血小板抗体检测及交叉配型在血小板输注患者中的运用
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摘要
目的探讨血小板抗体检测及交叉配型在血小板输注患者中的应用效果。方法于2017年1月—2018年6月期间,选取该段时间内在本院接受多次血小板输注的100例血液病患者随机分为2组,每组50例,对照组患者直接进行血小板输注,观察组患者先进行血小板抗体检测和交叉配型,再选择相容的血小板进行输注,两组患者就其血小板纠正指数、凝血功能、不良反应发生率、血小板输注有效率等指标进行比较。结果观察组的血小板输注有效率为74%(37/50),对照组仅为18%(9/50),观察组明显高于对照组(χ~2=31.562,P<0.05);血小板输注1 h、24 h后,观察组的血小板纠正计数指数均明显高于对照组(t=14.109,P<0.05);两组患者输血后的凝血酶原时间、活化部分凝血活酶时间、凝血酶时间均较输血前显著缩短(P<0.05),而在输血后,观察组的凝血酶原时间、活化部分凝血活酶时间、凝血酶时间均短于对照组(P<0.05);观察组的不良反应发生率为4%(2/50),明显低于对照组的18%(9/50)(χ~2=5.005,P<0.05)。结论在血小板输注前对患者施行交叉配型和血小板抗体检测,可有效提高血小板输注的效果,减少同种免疫反应,保证临床输血安全,还可改善患者的凝血功能,纠正其血小板计数。
Objective To evaluate the effect of platelet(Plt) antibody detection and cross matching in platelet transfusion patients. Methods From January 2017 to June 2018, 100 hematologic patients who received multiple platelet transfusion in our hospital were randomly divided into 2 groups, with 50 patients in each group.Random nonselected platelet was transfused in control group; Plt antigen(HPA) antibody screened and cross-match-compatible platelet in the observation group The comparisons between the 2 types of Plt transfusions, including corrected count increment(CCI), the blood coagulation function, incidence of adverse reactions and the frequencies of successful transfusion, were performed. Results The frequencies of successful transfusion between the two groups, being 74% for cross-matched compared to 18% for random-donor units, had a significant difference(χ~2=31.562,P<0.05). The 1-and 24-hour CCIs from the control group were lower than that of the observation group(P<0.05). Regarding prothrombin time, activated partial thromboplastin time and thrombin time(P<0.05) after transfusion, the observation group's data was significant shorter than that of the control group(P<0.05), although posttransfusion blood coagulation function in both groups improved significantly(t=14.109,P<0.05). The incidence of adverse reactions in observation group was 4%(2/50), which was significantly lower than the control group 18%(9/50),χ~2=5.005,P<0.05). Conclusion Plt antibody detection and cross matching before platelet transfusion can promote Plt utilization, reduce the development of alloimmunization, improve the blood coagulation function, and provide better increments in Plt count.
Objective To evaluate the effect of platelet(Plt) antibody detection and cross matching in platelet transfusion patients. Methods From January 2017 to June 2018, 100 hematologic patients who received multiple platelet transfusion in our hospital were randomly divided into 2 groups, with 50 patients in each group.Random nonselected platelet was transfused in control group; Plt antigen(HPA) antibody screened and cross-match-compatible platelet in the observation group The comparisons between the 2 types of Plt transfusions, including corrected count increment(CCI), the blood coagulation function, incidence of adverse reactions and the frequencies of successful transfusion, were performed. Results The frequencies of successful transfusion between the two groups, being 74% for cross-matched compared to 18% for random-donor units, had a significant difference(χ~2=31.562,P<0.05). The 1-and 24-hour CCIs from the control group were lower than that of the observation group(P<0.05). Regarding prothrombin time, activated partial thromboplastin time and thrombin time(P<0.05) after transfusion, the observation group's data was significant shorter than that of the control group(P<0.05), although posttransfusion blood coagulation function in both groups improved significantly(t=14.109,P<0.05). The incidence of adverse reactions in observation group was 4%(2/50), which was significantly lower than the control group 18%(9/50),χ~2=5.005,P<0.05). Conclusion Plt antibody detection and cross matching before platelet transfusion can promote Plt utilization, reduce the development of alloimmunization, improve the blood coagulation function, and provide better increments in Plt count.
引文
[1] Jia Y,Li W,Liu N,et al.Prevalence of platelet-specific antibodies and efficacy of crossmatch-compatible platelet transfusions in refractory patients.Transfusion medicine,2014,24(6):406-410.
[2] Beligaswatte A,Tsiopelas E,Humphreys I,et al.The mean fluorescence intensities of anti-HLA antibodies detected using micro-bead flow cytometry predict the risk of platelet transfusion refractoriness.British Journal of Haematology,2013,162(3):409-412.
[3] 陈兰兰,车进,张燕华,等.临床患者首次进行血小板交叉配型试验的结果分析.中国输血杂志,2017,30(2):148-150.
[4] 张趁利,庞桂芝,娄白敏,等.反复输血患者的血小板抗体检测及配型前后的疗效对比.临床输血与检验,2014,16(1):66-68.
[5] Khalafallah AA,Al-Barzan AM,Camino A,et al.An open-labelled,randomized cross-over study of the effect of electromechanical pumps versus conventional gravity flow on platelet transfusion in adult haematology patients.Transfusion medicine and hemotherapy,2013,40(1):22-26.
