Julmy Friedgard, Ammann Roland A, Mansouri Taleghani Behrouz, Fontana Stefano, Hirt Andreas, Leibundgut Kurt
Department of Pediatrics, University of Berne, Berne, Switzerland.
Transfusion. 2008 Mar;48(3):442-50. doi: 10.1111/j.1537-2995.2007.01548.x. Epub 2007 Dec 7.
The steadily increasing demands for single-donor apheresis platelet (PLT) concentrates (APCs) are a challenge to the PLT supply system. Therefore, efforts to improve plateletpheresis yield, allowing apheresis products to be split into 2 or more units, are valuable strategies. No data to demonstrate in vivo transfusion efficacy of these high-yield split-APCs are currently available, however.
The transfusion efficacy of APCs produced by two apheresis methods involving different harvest and storing procedures and varying PLT yields was investigated. Efficacy measures were the 1-hour percent PLT recovery (PPR(1h)) and the 1-hour corrected count increment (CCI(1h)). In total, 400 APCs, produced with either an Amicus device (Baxter) and stored in PLT additive solution (T-Sol; Amicus method [AM], n = 107) or a Trima device (Gambro) and stored in plasma (Trima method [TM], n = 293), were transfused to 55 children (31 girls; median age, 9.5 years; range, 0.2-18.5 years) with thrombocytopenia due to chemotherapy or aplastic anemia (median, 4 APCs per child; range, 1-68).
Transfusion efficacy was significantly lower for AM-APCs than for TM-APCs (median PPR(1h), 17 and 33%; median CCI(1h), 7.9 and 15.6, respectively; p < 0.001). Reduced transfusion efficacy correlated in a yield-dependent manner with high apheresis PLT yields (> or =6 x 10(11)) for AM-APCs (p < 0.001).
Although in vitro validation of AM- and TM-APCs has been performed, only by evaluating transfusion efficacy in vivo did the AM turn out to be not suitable for high-yield thrombocytapheresis. This study recommends the implementation of in vivo transfusion efficacy studies for high-yield APC apheresis donations.
对单供体单采血小板（PLT）浓缩物（APC）的需求稳步增长，这对PLT供应系统构成了挑战。因此，努力提高血小板单采产量，使单采产品可分成2个或更多单位，是有价值的策略。然而，目前尚无数据证明这些高产率分割APC的体内输血疗效。
研究了通过两种单采方法生产的APC的输血疗效，这两种方法涉及不同的采集和储存程序以及不同的PLT产量。疗效指标为1小时血小板回收率百分比（PPR(1h)）和1小时校正计数增加值（CCI(1h)）。总共400个APC被输注给55名儿童（31名女孩；中位年龄9.5岁；范围0.2 - 18.5岁），这些儿童因化疗或再生障碍性贫血导致血小板减少（中位值，每名儿童4个APC；范围1 - 68）。这些APC要么由Amicus设备（百特公司）生产并储存在PLT添加剂溶液（T - Sol；Amicus方法[AM]，n = 107）中，要么由Trima设备（甘布罗公司）生产并储存在血浆中（Trima方法[TM]，n = 293）。
AM - APC的输血疗效显著低于TM - APC（中位PPR(1h)分别为17%和33%；中位CCI(1h)分别为7.9和15.6；p < 0.001）。对于AM - APC，输血疗效降低与高产率单采PLT产量（≥6×10¹¹）呈产量依赖性相关（p < 0.001）。
虽然已对AM - APC和TM - APC进行了体外验证，但只有通过评估体内输血疗效，才发现AM不适合高产率血小板单采。本研究建议对高产率APC单采捐献开展体内输血疗效研究。
