Callan Mary Beth, Appleman Elizabeth H, Sachais Bruce S
Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6010, USA.
J Vet Emerg Crit Care (San Antonio). 2009 Oct;19(5):401-15. doi: 10.1111/j.1476-4431.2009.00454.x.
To review potential platelet storage options, guidelines for administration of platelets, and adverse events associated with platelet transfusions.
Data sources included original research publications and scientific reviews.
Transfusion of platelet concentrates (PCs) plays a key role in the management of patients with severe thrombocytopenia. Currently PCs are stored at 22 degrees C under continuous gentle agitation for up to 5 days. Chilling of platelets is associated with rapid clearance of transfused platelets, and galactosylation of platelets has proven unsuccessful in prolonging platelet survival. Although approved by the American Association of Blood Banks, cryopreservation of human platelets in 6% DMSO largely remains a research technique. Pre-storage leukoreduction of PCs has reduced but not eliminated acute inflammatory transfusion reactions, with platelet inflammatory mediators contributing to such reactions.
Canine plateletpheresis allows collection of a concentrate with a high platelet yield, typically 3-4.5 x 10(11) versus <1 x 10(11) for whole blood-derived platelets, improving the ability to provide sufficient platelets to meet the recipient's transfusion needs. Cryopreservation of canine platelets in 6% DMSO offers immediate availability of platelets, with an acceptable posttransfusion in vivo platelet recovery and half-life of 50% and 2 days, respectively. While data on administration of rehydrated lyophilized platelets in bleeding animal models are encouraging, due to a short lifespan (min) posttransfusion, their use will be limited to control of active bleeding, without a sustained increase in platelet count.
Fresh PC remains the product of choice for control of bleeding due to severe thrombocytopenia or thrombopathia. While cryopreservation and lyophilization of canine platelets offer the benefits of immediate availability and long-term storage, the compromise is decreased in vivo recovery and survival of platelets and some degree of impaired function, though such products could still be life saving.
回顾血小板潜在的储存方法、血小板输注指南以及与血小板输注相关的不良事件。
数据来源包括原始研究出版物和科学综述。
浓缩血小板（PC）的输注在严重血小板减少症患者的治疗中起着关键作用。目前，PC在22摄氏度下持续轻柔搅拌储存，最长可达5天。血小板冷藏会导致输注的血小板迅速清除，而血小板半乳糖基化在延长血小板存活期方面已被证明不成功。尽管得到了美国血库协会的批准，但在6%二甲基亚砜中对人类血小板进行冷冻保存很大程度上仍是一种研究技术。PC储存前白细胞去除减少了但并未消除急性炎症性输血反应，血小板炎症介质会导致此类反应。
犬类血小板单采可收集到高产量的浓缩物，通常为3 - 4.5×10¹¹个，而全血来源的血小板产量小于1×10¹¹个，提高了提供足够血小板以满足受血者输血需求的能力。在6%二甲基亚砜中对犬类血小板进行冷冻保存可使血小板即时可用，体内输血后血小板回收率和半衰期分别为50%和2天，可接受。虽然在出血动物模型中关于复水冻干血小板给药的数据令人鼓舞，但由于输血后寿命较短（分钟），其应用将仅限于控制活动性出血，而不会使血小板计数持续增加。
新鲜PC仍然是控制严重血小板减少症或血小板病所致出血的首选产品。虽然犬类血小板的冷冻保存和冻干提供了即时可用和长期储存的益处，但代价是体内血小板回收率和存活率降低以及一定程度的功能受损，不过此类产品仍可能挽救生命。
