Eriksson L, Kristensen J, Olsson K, Bring J, Högman C F
Department of Clinical Immunology and Transfusion Medicine, Regional Oncologic Center, University Hospital, Uppsala, Sweden.
Vox Sang. 1996;70(2):69-75. doi: 10.1111/j.1423-0410.1996.tb01296.x.
The functional capacity of transfused platelets was evaluated with in vitro bleeding time (IVBT) and corrected count increment (CCI) in order to compare platelet concentrates (PCs) derived from pooled buffy coats (BC-PCs) with PCs collected by apheresis (A-PCs). The suspension medium in the BC-PCs was 30% CPD plasma and 70% of an additive solution (containing sodium and potassium chloride, sodium citrate and phosphate, mannitol), and in the A-PCs the medium was 100% CPD plasma. IVBT was evaluated using a Thrombostat 4000/2. BC-PC and A-PC were transfused 57 and 41 times, respectively to 36 patients with chemotherapy-induced thrombocytopenia. PCs transfused within 2 days of donation were considered fresh, and those transfused within 3-5 days were considered stored. IVBT was determined before, as well as 10-30 min and 24 h after transfusion; CCI was determined 10-30 min and 24 h after transfusion. The median pretransfusion IVBT value was 486 s. It was measurable in 21 of 98 (21%) of the transfusions, i.e. below the cutoff limit of 486 s. Ten to 30 min after transfusion, the IVBT showed a measurable reduction in 90% of the transfusions with fresh BC-PCs, 92% of those with fresh a-PCs, 63% of those with stored BC-PCs and 79% of those with stored A-PCs. After 24 h, the corresponding values were 63% for fresh BC-PCs, 50% for fresh A-PCs, 26% for stored BC-PCs and 38% for stored A-PCs. The median value of CCI 10-30 min after transfusion was 20 for fresh BC-PCs, 17 for fresh A-PCs, 16 for stored BC-PCs and 14 for stored A-PCs. The difference in IVBT between fresh and stored BC-PCs was significant (p = 0.032), unlike that between fresh and stored A-PC. After 24 h the corresponding values were 7 for fresh BC-PCs, 4 for fresh A-PCs, 4 for stored BC-PCs and 3 for stored A-PCs. When all transfusions with fresh PCs (BC-PCs + A-PCs) were compared with all transfusions with stored PCs, a statistical difference was demonstrated in both CCI (p = 0.027) and IVBT (p = 0.043). Spearman's rank correlation coefficient (rs) was -0.41 between CCI and IVBT < 486 s 10-30 min after transfusion, and -0.55 between the posttransfusion platelet count and IVBT, indicating a relatively poor correlation between CCI and IVBT, and a slightly better correlation between platelet count and IVBT. In conclusion, BC-PCs showed a slightly higher CCI and a better response in IVBT than A-PCs. No statistical difference was demonstrated between BC-PCs and A-PCs transfused within 2 days after donation, with respect to function and recovery in vivo. BC-PCs stored for 3 days or more showed about the same CCI and IVBT as stored A-PC but significantly lower CCI and higher IVBT than fresh BC-PCs. This may indicate that the preparation and/or storage conditions were not optimal. IVBT seems to be a useful possibility to test the in vivo behavior of transfused platelets.
通过体外出血时间（IVBT）和校正计数增加值（CCI）评估输注血小板的功能能力，以便比较来自混合 Buffy 层的血小板浓缩物（BC-PCs）与单采血小板（A-PCs）。BC-PCs 中的悬浮介质是 30%的 CPD 血浆和 70%的添加剂溶液（含有氯化钠、氯化钾、柠檬酸钠和磷酸盐、甘露醇），而 A-PCs 中的介质是 100%的 CPD 血浆。使用 Thrombostat 4000/2 评估 IVBT。分别向 36 例化疗诱导的血小板减少症患者输注 BC-PC 和 A-PC，次数分别为 57 次和 41 次。在献血后 2 天内输注的血小板被视为新鲜的，在 3 - 5 天内输注的被视为储存的。在输血前、输血后 10 - 30 分钟和 24 小时测定 IVBT；在输血后 10 - 30 分钟和 24 小时测定 CCI。输血前 IVBT 的中位数为 486 秒。在 98 次输血中的 21 次（21%）中可测量到该值，即低于 486 秒的临界值。输血后 10 - 30 分钟，90%输注新鲜 BC-PCs 的输血、92%输注新鲜 A-PCs 的输血、63%输注储存 BC-PCs 的输血和 79%输注储存 A-PCs 的输血中，IVBT 显示出可测量的降低。24 小时后，新鲜 BC-PCs 的相应值为 63%，新鲜 A-PCs 为 50%，储存 BC-PCs 为 26%，储存 A-PCs 为 38%。输血后 10 - 30 分钟 CCI 的中位数，新鲜 BC-PCs 为 20，新鲜 A-PCs 为 17，储存 BC-PCs 为 16，储存 A-PCs 为 14。新鲜和储存的 BC-PCs 之间 IVBT 的差异具有统计学意义（p = 0.032），与新鲜和储存的 A-PC 之间不同。24 小时后，新鲜 BC-PCs 的相应值为 7，新鲜 A-PCs 为 4，储存 BC-PCs 为 4，储存 A-PCs 为 3。当将所有输注新鲜血小板（BC-PCs + A-PCs）与所有输注储存血小板进行比较时，CCI（p = 0.027）和 IVBT（p = 0.043）均显示出统计学差异。输血后 10 - 30 分钟，CCI 与 IVBT < 486 秒之间的 Spearman 等级相关系数（rs）为 -0.41，输血后血小板计数与 IVBT 之间为 -0.55，表明 CCI 与 IVBT 之间相关性相对较差，血小板计数与 IVBT 之间相关性稍好。总之，BC-PCs 显示出略高于 A-PCs 的 CCI 和在 IVBT 方面更好的反应。在献血后 2 天内输注的 BC-PCs 和 A-PCs 在体内功能和恢复方面未显示出统计学差异。储存 3 天或更长时间的 BC-PCs 显示出与储存 A-PCs 大致相同的 CCI 和 IVBT，但与新鲜 BC-PCs 相比，CCI 显著更低，IVBT 更高。这可能表明制备和/或储存条件并非最佳。IVBT 似乎是测试输注血小板体内行为的一种有用方法。
