Transfusion Medicine, Department of Pathology and Laboratory, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY.
Critical Care and Cardiology, Department of Pediatrics, Strong Memorial Hospital and Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY.
Transfus Med Rev. 2017 Oct;31(4):252-257. doi: 10.1016/j.tmrv.2017.04.002. Epub 2017 May 4.
Thrombocytopenia or receipt of antiplatelet drugs, with or without bleeding, is a common indication for platelet transfusions in the ICU. However, there is almost no evidence base for these practices other than expert opinion. Also common is use of platelet transfusions prior to invasive procedures or surgery in patients with thrombocytopenia. Likewise, there is no high-quality evidence that such practices are efficacious or safe. Recently, it has become clear that, whether causal or not, patients receiving prophylactic platelet transfusions experience high rates of nosocomial infection, thrombosis, organ failure, and mortality, which increase the urgency and need for randomized trials to assess these practices. Investigational methods of improving the safety and efficacy of platelet transfusions include use of alternate strategies such as antifibrinolytics; use of ABO-identical, leukoreduced, and washed platelet transfusions; and improved storage solutions.
血小板减少症或使用抗血小板药物，无论是否有出血，都是 ICU 中血小板输注的常见指征。然而，除了专家意见外，这些做法几乎没有任何证据基础。在血小板减少症患者进行侵入性操作或手术前输注血小板也很常见。同样，也没有高质量的证据表明这些做法是有效或安全的。最近，人们已经清楚地认识到，无论是否有因果关系，接受预防性血小板输注的患者都会发生高比例的医院感染、血栓形成、器官衰竭和死亡，这增加了进行随机试验以评估这些做法的紧迫性和必要性。提高血小板输注安全性和有效性的研究方法包括使用替代策略，如抗纤维蛋白溶解剂；使用 ABO 同型、白细胞减少和洗涤血小板输注；以及改进储存液。
