Klingemann H G, Self S, Banaji M, Deeg H J, Doney K, Slichter S J, Thomas E D, Storb R
Br J Haematol. 1987 May;66(1):115-21.
Frequent platelet support is an essential part of the management of patients with severe aplastic anaemia and platelet transfusions from random donors are usually given as initial therapy. To evaluate those parameters that might correlate with the development of refractoriness to platelets from random donors, we performed a retrospective multivariate analysis in 264 patients with severe aplastic anaemia who presented for allogeneic bone marrow transplantation. Two hundred and ten (79.5%) of these patients had received multiple platelet and red cell transfusions, and 71 (34%) were refractory to random donor platelets. The strongest factor correlating with refractoriness was the presence of lymphocytotoxic antibodies, followed by the number of platelet units previously transfused. However, the latter variable attained significance only when the number of platelet units transfused exceeded 40. When given HLA-compatible platelet transfusions, only five (7%) of the refractory patients did not show a reasonable post-transfusion platelet increment. Measures which would delay or prevent platelet alloimmunization might include a policy of therapeutic rather than prophylactic platelet transfusions, and referring patients early in the course of their disease for marrow grafting if a suitable donor is available.
频繁的血小板支持是重型再生障碍性贫血患者治疗的重要组成部分，随机供者的血小板输注通常作为初始治疗。为了评估那些可能与对随机供者血小板产生不应性相关的参数，我们对264例准备接受异基因骨髓移植的重型再生障碍性贫血患者进行了回顾性多变量分析。其中210例（79.5%）患者接受了多次血小板和红细胞输注，71例（34%）对随机供者血小板不应。与不应性相关的最强因素是淋巴细胞毒性抗体的存在，其次是先前输注的血小板单位数量。然而，只有当输注的血小板单位数量超过40时，后一个变量才具有统计学意义。当给予HLA配型相合的血小板输注时，只有5例（7%）不应性患者在输血后血小板未出现合理的增加。延迟或预防血小板同种免疫的措施可能包括采取治疗性而非预防性血小板输注策略，以及如果有合适供者，在疾病早期就将患者转介进行骨髓移植。
