Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, United States of America.
Blood Transfus. 2019 Jul;17(4):321-330. doi: 10.2450/2019.0095-19.
Reports from both adult and paediatric populations indicate that approximately two-thirds of platelet transfusions are used prophylactically to prevent bleeding, while the remaining one-third are used therapeutically to manage active bleeding. These two indications, prophylactic and therapeutic, serve two very distinct purposes and therefore will have two different functional requirements. In addition, disease aetiology in a given patient may require platelets with different functional characteristics. These characteristics can be derived from the various manufacturing methods used in platelet product production, including collection methods, processing methods, and storage options. The iterative combinations of manufacturing methods can result in a number of unique platelet products with different efficacy and safety profiles, which could potentially be used to benefit patient populations by meeting diverse clinical needs. In particular, cold storage of platelet products causes many biochemical and functional changes, of which the most notable characterised to date include increased haemostatic activity and altered expression of molecules inherent to platelet:leucocyte interactions. The in vivo consequences, both short- and long-term, of these molecular and cellular cold-storage-induced changes have yet to be clearly defined. Elucidation of these mechanisms would potentially reveal unique biologies that could be harnessed to provide more targeted therapies. To this end, in this new era of personalised medicine, perhaps there is an opportunity to provide individual patients with platelet products that are tailored to their clinical condition and the specific indication for transfusion.
来自成人和儿科人群的报告表明，大约三分之二的血小板输注是预防性的，用于预防出血，而其余的三分之一是用于治疗活动性出血。这两个适应症，预防性和治疗性，有两个非常不同的目的，因此将有两个不同的功能要求。此外，患者的疾病病因可能需要具有不同功能特性的血小板。这些特性可以从血小板产品生产中使用的各种制造方法中获得，包括采集方法、处理方法和储存选择。制造方法的迭代组合可以产生许多具有不同疗效和安全性特征的独特血小板产品，这些产品有可能通过满足不同的临床需求来使患者群体受益。特别是，血小板产品的冷藏会导致许多生化和功能变化，其中迄今为止最显著的特点包括止血活性增加和血小板：白细胞相互作用固有分子的表达改变。这些分子和细胞冷藏诱导变化的体内短期和长期后果尚未明确界定。阐明这些机制可能会揭示出独特的生物学特性，从而为提供更有针对性的治疗提供可能。为此，在这个个性化医疗的新时代，也许有机会为患者提供根据其临床状况和输血的具体适应症定制的血小板产品。
