Groh J, Storck K, Kratzer M A
Institut für Anaesthesiologie, Ludwig-Maximilians-Universität München.
Anaesthesist. 1993 Dec;42(12):847-55.
Platelet concentrates transfused for correction of thrombocytopenia or reduced platelet function do not consistently improve primary haemostasis in the recipient. Insufficient therapeutic effects may be caused by impaired donor platelet function and by unfavourable donation and storage conditions, as well as by immunological interactions with the recipient blood. The present study was designed to investigate whether the effect of platelet transfusion on recipient platelet function can be predicted by in vitro methods. METHODS. Blood samples were taken from 12 thrombocytopenic patients before (20 ml, P0) and after (10 ml, P(vivo)) transfusion of one unit of platelets previously stored for 24-120 h in acid citrate dextrose. An additional sample was taken from the platelet concentrate (TK) immediately before transfusion. P0 was divided into two specimens and TK platelets were added to one of them (P(vitro) in order to obtain a platelet count similar to that in P(vivo). Bleeding time (BT) and bleeding volume (BV) of the samples P0, P(vivo) and P(vitro) were measured using the method of Kratzer and Born (Fig. 2); mean values were calculated for each sample from six measurements. Aggregability of TK platelets was determined in addition by aggregometry. In contrast to previous studies, physiological Ca2+ concentrations were restored and secondary haemostasis was inhibited by low-molecular-weight heparin (Fragmin P, Pfrimmer Kabi GmbH und Co. KG, Erlangen) in the platelet-rich plasma used for aggregometry. RESULTS. Platelet counts increased in all patients after transfusion (P(vivo) vs P0, Table 1) and were nearly identical in P(vitro) and P(vivo) (r = 0.94, P < 0.001; Fig. 3). Parameters of primary haemostasis were significantly improved by addition of platelets to P0 in vitro (BT P < 0.05, BV P < 0.01) as well as by platelet transfusion (BT P < 0.05, BV P < 0.01). Direct comparison of P(vitro) and P(vivo) yielded a very close correlation of BT (r = 0.88, P < 0.001) and BV (r = 0.89, P < 0.01) in both samples. Although aggregometry revealed decreasing platelet function with increased storage time, aggregability was considerably higher compared to previous studies of platelet concentrates stored for 2-5 days. CONCLUSION. A new technique has been developed which allows reliable prediction of the effect of platelet concentrates on primary haemostasis of the recipient by in vitro measurement of bleeding time and bleeding volume prior to transfusion using the method of Kratzer and Born.
输注血小板浓缩物以纠正血小板减少或血小板功能降低，并不能始终如一地改善受者的初级止血功能。治疗效果不佳可能是由于供体血小板功能受损、不利的采集和储存条件，以及与受者血液的免疫相互作用所致。本研究旨在调查是否可以通过体外方法预测血小板输注对受者血小板功能的影响。方法。从12名血小板减少患者身上采集血样，在输注1单位先前在酸性枸橼酸盐葡萄糖溶液中储存24 - 120小时的血小板之前（20毫升，P0）和之后（10毫升，P（体内））各采集一次。在输血前立即从血小板浓缩物中采集另一份样本（TK）。将P0分成两份样本，将TK血小板加入其中一份（P（体外）），以使血小板计数与P（体内）相似。使用克拉策尔和博恩的方法测量样本P0、P（体内）和P（体外）的出血时间（BT）和出血量（BV）（图2）；每个样本从六次测量中计算平均值。此外，通过凝集测定法测定TK血小板的聚集性。与先前的研究不同，在用于凝集测定的富血小板血浆中，恢复了生理Ca2+浓度，并通过低分子量肝素（法安明P，普瑞美制药有限公司，埃尔朗根）抑制了次级止血。结果。所有患者输血后血小板计数均增加（P（体内）与P0相比，表1），且P（体外）和P（体内）的血小板计数几乎相同（r = 0.94，P < 0.001；图3）。体外向P0中添加血小板以及进行血小板输注均显著改善了初级止血参数（BT P < 0.05，BV P < 0.01）。P（体外）和P（体内）的直接比较显示，两个样本中的BT（r = 0.88，P < 0.001）和BV（r = 0.89，P < 0.01）具有非常紧密的相关性。尽管凝集测定显示随着储存时间延长血小板功能下降，但与先前对储存2 - 5天的血小板浓缩物的研究相比，聚集性要高得多。结论。已开发出一种新技术，该技术通过使用克拉策尔和博恩的方法在输血前体外测量出血时间和出血量，能够可靠地预测血小板浓缩物对受者初级止血的影响。
