Goldberg G L, Gibbon D G, Smith H O, DeVictoria C, Runowicz C D, Burns E R
Department of Obstetrics and Gynecology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10461.
J Clin Oncol. 1994 Nov;12(11):2317-20. doi: 10.1200/JCO.1994.12.11.2317.
This retrospective analysis of 501 patients with gynecologic cancer treated with chemotherapy evaluates the relationship between platelet count and clinical bleeding, as well as the clinical effects of platelet transfusion therapy. Thrombocytopenic patients were divided into six groups according to platelet counts, and major or minor bleeding manifestations were documented. Thrombocytopenia was defined as a platelet count less than 100,000/microL.
Thrombocytopenia occurred in 182 (36.3%) patients over 808 of 1,546 chemotherapy cycles (52%). No intracranial or life-threatening bleeding occurred in any patient. The majority of patients (139 [76.4%]) had no clinical bleeding. Minor bleeding, such as purpura, occurred in 34 patients (18.7%) and 44 cycles (5.4%). Major bleeding occurred in nine patients (4.9%) and 10 cycles (1.3%). Five major bleeding events occurred in 49 patients with platelet counts between 0 and 10,000/microL. Forty-three of these patients received platelet transfusions. Thirty-eight of 43 transfused patients (88.3%) had no bleeding. Of the remaining five patients, two were transfused prophylactically with no effect. Three major bleeding events occurred in patients with platelet counts that ranged from 11,000 to 20,000/microL, but these were due to chronic instrumentation or trauma. In patients with platelet counts more than 20,000/microL, major bleeding occurred only from necrotic metastatic lesions. Random-donor platelet transfusions provided inconsistent increments in platelet counts. Overall, 27.5% of patients achieved the expected increase in platelet number based on units of platelet concentrate transfused. The use of single-donor or human leukocyte antigen (HLA)-matched platelets did not provide greater increments in those patients who were refractory to random-donor platelets.
Platelet counts > or = 10,000/microL are not associated with spontaneous major bleeding. Prophylactic platelet transfusions in patients with gynecologic malignancies and chemotherapy-induced thrombocytopenia should be limited to those with platelet counts < or = 10,000/microL, provided they are not bleeding and have no major anatomic or pathophysiologic precursors of bleeding.
本回顾性分析对501例接受化疗的妇科癌症患者进行研究，以评估血小板计数与临床出血之间的关系，以及血小板输注治疗的临床效果。血小板减少症患者根据血小板计数分为六组，并记录严重或轻微出血表现。血小板减少症定义为血小板计数低于100,000/微升。
在1546个化疗周期中的808个周期（52%），182例（36.3%）患者出现血小板减少症。所有患者均未发生颅内出血或危及生命的出血。大多数患者（139例[76.4%]）无临床出血。34例患者（18.7%）和44个周期（5.4%）出现轻微出血，如紫癜。9例患者（4.9%）和10个周期（1.3%）发生严重出血。49例血小板计数在0至10,000/微升之间的患者发生了5次严重出血事件。其中43例患者接受了血小板输注。43例输注患者中有38例（88.3%）未出血。其余5例患者中，2例预防性输注无效。3例严重出血事件发生在血小板计数为11,000至20,000/微升的患者中，但这些是由于长期器械操作或创伤所致。血小板计数超过20,000/微升的患者，严重出血仅发生于坏死性转移病灶。随机供者血小板输注后血小板计数的增加并不一致。总体而言，27.5%的患者根据输注的血小板浓缩单位数达到了预期的血小板数量增加。对于对随机供者血小板难治的患者，使用单供者或人类白细胞抗原（HLA）匹配的血小板并未使其血小板计数有更大增加。
血小板计数≥10,000/微升与自发性严重出血无关。对于妇科恶性肿瘤及化疗所致血小板减少症患者，预防性血小板输注应限于血小板计数≤10,000/微升、未出血且无严重解剖学或病理生理学出血先兆的患者。
