Bishop J F, McGrath K, Wolf M M, Matthews J P, De Luise T, Holdsworth R, Yuen K, Veale M, Whiteside M G, Cooper I A
Alfred Hospital, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.
Blood. 1988 Feb;71(2):383-7.
To determine the relative importance of clinical factors on the efficacy of platelet transfusions, 941 pooled platelet transfusions from HLA-unmatched donors were studied prospectively in 133 patients with bone marrow failure. Multiple linear regression analyses identified the major factors influencing one-hour-corrected increments (CI) as prior splenectomy, bone marrow transplantation, disseminated intravascular coagulation, concurrent intravenous amphotericin B, splenomegaly, and HLA antibody grade. The relative impact of these factors on CI has been quantitated by using a formula developed from these data. A linear relationship was demonstrated between increasing percentage of HLA antibody grade and decreasing CI. A number of other factors were less important in the linear regression model than the aforementioned major factors. These included platelet-specific antibodies, concurrent antibacterial antibiotics, clinical bleeding grade, and temperature. Factors that did not influence CI included the number of prior platelet transfusions, prior granulocyte transfusions, prior red cell transfusions, infection, age, blood group, diagnosis, sex, pretransfusion platelet count, prior pregnancies, and concurrent antineoplastic drugs. This study identified major clinical factors that significantly influenced CI and were major causes of refractoriness to pooled platelet transfusions.
为确定临床因素对血小板输注疗效的相对重要性，我们对133例骨髓衰竭患者前瞻性地研究了941次来自HLA不匹配供者的混合血小板输注。多元线性回归分析确定影响1小时校正增加值（CI）的主要因素为既往脾切除术、骨髓移植、弥散性血管内凝血、同时静脉使用两性霉素B、脾肿大和HLA抗体分级。通过使用根据这些数据推导的公式对这些因素对CI的相对影响进行了量化。结果表明HLA抗体分级百分比增加与CI降低之间存在线性关系。在多元线性回归模型中，许多其他因素不如上述主要因素重要。这些因素包括血小板特异性抗体、同时使用的抗菌抗生素、临床出血分级和体温。不影响CI的因素包括既往血小板输注次数、既往粒细胞输注次数、既往红细胞输注次数、感染、年龄、血型、诊断、性别、输血前血小板计数、既往妊娠次数和同时使用的抗肿瘤药物。本研究确定了显著影响CI且是混合血小板输注无效的主要原因的主要临床因素。
