Silver S S, Rock G, Décary F, Luke K H, Olberg B J, Jones T G, Fournier P W, Taylor J R, Bell M E, Giles A R
CMAJ. 1987 Jul 15;137(2):128-32.
To better understand the reasons for the increasing use of platelet concentrate in Canada, we undertook a 4-month study of platelet concentrate transfusion in six eastern Ontario hospitals in 1985. A total of 4801 units of platelet concentrate were transfused on 687 occasions to 303 patients; the average number of transfusions per patient was 2.3, the average number of units per transfusion 7.0 and the average number of units per patient 15.8. The cardiovascular service used the largest proportion of units (28%), aortocoronary bypass grafting being the most common procedure. The mean pretransfusion platelet count for the medical and oncology services was about 30.0 X 10(9)/L, compared with 155.5 X 10(9)/L for the cardiovascular service. An increment in platelet count 1 hour after transfusion was noted with 238 (75%) of the transfusions for which the data were available; the average increment was 3.4 X 10(9)/L per unit of platelet concentrate transfused. When the data for patients who did not respond were excluded, the average increment was 6.9 X 10(9)/L. Single-donor platelet concentrate was requested for only half of the transfusions to which no response was detected. The current medical literature supports the appropriate use of platelet concentrate in patients with thrombocytopenia due to chemotherapy, but prophylactic platelet transfusion for patients undergoing cardiovascular bypass procedures is being questioned. We advise continued surveillance of the use of these products and re-evaluation of the aims of platelet transfusion therapy.
为了更好地理解加拿大血小板浓缩物使用增加的原因，我们于1985年在安大略省东部的六家医院进行了一项为期4个月的血小板浓缩物输血研究。总共687次向303名患者输注了4801单位的血小板浓缩物；每位患者的平均输血次数为2.3次，每次输血的平均单位数为7.0个，每位患者的平均单位数为15.8个。心血管科使用的单位比例最大（28%），主动脉冠状动脉搭桥术是最常见的手术。内科和肿瘤科输血前的平均血小板计数约为30.0×10⁹/L，而心血管科为155.5×10⁹/L。在有数据的238次（75%）输血中，输血后1小时血小板计数有增加；每输注1单位血小板浓缩物的平均增加量为3.4×10⁹/L。排除无反应患者的数据后，平均增加量为6.9×10⁹/L。在未检测到反应的输血中，仅一半要求使用单采血小板浓缩物。当前医学文献支持对化疗引起的血小板减少症患者适当使用血小板浓缩物，但对接受心血管搭桥手术的患者进行预防性血小板输血正受到质疑。我们建议继续监测这些产品的使用情况，并重新评估血小板输血治疗的目标。
