Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
J Neurosurg. 2011 Aug;115(2):268-72. doi: 10.3171/2011.4.JNS101784. Epub 2011 May 13.
Intracranial hemorrhage (ICH) is a frequent complication found in leukemia patients with thrombocytopenia. At the University of Texas MD Anderson Cancer Center, when a leukemia patient is found to have ICH, a platelet transfusion is generally recommended until 50,000/μl is reached. The authors examine the feasibility and outcome of their intervention strategy in this study.
Records were reviewed from 76 consecutive leukemia patients with newly diagnosed ICH at the University of Texas MD Anderson Cancer Center from January 1, 2007, to December 31, 2009. Variables of interest included age, platelet count at presentation, leukemia subtype, history of trauma, Glasgow Coma Scale score at presentation, whether the 50,000/μl goal was reached after transfusion, and whether the patient was a transfusion responder (platelet count increase > 2000/μl/unit transfused). Outcome parameters were mortality rates at 72 hours and 30 days and imaging-documented hemorrhage progression.
Thrombocytopenia was prevalent at the time of presentation (68 of 76 patients had platelet levels < 50,000/μl at presentation). Despite an aggressive transfusion protocol, only 24 patients reached the 50,000/μl target after an average of 16 units of transfusion. Death due to ICH occurred in 15 patients within the first 72 hours (mortality rate 19.7%). Death correlated with the presenting Glasgow Coma Scale score (p = 0.0075) but not with other transfusion-related parameters. A significant mortality rate was again observed after 30 days (32.7%). The 30-day mortality rate, however, was largely attributable to non-ICH related causes and correlated with patient age (p = 0.032) and whether the patient was a transfusion responder (p = 0.022). Reaching and maintaining a platelet count > 50,000/μl did not positively correlate with the 30-day mortality rate (p = 0.392 and 0.475, respectively).
Platelet transfusion in the setting of ICH in leukemia patients is undoubtedly necessary, but whether the transfusion threshold should be 50,000/μl remains unclear. Factors other than thrombocytopenia likely contribute to the overall poor prognosis.
颅内出血（ICH）是血小板减少症白血病患者常见的并发症。在德克萨斯大学 MD 安德森癌症中心，当白血病患者被发现患有 ICH 时，通常建议进行血小板输注，直到血小板计数达到 50,000/μl。作者在这项研究中检查了他们干预策略的可行性和结果。
对 2007 年 1 月 1 日至 2009 年 12 月 31 日期间在德克萨斯大学 MD 安德森癌症中心新诊断为 ICH 的 76 例连续白血病患者的记录进行了回顾。感兴趣的变量包括年龄、就诊时的血小板计数、白血病亚型、创伤史、就诊时的格拉斯哥昏迷量表评分、输注后是否达到 50,000/μl 目标以及患者是否为输血应答者（血小板计数增加> 2000/μl/单位输注）。预后参数为 72 小时和 30 天的死亡率以及影像学记录的出血进展。
就诊时血小板减少症很常见（76 例患者中有 68 例就诊时血小板水平<50,000/μl）。尽管采用了积极的输血方案，但只有 24 例患者在平均输注 16 单位后达到了 50,000/μl 的目标。15 例患者在最初的 72 小时内因 ICH 死亡（死亡率为 19.7%）。死亡与就诊时的格拉斯哥昏迷量表评分相关（p = 0.0075），但与其他输血相关参数无关。30 天后再次观察到显著的死亡率（32.7%）。然而，30 天的死亡率主要归因于非 ICH 相关原因，并与患者年龄（p = 0.032）和患者是否为输血应答者（p = 0.022）相关。达到并维持血小板计数> 50,000/μl 与 30 天死亡率无显著相关性（分别为 p = 0.392 和 0.475）。
白血病患者 ICH 时进行血小板输注无疑是必要的，但输注阈值是否应为 50,000/μl 尚不清楚。除血小板减少症以外的因素可能对整体预后产生不利影响。
