Nevo Shoshan, Fuller Alice K, Hartley Eric, Borinsky Mark E, Vogelsang Georgia B
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Bunting Blaustein Cancer Research Building, Baltimore, Maryland, USA.
Transfusion. 2007 May;47(5):801-12. doi: 10.1111/j.1537-2995.2007.01193.x.
Prophylactic platelet (PLT) transfusions are given as a standard care in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT). This retrospective analysis evaluates utilization of blood transfusions, risk of bleeding, and survival in 480 HSCT patients at 10 x 10(9) and 20 x 10(9) per L prophylactic trigger levels.
A total of 224 patients received prophylactic PLT transfusions at 20 x 10(9) per L threshold (1997-1998, SP1); 256 patients had prophylaxis at 10 x 10(9) per L (1999-2001, SP2). Bleeding scores were assigned daily.
A slight reduction in PLT transfusions per patient in SP2 compared with SP1 was not statistically significant (odds ratio, 0.82; 95% confidence interval, 0.51-1.33; p = 0.416), yet a significantly higher proportion of patients in SP2 had PLT counts less than or equal to 10 x 10(9) per L compared to SP1 (p < 0.001). In patients who bled, however, there was no excess exposure to low PLT counts before bleeding started. A substantial number of patients who bled received PLT transfusions above the goal before bleeding started (82.9% in SP2, 41.5% in SP1) because of medical complications that associated with increased risk of bleeding. Bleeding incidence was similar in both study periods (21.9% in SP1, 16.4% in SP2; p = 0.526). Bleeding was significantly associated with reduced survival in both study periods.
Patients who bled were usually placed on a higher threshold before the onset of their major bleeding event and were not exposed to additional risk of bleeding from thrombocytopenia. Similarity in bleeding incidence between study periods appears to associate with adjustments to high-risk conditions and may not reflect consequences of the lower transfusion threshold.
预防性血小板（PLT）输注是接受造血干细胞移植（HSCT）的血液系统恶性肿瘤患者的标准治疗措施。本回顾性分析评估了480例HSCT患者在每升10×10⁹和20×10⁹的预防性触发水平下的输血利用率、出血风险和生存率。
共有224例患者在每升20×10⁹的阈值下接受预防性PLT输注（1997 - 1998年，SP1）；256例患者在每升10×10⁹的阈值下接受预防（1999 - 2001年，SP2）。每天记录出血评分。
与SP1相比，SP2中每位患者的PLT输注量略有减少，但无统计学意义（优势比，0.82；95%置信区间，0.51 - 1.33；p = 0.416），然而，与SP1相比，SP2中PLT计数小于或等于每升10×10⁹的患者比例显著更高（p < 0.001）。然而，在出血的患者中，出血开始前并未过度暴露于低PLT计数情况。大量出血的患者在出血开始前接受了高于目标值的PLT输注（SP2中为82.9%，SP1中为41.5%），原因是与出血风险增加相关的医疗并发症。两个研究时期的出血发生率相似（SP1中为21.9%，SP2中为16.4%；p = 0.526）。在两个研究时期，出血均与生存率降低显著相关。
出血的患者在大出血事件发生前通常处于较高的阈值，并未因血小板减少而面临额外的出血风险。研究时期之间出血发生率的相似性似乎与对高危情况的调整有关，可能并未反映较低输血阈值的影响。
