Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Transfusion. 2011 May;51(5):1030-6. doi: 10.1111/j.1537-2995.2010.02897.x. Epub 2010 Oct 4.
Washed or volume-reduced platelets (PLTs) are occasionally requested for patients with a history of allergic or anaphylactic transfusion reactions. However, conclusive data are not available as to which method is more suitable.
A direct comparison of saline-washed and volume-reduced PLTs was performed by splitting 11 units of 6-day-old apheresis PLT units. PLT activation, aggregation, plasma protein, and PLT count were determined before and after each procedure. To assess whether washing using neutral, calcium-free Ringer's acetate (NRA) would better preserve PLT function, 8 additional units of apheresis PLTs were split and were washed in saline or NRA.
Saline washing resulted in significantly increased number of activated, P-selectin-expressing PLTs compared to volume reduction (24.2% vs. 10.3%, p = 0.001). Aggregation was also significantly reduced (-40.6% vs. -0.8%, p = 0.004). Plasma protein removal was significantly better for saline-washed than volume-reduced PLTs (96% vs. 51.1%, p < 0.001). PLT recovery was not significantly different for saline-washed versus volume-reduced PLTs (70.5% vs. 80.7%, p = 0.079). There was no difference between washing in saline or NRA with regard to PLT activation and loss of aggregation.
PLT washing with saline or NRA significantly increases PLT activation and decreases PLT aggregability. On the other hand, volume reduction does not adequately remove plasma proteins. Therefore, PLT washing should be reserved for patients with a history of severe allergic or anaphylactic transfusion reactions. We suggest that fresher PLTs be selected to improve the functionality of washed PLTs.
对于有过敏或过敏样输血反应史的患者，偶尔会要求使用洗涤或体积减少的血小板（PLT）。然而，目前尚无确凿数据表明哪种方法更合适。
通过将 11 个 6 天龄的单采 PLT 单位分成两半，对生理盐水洗涤和体积减少的 PLT 进行了直接比较。在每个程序前后测定 PLT 激活、聚集、血浆蛋白和 PLT 计数。为了评估使用中性、无钙林格醋酸盐（NRA）洗涤是否能更好地保存 PLT 功能，将另外 8 个单采 PLT 单位分成两半，分别在生理盐水或 NRA 中洗涤。
与体积减少相比，生理盐水洗涤导致激活的、P-选择素表达的 PLT 数量显著增加（24.2%比 10.3%，p=0.001）。聚集也明显减少（-40.6%比-0.8%，p=0.004）。与体积减少的 PLT 相比，生理盐水洗涤的血浆蛋白清除率显著更好（96%比 51.1%，p<0.001）。生理盐水洗涤与体积减少的 PLT 相比，PLT 回收率无显著差异（70.5%比 80.7%，p=0.079）。生理盐水或 NRA 洗涤对 PLT 激活和聚集损失没有差异。
用生理盐水或 NRA 洗涤 PLT 会显著增加 PLT 激活并降低 PLT 聚集性。另一方面，体积减少不能充分去除血浆蛋白。因此，PLT 洗涤应保留给有严重过敏或过敏样输血反应史的患者。我们建议选择更新鲜的 PLT 以改善洗涤 PLT 的功能。
