Ishida A, Handa M, Wakui M, Okamoto S, Kamakura M, Ikeda Y
Blood Center, Department of Medicine, School of Medicine, Keio University, Tokyo, Japan.
Transfusion. 1998 Sep;38(9):839-47. doi: 10.1046/j.1537-2995.1998.38998409004.x.
Platelet transfusion refractoriness remains problematic in the management of patients who have undergone hematopoietic progenitor cell transplantation. Bone marrow transplantation itself is reported to be a relevant factor hampering efficient platelet transfusions. However, a prospective analysis assessing factors affecting platelet transfusion efficacy in the setting of hematopoietic progenitor cell transplantation has yet to be conducted.
To identify factors independently influencing platelet transfusion efficacy after hematopoietic progenitor cell transplantation, a prospective study was performed to determine the effectiveness of platelet transfusions by estimating posttransfusion (16-hour) corrected count increments (CCI) in 42 consecutive patients (26 who received allogeneic transplants and 16 who received autologous transplants) with 439 available platelet transfusions.
The mean CCI and percentage of CCI <4500 for all transfusions were 6161.1 +/- 7775.2 per microL and 42.1 percent, respectively. Multiple linear regression analyses revealed high total bilirubin, total body irradiation, high serum tacrolimus, and high serum cyclosporin A to be major factors independently predicting a lower CCI. HLA antibodies with restricted specificity and platelet antibodies were detected transiently in 17 and 14 percent of the patients, respectively. The presence of these antibodies was not, however, associated with a poor response to platelet transfusions.
Platelet transfusion efficacy in hematopoietic progenitor cell transplant recipients is markedly influenced by clinical factors specific to the procedure as well as those already recognized in other settings. Alloimmunization is not, however, a major factor associated with a poor response to platelet transfusions after this procedure.
在造血祖细胞移植患者的管理中，血小板输注无效仍然是个问题。据报道，骨髓移植本身是阻碍有效血小板输注的一个相关因素。然而，尚未进行一项前瞻性分析来评估影响造血祖细胞移植中血小板输注疗效的因素。
为了确定独立影响造血祖细胞移植后血小板输注疗效的因素，进行了一项前瞻性研究，通过估计42例连续患者（26例接受异基因移植，16例接受自体移植）的439次可用血小板输注的输血后（16小时）校正计数增加值（CCI）来确定血小板输注的有效性。
所有输血的平均CCI和CCI<4500的百分比分别为每微升6161.1±7775.2和42.1%。多元线性回归分析显示，高总胆红素、全身照射、高血清他克莫司和高血清环孢素A是独立预测较低CCI的主要因素。分别在17%和14%的患者中短暂检测到具有受限特异性的HLA抗体和血小板抗体。然而，这些抗体的存在与对血小板输注的不良反应无关。
造血祖细胞移植受者的血小板输注疗效受到该手术特有的临床因素以及其他情况下已被认识的因素的显著影响。然而，同种免疫不是该手术后与血小板输注不良反应相关的主要因素。
