Murphy M F
Department of Haematology, St. Bartholomew's Hospital and Medical College, London, UK.
Infusionsther Transfusionsmed. 1994 Nov;21 Suppl 3:34-8. doi: 10.1159/000223060.
Platelet transfusions are established as effective treatment for thrombocytopenic bleeding. However, the indications for prophylactic platelet transfusions are being reconsidered because of the greatly increased demand for platelet concentrates. Platelet refractoriness is the main clinical problem associated with repeated platelet transfusions. This is most frequently due to HLA alloimmunisation or non-immune platelet consumption associated with clinical factors such as septicaemia. The initial management of refractory alloimmunised patients is to use HLA-matched platelet transfusions. If there is no improvement with HLA-matched platelet transfusions, platelet crossmatching may identify the cause of the problem and help with the selection of compatible donors. Other measures used to improve responses to platelet transfusions are usually ineffective. There has been considerable interest in methods to prevent HLA alloimmunisation and platelet refractoriness and particularly in leucocyte depletion of blood components. The use of leucocyte-depleted blood components has other benefits for multitransfused patients, but further studies are needed before the routine use of leucocyte-depleted blood components can be recommended for patients likely to receive repeated platelet transfusions.
血小板输注已被确立为治疗血小板减少性出血的有效方法。然而，由于对血小板浓缩物的需求大幅增加，预防性血小板输注的指征正在重新审视。血小板输注无效是与反复血小板输注相关的主要临床问题。这最常见的原因是 HLA 同种免疫或与败血症等临床因素相关的非免疫性血小板消耗。对输注无效的同种免疫患者的初始处理是使用 HLA 配型的血小板输注。如果 HLA 配型的血小板输注没有改善，血小板交叉配型可能会确定问题的原因并有助于选择相容的供体。用于改善对血小板输注反应的其他措施通常无效。预防 HLA 同种免疫和血小板输注无效的方法备受关注，尤其是血液成分的白细胞去除。使用去除白细胞的血液成分对多次输血的患者还有其他益处，但在建议可能接受反复血小板输注的患者常规使用去除白细胞的血液成分之前，还需要进一步研究。
