Vande Vusse Lisa K, Madtes David K, Bolgiano Douglas, Watkins Timothy R
Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington.
Fred Hutchinson Cancer Research Center, Seattle, Washington.
Transfusion. 2016 Feb;56(2):489-96. doi: 10.1111/trf.13361. Epub 2015 Oct 4.
Methods used to produce platelet (PLT) components, pooling of PLT-rich plasma (PRP-PLT) and apheresis (AP-PLT), may variably contribute to the pathogenesis and severity of idiopathic pneumonia syndrome (IPS).
We performed a retrospective cohort study of 906 allogeneic hematopoietic cell transplant recipients to examine associations between PLT product type and risks of developing IPS and dying after IPS onset. Proportional hazards models included separate terms for the sum of all PLT transfusions and the sum of PRP-PLT units received in the 3 or 7 days before IPS onset. Similarly constructed models analyzed the outcome of time to death after IPS onset. All analyses were adjusted for known IPS risk factors.
Patients received a median of three PRP-PLT transfusions (interquartile range [IQR], 0-6) and five AP-PLT transfusions (IQR, 1-13) while at risk for IPS. Seventy-five patients (8%) developed IPS by Posttransplant Day 120. The proportion of PRP-PLT transfusions was not associated with risk of developing IPS (3-day hazard ratio [HR] 0.98, 95% CI 0.74-1.29, p = 0.86; 7-day HR 1.00, 95% CI 0.86-1.15, p = 0.95) or dying after IPS onset (3-day HR 0.99, 95% CI 0.75-1.31, p = 0.97; 7-day HR 0.98, 95% CI 0.78-1.12, p = 0.47).
The association between PLT transfusions and risk of developing IPS or dying after IPS onset does not differ according to PLT product type. Further research is required to identify potentially modifiable steps in PLT component production that contribute to IPS.
用于制备血小板（PLT）成分的方法，即富含血小板血浆汇集法（PRP-PLT）和单采法（AP-PLT），可能在特发性肺炎综合征（IPS）的发病机制和严重程度中发挥不同作用。
我们对906例异基因造血细胞移植受者进行了一项回顾性队列研究，以检验PLT产品类型与发生IPS的风险以及IPS发病后死亡风险之间的关联。比例风险模型包括IPS发病前3天或7天内所有PLT输注总量以及接受的PRP-PLT单位总量的单独项。类似构建的模型分析了IPS发病后至死亡时间的结局。所有分析均对已知的IPS风险因素进行了校正。
患者在有发生IPS风险期间，接受PRP-PLT输注的中位数为3次（四分位间距[IQR]，0 - 6），接受AP-PLT输注的中位数为5次（IQR，1 - 13）。75例患者（8%）在移植后第120天前发生了IPS。PRP-PLT输注的比例与发生IPS的风险（3天风险比[HR] 0.98，95%可信区间[CI] 0.74 - 1.29，p = 0.86；7天HR 1.00，95% CI 0.86 - 1.15，p = 0.95）或IPS发病后死亡风险（3天HR 0.99，95% CI 0.75 - 1.31，p = 0.97；7天HR 0.98，95% CI 0.78 - 1.12，p = 0.47）均无关联。
PLT输注与发生IPS的风险或IPS发病后死亡风险之间的关联不因PLT产品类型而异。需要进一步研究以确定PLT成分生产中可能导致IPS的可改变步骤。
