Norol F, Bierling P, Roudot-Thoraval F, Le Coeur F F, Rieux C, Lavaux A, Kuentz M, Duedari N
ETS Sud-Est Francilien, Hôpital Henri Mondor, Creteil; Unité Evaluation Etude, Hôpital Henri Mondor, Creteil, France.
Blood. 1998 Aug 15;92(4):1448-53.
Early recommendations on prophylactic transfusion of thrombocytopenic patients involved a standard platelet dose of about 0.5 x 10(11)/10 kg body weight. Given the lack of data supporting this dose, we prospectively studied the dose response to platelet transfusions in adults and children with hematologic malignancies. Each patient received, in similar clinical conditions, a medium, high, and very high dose of fresh (< 24 hours old) ABO-compatible platelets, in the form of apheresis platelet concentrates (APC). For the adults, the medium dose was defined as APC containing between 4 and 6 x 10(11) platelets, the high dose between 6 and 8 x 10(11), and the very high dose > 8 x 10(11); for the children, the three doses corresponded to 2 to 4, 4 to 6, and > 6 x 10(11) platelets. The end points were the platelet increment, platelet recovery, and the transfusion interval, and the results were compared with a paired t-test. Sixty-nine adults and 13 children could be assessed. Recoveries in the adults were similar with the three doses (from 28% to 30%), but the high and very high doses led to a significantly better platelet increment (52 and 61 x 10(9)/L, respectively) than the medium dose (33 x 10(9)/L, P < .01). The main difference was in the transfusion interval, which increased with the dose of platelets transfused, from 2.6 days with the medium dose to 3.3 and 4.1 days with the high and very high doses, respectively (P < .01). The positive effect of the high dose was observed regardless of pretransfusional clinical status, but was more marked in patients with no clinical factors known to impair platelet recovery. In these patients, a platelet dose of 0.07 x 10(11) per kg of body weight led to a transfusion interval of more than 2 days in 95% of cases. In patients with clinical factors favoring platelet consumption, the proportion of transfusions yielding an optimal platelet increment and transfusion interval increased with the dose of platelets. The platelet dose-effect was also significant in the children, in whom the high and very high doses led to 1.5-fold to twofold higher posttransfusion platelet counts and transfusion intervals. We conclude that transfusion of high platelet doses can reduce the number of platelet concentrates required by thrombocytopenic patients and significantly reduce donor exposure.
早期关于血小板减少症患者预防性输血的建议是采用约0.5×10¹¹/10kg体重的标准血小板剂量。鉴于缺乏支持该剂量的数据，我们对血液系统恶性肿瘤的成人和儿童患者进行了血小板输注剂量反应的前瞻性研究。在相似的临床条件下，每位患者接受中等剂量、高剂量和非常高剂量的新鲜（<24小时）ABO相容血小板，以单采血小板浓缩物（APC）的形式。对于成人，中等剂量定义为APC含4至6×10¹¹个血小板，高剂量为6至8×10¹¹个，非常高剂量>8×10¹¹个；对于儿童，这三种剂量分别对应2至4×10¹¹个、4至6×10¹¹个和>6×10¹¹个血小板。观察终点为血小板增加值、血小板回收率和输血间隔时间，结果采用配对t检验进行比较。69名成人和13名儿童可纳入评估。成人中三种剂量的血小板回收率相似（28%至30%），但高剂量和非常高剂量组的血小板增加值（分别为52和61×10⁹/L）显著高于中等剂量组（33×10⁹/L，P<.01）。主要差异在于输血间隔时间，其随输注血小板剂量的增加而延长，中等剂量组为2.6天，高剂量组为3.3天，非常高剂量组为4.1天（P<.01）。无论输血前临床状态如何，高剂量均显示出积极效果，但在无已知影响血小板恢复临床因素的患者中更为明显。在这些患者中，每千克体重0.07×10¹¹个血小板剂量在95%的病例中可使输血间隔时间超过2天。在有促进血小板消耗临床因素的患者中，产生最佳血小板增加值和输血间隔时间的输血比例随血小板剂量增加而升高。血小板剂量效应在儿童中也很显著，高剂量和非常高剂量组输血后血小板计数和输血间隔时间高出1.5倍至2倍。我们得出结论，高剂量血小板输注可减少血小板减少症患者所需的血小板浓缩物数量，并显著减少供体暴露。