[6] 郑元,蒋敏,李勇,等.血小板交叉配型在免疫性输注无效患者中的临床应用.中国输血杂志,2016,29(7):711-712.
[7] Sturmer M,Arroyo A,Brachert J,et al.Establishment of the first International Repository for Transfusion-Relevant Bacteria Reference Strains:ISBT Working Party Transfusion-Transmitted Infectious Diseases (WP-TTID),Subgroup on Bacteria.Vox Sanguinis,2012,102(1):22-31.
[8] 王辉.血小板抗体检测及交叉配型在临床血小板输注中的应用.江苏医药,2015,41(8):910-911,912.
[9] 杜玮璐.血小板抗体检测及交叉配型在血小板临床输注中的应用分析.中国社区医师,2014,27(28):117-118.
[10] 张秋会,胡兴斌,孙文利,等.血小板抗体检测及配型在肿瘤患者中的临床应用.中国输血杂志,2016,29(7):708-710.
[11] 施清蓉,彭绍军,何小英,等.血小板抗体检测方法及其配型的应用与血小板输注疗效关系的研究.当代医学,2014,21(6):87-87,88.
[12] Vassallo RR,Fung M,Rebulla P,et al.Utility of cross-matched platelet transfusions in patients with hypoproliferative thrombocytopenia:A systematic review.Transfusion,2014,54(4):1180-1191.
[13] 叶海辉,皮佑珺,润袁敏,等.血小板抗体检测及交叉配型在临床输注无效患者中的应用.实用临床医药杂志,2014,18(13):174-175.
[14] 王艳春,韦庆文,肖庆,等.血小板抗体筛选及血小板交叉配型对血小板输注效果的影响.中外医学研究,2014,12(27):25-26.
[15] Rioux-Masse B,Cohn C,Lindgren B,et al.Utilization of cross-matched or HLA-matched platelets for patients refractory to platelet transfusion.Transfusion,2014,54(12):3080-3087.
[16] 陈晓军,孙景春,段生宝,等.血小板抗体检测及交叉配型在血小板输注无效患者中的应用.中国实验诊断学,2013,17(1):143-144.
[17] 韩日成,张家明,陈锦艳,等.血小板抗体检测及交叉配型在血小板输注患者中的应用.广东医学院学报,2012,30(1):56-58.
[2] Beligaswatte A,Tsiopelas E,Humphreys I,et al.The mean fluorescence intensities of anti-HLA antibodies detected using micro-bead flow cytometry predict the risk of platelet transfusion refractoriness.British Journal of Haematology,2013,162(3):409-412.
[3] 陈兰兰,车进,张燕华,等.临床患者首次进行血小板交叉配型试验的结果分析.中国输血杂志,2017,30(2):148-150.
[4] 张趁利,庞桂芝,娄白敏,等.反复输血患者的血小板抗体检测及配型前后的疗效对比.临床输血与检验,2014,16(1):66-68.
[5] Khalafallah AA,Al-Barzan AM,Camino A,et al.An open-labelled,randomized cross-over study of the effect of electromechanical pumps versus conventional gravity flow on platelet transfusion in adult haematology patients.Transfusion medicine and hemotherapy,2013,40(1):22-26.
[6] 郑元,蒋敏,李勇,等.血小板交叉配型在免疫性输注无效患者中的临床应用.中国输血杂志,2016,29(7):711-712.
[7] Sturmer M,Arroyo A,Brachert J,et al.Establishment of the first International Repository for Transfusion-Relevant Bacteria Reference Strains:ISBT Working Party Transfusion-Transmitted Infectious Diseases (WP-TTID),Subgroup on Bacteria.Vox Sanguinis,2012,102(1):22-31.
[8] 王辉.血小板抗体检测及交叉配型在临床血小板输注中的应用.江苏医药,2015,41(8):910-911,912.
[9] 杜玮璐.血小板抗体检测及交叉配型在血小板临床输注中的应用分析.中国社区医师,2014,27(28):117-118.
[10] 张秋会,胡兴斌,孙文利,等.血小板抗体检测及配型在肿瘤患者中的临床应用.中国输血杂志,2016,29(7):708-710.
[11] 施清蓉,彭绍军,何小英,等.血小板抗体检测方法及其配型的应用与血小板输注疗效关系的研究.当代医学,2014,21(6):87-87,88.
[12] Vassallo RR,Fung M,Rebulla P,et al.Utility of cross-matched platelet transfusions in patients with hypoproliferative thrombocytopenia:A systematic review.Transfusion,2014,54(4):1180-1191.
[13] 叶海辉,皮佑珺,润袁敏,等.血小板抗体检测及交叉配型在临床输注无效患者中的应用.实用临床医药杂志,2014,18(13):174-175.
[14] 王艳春,韦庆文,肖庆,等.血小板抗体筛选及血小板交叉配型对血小板输注效果的影响.中外医学研究,2014,12(27):25-26.
[15] Rioux-Masse B,Cohn C,Lindgren B,et al.Utilization of cross-matched or HLA-matched platelets for patients refractory to platelet transfusion.Transfusion,2014,54(12):3080-3087.
[16] 陈晓军,孙景春,段生宝,等.血小板抗体检测及交叉配型在血小板输注无效患者中的应用.中国实验诊断学,2013,17(1):143-144.
[17] 韩日成,张家明,陈锦艳,等.血小板抗体检测及交叉配型在血小板输注患者中的应用.广东医学院学报,2012,30(1):56-58.