Methods:158casesofpatients

4、withhematologicmalignancieswereselectedanddividedintogroupAwith80casesundcrwcntW5timesplatelettransfusionandgroupBwith78casesunderwent>5timesplatelettransfusion.Comparedthebloodplateletnumberbeforeandonehouraftertransfusion.Calculatedmodifiedplateletcorrectedcountincreament(CCT)asben

5、chmarktojudgeineffectiveplatelettransfusion.ClassifiedthebleedingsymptomandanalyzedtherelationshipofPTRandimmune・Results:Thetransfusioncurativeeffectratewas80%ingroupAand51.3%ingroupB・ThePTRratewas20%ingroupAand48・7%ingroupBwithsignificantstatisticaldifferences.BleedingdegreeandPTRwe

6、repositivecorrelation,thesymptemimprovedafterplatelettransfusion.PTRusuallyhappenedinthosecaseswith>5timesplatelettransfusion.Conclusion:HematologicmalignancieswithPTRareconcernedwiththetimeofplatelettransfusion.Themoretimesoftransfusion,themorelikelytohappenisoimmuni/ationandinduceP

7、TR.［Keywords］Platelettransfusionrefractoriness;Apheresisplatelet;Hematologicmalignancie输注机釆血小板是临床治疗恶性血液病患者血小板减少最有效的治疗手段z—,但对于反复输注血小板恶性血液病患者，容易使体内产生-血小板相关抗体(主要是HLA抗体)和血小板特异性抗体(主要是IIPA抗体)，导致血小板输注无效，即血小板无效输注(platelettransfusionrefractoriness,PTR)。本文中笔者收集郴州市第一人民医院血液内科2007年1刀〜2009年12刀输注血小

8、板的恶性血液病病例158