Martinaud C, Chastagnet N, Sailliol A, de Jaureguiberry J-P, Aguilon P
Fédération de biologie clinique, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
Transfus Clin Biol. 2012 Feb;19(1):25-31. doi: 10.1016/j.tracli.2011.08.002. Epub 2012 Jan 30.
Platelet transfusion follows the national guidelines published in 2003 by the AFSSAPS, determining, for instance, indications, transfusion threshold and platelets dose. We wanted to assess how these guidelines are routinely used in our hospital, with a special focus on transfusion threshold and delivered dose.
We conducted a prospective study during 11 months on every platelet transfusion. Our establishment is a medium size structure, devoted to emergency and oncology, without bone marrow transplantation. During this period, 235 products were delivered to 105 patients. Half (52%) were delivered to oncological units, a third to emergency units and the remaining to medical and surgical units.
The average dose was 4.3±0.8×10(11) platelets (2.0 to 7.6×10(11) platelets), corresponding to 0.45×10(11) platelets per 7kg. During prophylactic transfusions, the average platelet count was 9.4±5.5G/L ; during curative transfusions (43%), it was 39.0±47.8G/L and finally when platelets were infused during surgery (21%), the average platelet count was 57.8±61.4G/L.
Globally, with regard to transfusion threshold, guidelines were followed in 71%, and 93% in oncological units. Transfusion efficacy, attested by post-transfusion platelet efficiency was above 20% in 59% of the cases. These data highlight a good respect of the transfusion thresholds in the usual platelets-consuming units, but raise the question of the dose, often under those proposed by the guidelines.
血小板输注遵循法国药品安全局（AFSSAPS）2003年发布的国家指南，该指南确定了例如适应证、输血阈值和血小板剂量等内容。我们希望评估这些指南在我院的常规使用情况，特别关注输血阈值和输注剂量。
我们对11个月内的每一次血小板输注进行了前瞻性研究。我们的机构是一个中等规模的医疗机构，专注于急诊和肿瘤治疗，不进行骨髓移植。在此期间，共向105例患者输注了235个血小板制品。其中一半（52%）输注到肿瘤科室，三分之一输注到急诊科室，其余输注到内科和外科科室。
平均剂量为4.3±0.8×10¹¹个血小板（2.0至7.6×10¹¹个血小板），相当于每7千克体重输注0.45×10¹¹个血小板。在预防性输注期间，平均血小板计数为9.4±5.5G/L；在治疗性输注时（43%），平均血小板计数为39.0±47.8G/L；最后在手术期间输注血小板时（21%），平均血小板计数为57.8±61.4G/L。
总体而言，在输血阈值方面，71%的情况遵循了指南，在肿瘤科室这一比例为93%。通过输血后血小板效率证实的输血疗效在59%的病例中高于20%。这些数据表明在通常消耗血小板的科室中对输血阈值的遵循情况良好，但也提出了剂量问题，实际剂量往往低于指南建议的剂量。
