Lozano Miguel, Cid Joan
University Clinic Hospital, Biomedical Diagnosis Center, IDIBAPS, Department of Hemotherapy and Hemostasis, Barcelona, Spain.
University Clinic Hospital, Biomedical Diagnosis Center, IDIBAPS, Department of Hemotherapy and Hemostasis, Barcelona, Spain.
Presse Med. 2016 Jul-Aug;45(7-8 Pt 2):e289-98. doi: 10.1016/j.lpm.2016.06.020. Epub 2016 Jul 27.
Platelet transfusions continue to be the mainstay to treat patients with quantitative and qualitative platelet disorders. Each year, about 10 millions of platelet transfusions are administered to patients worldwide with marked differences in usage between regions depending on socioeconomic development of the countries. Unfortunately, its use is associated to immune and non-immune side effects. Among the non-immune, bacterial contamination is still the major infectious risk. When bacterial culture methods are introduced for preventing bacterial septic reactions it has been found that this strategy reduce to one half the septic reactions, but do not eliminate completely that risk. To remove completely the risk, a new bacteria detection test at the time of issuance in the case of platelets stored for four or five days would be needed. Pathogen inactivation (PI) methods already in the market (based in the addition of amotosalen (A-L) or riboflavin (R-L) and the illumination with ultraviolet light) or under development (ultraviolet light C and agitation) have shown to be efficacious in the inactivation of bacteria and no cases of septic reactions associated to a pathogen-reduced product has been identified. However, it has been shown that PI technologies have measurable effects on platelet in vitro parameters and reduce the recovery and survival of treated platelets in vivo. Although these effects do not hamper the hemostatic capacity of treated platelets, an increased usage associated with PI technologies has been reported. This increase in utilization seems to be the toll to be paid if we want to completely eliminate the risk of bacterial sepsis in the recipients of platelet transfusion.
血小板输注仍然是治疗血小板数量和质量异常患者的主要手段。每年，全球约有1000万次血小板输注用于患者，不同地区的使用情况存在显著差异，这取决于各国的社会经济发展水平。不幸的是，其使用与免疫和非免疫副作用相关。在非免疫副作用中，细菌污染仍然是主要的感染风险。当引入细菌培养方法来预防细菌败血症反应时，发现这种策略可将败血症反应减少一半，但并不能完全消除该风险。为了完全消除风险，需要在发放储存四五天的血小板时进行新的细菌检测试验。市场上已有的病原体灭活（PI）方法（基于添加氨甲环酸（A-L）或核黄素（R-L）并进行紫外线照射）或正在研发的方法（紫外线C和搅拌）已证明对细菌灭活有效，且未发现与病原体减少产品相关的败血症反应病例。然而，已表明PI技术对血小板的体外参数有可测量的影响，并降低了体内处理后血小板的回收率和存活率。尽管这些影响不妨碍处理后血小板的止血能力，但据报道与PI技术相关的使用量有所增加。如果我们想完全消除血小板输注受者的细菌败血症风险，这种使用量的增加似乎是要付出的代价。
