冷存全血血小板功能在合并失血性休克的创伤患儿中得到保存。
Cold-stored whole blood platelet function is preserved in injured children with hemorrhagic shock.
机构信息
From the Department of Surgery, (C.M.L., B.A.G.); Department of Pathology (M.H.Y., D.T.), the University of Pittsburgh Medical Center; Department of Surgery (C.M.L., B.A.G.), Division of Pediatric Emergency Medicine (R.S.), Department of Anesthesiology and Perioperative Medicine (F.P.C.), Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
出版信息
J Trauma Acute Care Surg. 2019 Jul;87(1):49-53. doi: 10.1097/TA.0000000000002340.
BACKGROUND
Recent data demonstrate the safety of uncrossmatched cold-stored whole blood (WB) transfusion in pediatric trauma patients. The hemostatic capabilities of platelets within the cold-stored WB unit have been demonstrated via in vitro studies and animal models. However, platelet function has not been evaluated in pediatric recipients of cold-stored WB transfusions.
METHODS
Injured children, 2 years or older and 10 kg or greater with hemorrhagic shock received up to 30 mL/kg of cold-stored, low titer (<50) anti-A and -B, leukoreduced, group O- WB during their initial resuscitation. Patients were included if (1) they received WB and no conventional platelets, and (2) platelet count and thromboelastography maximum amplitude were measured both before and after transfusion. These data and relevant clinical outcomes (mortality, intensive care unit length of stay [LOS], hospital LOS and ventilator days) were compared to a historical cohort of pediatric trauma patients who received uncrossmatched red blood cells (RBC) and conventional room temperature platelets.
RESULTS
Twenty-two children were included in the study; 14 in the component cohort versus 8 in the WB cohort. Neither posttransfusion platelet count (129 × 109/L vs. 135 × 109/L) nor function (thromboelastography maximum amplitude, 59.5 mm vs. 60.2 mm) differed significantly between children receiving cold-stored platelets within the WB unit versus children who received conventional warm platelets. Median (interquartile range) weight-adjusted platelet transfusion volume in the historical cohort was 4.6 (2.5-7.7) mL/kg vs. 2.4 (1.3-4.0) mL/kg in the WB cohort (p = 0.03). There was no difference between groups in age, race, mechanism of injury, Injury Severity Score, vital signs, and severe traumatic brain injury (TBI). Outcomes, including mortality, intensive care unit LOS, hospital LOS, and ventilator days, were not significantly different between groups.
CONCLUSION
No difference was seen in posttransfusion platelet number or function in severely injured children receiving cold-stored WB platelets as compared to those receiving conventional room temperature-stored platelets. Larger cohorts are required to confirm these findings.
LEVEL OF EVIDENCE
Therapeutic, level IV.
背景
最近的数据表明，在儿科创伤患者中输注未经交叉配型的冷藏储存全血（WB）是安全的。通过体外研究和动物模型已经证明了冷藏储存 WB 单位内血小板的止血能力。然而，尚未在接受冷藏储存 WB 输注的儿科患者中评估血小板功能。
方法
2 岁及以上、体重 10kg 及以上且合并失血性休克的受伤儿童，在初始复苏期间接受高达 30mL/kg 的冷藏、低滴度（<50）抗-A 和抗-B、白细胞减少、O 型 WB。如果患者符合以下条件，则纳入研究：（1）输注 WB 且未输注常规血小板；（2）在输注前后均测量血小板计数和血栓弹性描记术最大振幅。将这些数据以及相关的临床结局（死亡率、重症监护病房住院时间[LOS]、医院 LOS 和呼吸机天数）与接受未经交叉配型的红细胞（RBC）和常规室温血小板的儿科创伤患者的历史队列进行比较。
结果
研究纳入了 22 名儿童；其中 14 名在成分组，8 名在 WB 组。输注后血小板计数（129×109/L 与 135×109/L）和功能（血栓弹性描记术最大振幅，59.5mm 与 60.2mm）在接受冷藏储存 WB 内血小板的儿童与接受常规温血小板的儿童之间无显著差异。历史队列中经体重校正的血小板输注量中位数（四分位距）为 4.6（2.5-7.7）mL/kg，而 WB 组为 2.4（1.3-4.0）mL/kg（p=0.03）。两组在年龄、种族、损伤机制、损伤严重程度评分、生命体征和严重创伤性脑损伤（TBI）方面无差异。死亡率、重症监护病房 LOS、医院 LOS 和呼吸机天数等结局在两组之间也无显著差异。
结论
与接受常规室温储存血小板的患者相比，严重受伤儿童输注冷藏储存的 WB 血小板后，血小板数量或功能无差异。需要更大的队列来证实这些发现。
证据水平
治疗性，IV 级。
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