Kobayashi J, Yanagisawa R, Ono T, Tatsuzawa Y, Tokutake Y, Kubota N, Hidaka E, Sakashita K, Kojima S, Shimodaira S, Nakamura T
Department of Laboratory Medicine, Nagano Children's Hospital, Azumino, Japan.
Life Science Research Center, Nagano Children's Hospital, Azumino, Japan.
Vox Sang. 2018 Feb;113(2):128-135. doi: 10.1111/vox.12608. Epub 2017 Oct 25.
Adverse reactions to platelet transfusions are a problem. Children with primary haematological and malignant diseases may experience allergic transfusion reactions (ATRs) to platelet concentrates (PCs), which can be prevented by giving washed PCs. A new platelet additive solution, using bicarbonated Ringer's solution and acid-citrate-dextrose formula A (BRS-A), may be better for platelet washing and storage, but clinical data are scarce.
A retrospective cohort study for consecutive cases was performed between 2013 and 2017. For 24 months, we transfused washed PCs containing BRS-A to children with primary haematological and malignant diseases and previous adverse reactions. Patients transfused with conventional PCs (containing residual plasma) were assigned as controls, and results were compared in terms of frequency of ATRs, corrected count increment (CCI) and occurrence of bleeding. We also studied children transfused with PCs washed by a different system as historical controls.
Thirty-two patients received 377 conventional PC transfusions. ATRs occurred in 12 (37·5%) patients from transfused with 18 (4·8%) bags. Thirteen patients, who experienced reactions to regular PCs in plasma, then received 119 transfusion bags of washed PCs containing BRS-A, and none had ATRs to washed PCs containing BRS-A. Before study period, six patients transfused 137 classical washed PCs with different platelet additive solution, under same indication, ATRs occurred in one (16·7%) patient from transfused with one (0·7%) bags. CCIs (24 h) in were lower with classical washed PCs (1·26 ± 0·54) compared to regular PCs in plasma (2·07 ± 0·76) (P < 0·001), but there was no difference between washed PCs containing BRS-A (2·14 ± 0·77) and regular PCs (2·21 ± 0·79) (P = 0·769), and we saw no post-transfusion bleeding.
Washed PCs containing BRS-A appear to prevent ATRs without loss of transfusion efficacy in children with primary haematological and malignant diseases. Their efficacy should be further evaluated through larger prospective clinical trials.
血小板输注的不良反应是一个问题。患有原发性血液系统疾病和恶性疾病的儿童可能会对血小板浓缩物（PC）发生过敏输血反应（ATR），而输注洗涤后的PC可预防此类反应。一种使用碳酸氢林格氏溶液和酸性枸橼酸盐葡萄糖配方A（BRS - A）的新型血小板添加剂溶液，可能更有利于血小板的洗涤和储存，但临床数据较少。
对2013年至2017年的连续病例进行了一项回顾性队列研究。在24个月的时间里，我们将含有BRS - A的洗涤后PC输注给患有原发性血液系统疾病和恶性疾病且既往有不良反应的儿童。将输注传统PC（含有残余血浆）的患者作为对照，并比较两组在ATR频率、校正计数增加值（CCI）和出血发生率方面的结果。我们还研究了用不同系统洗涤的PC进行输血的儿童作为历史对照。
32例患者接受了377次传统PC输注。接受18袋（4.8%）传统PC输注的12例（37.5%）患者发生了ATR。13例曾对血浆中的常规PC有反应的患者，随后接受了119袋含有BRS - A的洗涤后PC输注，且无一例对含有BRS - A的洗涤后PC发生ATR。在研究期之前，6例患者在相同指征下输注了137袋用不同血小板添加剂溶液洗涤的传统洗涤后PC，接受1袋（0.7%）输注的1例（16.7%）患者发生了ATR。与血浆中的常规PC（2.07±0.76）相比，传统洗涤后PC的（24小时）CCI较低（1.26±0.54）（P<0.001），但含有BRS - A的洗涤后PC（2.14±0.77）与常规PC（2.21±0.79）之间无差异（P = 0.769），且我们未观察到输血后出血情况。
含有BRS - A的洗涤后PC似乎可预防患有原发性血液系统疾病和恶性疾病儿童的ATR，且不损失输血疗效。其疗效应通过更大规模的前瞻性临床试验进一步评估。
