Hernández M R, Bozzo J, Mazzara R, Ordinas A, Escolar G
Servei d'Hemoteràpia, Hospital Clínic i Provincial, Barcelona, Spain.
Transfusion. 1995 Aug;35(8):660-5. doi: 10.1046/j.1537-2995.1995.35895357897.x.
Evaluation of the hemostatic effectiveness of platelet transfusions is difficult. Perfusion methods have been employed to test the quality and function of platelet concentrates, allowing differentiation between platelet-platelet and platelet-surface interactions.
A study was performed to investigate platelet adhesive and cohesive properties as well as the formation of fibrin when aliquots of platelet concentrates were added to thrombocytopenic blood. Blood previously anticoagulated with low-molecular-weight heparin (20 U/mL) underwent platelet and white cell reduction by filtration. Perfusates were prepared by adding to filtered blood platelets obtained from standard concentrates (stored for 1, 3, and 5 days). The final platelet count in these perfusates was standardized at 80,000 per microL. After perfusions, platelet-subendothelium interaction and fibrin formation were analyzed morphometrically. Results were always compared with those obtained in unfiltered blood (> 150,000 platelets/microL).
A slight impairment in the ability of stored platelets to interact with the subendothelium was noticed during the storage period. However, the presence of fibrin was significantly greater than that observed in studies with unfiltered blood (Day 1 = 23.48 +/- 9.43%; Day 3 = 26.99 +/- 6.74%; Day 5 = 17.95 +/- 9.06% vs. unfiltered blood = 12.60 +/- 3.08%; *p < 0.05). The lower platelet counts (80,000/microL) in the perfusates containing platelets from concentrates could account for the reduced platelet-subendothelium interactions, but they cannot explain the increments in fibrin formation.
While the preparation and storage of platelets have a detrimental effect on platelet adhesiveness, such procedures can positively influence the platelet procoagulant activity necessary to platelet hemostasis.
评估血小板输注的止血效果存在困难。已采用灌注方法来检测血小板浓缩物的质量和功能，从而区分血小板与血小板之间以及血小板与表面之间的相互作用。
开展了一项研究，以调查当将血小板浓缩物的等分试样添加到血小板减少的血液中时血小板的黏附性和凝聚性以及纤维蛋白的形成情况。先前用低分子量肝素（20 U/mL）抗凝的血液通过过滤进行血小板和白细胞减少处理。通过向过滤后的血液中添加从标准浓缩物（储存1、3和5天）中获得的血小板来制备灌注液。这些灌注液中的最终血小板计数标准化为每微升80,000个。灌注后，对血小板与内皮下的相互作用以及纤维蛋白的形成进行形态计量学分析。结果始终与在未过滤血液（>150,000个血小板/微升）中获得的结果进行比较。
在储存期间，注意到储存的血小板与内皮下相互作用的能力略有受损。然而，纤维蛋白的存在明显高于在未过滤血液的研究中观察到的情况（第1天 = 23.48 +/- 9.43%；第3天 = 26.99 +/- 6.74%；第5天 = 17.95 +/- 9.06%，而未过滤血液为 = 12.60 +/- 3.08%；*p < 0.05）。含有来自浓缩物的血小板的灌注液中较低的血小板计数（80,000/微升）可能是血小板与内皮下相互作用减少的原因，但无法解释纤维蛋白形成的增加。
虽然血小板的制备和储存对血小板黏附性有不利影响，但此类操作可对血小板止血所需的血小板促凝活性产生积极影响。
