血液病患者预防性血小板输注阈值的比较

目的探讨预防性血小板输注阈值对血液病患者的影响。方法将确诊为血液系统疾病且出血程度为0级的患者分为A、B两组,A组:血小板<10×109/L,B组:血小板(10～20)×109/L,比较两组患者在输注不同剂量血小板后,出血改善及输血不良反应情况。结果 A组患者输注次数和输注量明显低于B组,而两组间出血发生率的差异无统计学意义(P>0.05),但输血不良反应的发生率A组略低于B组。结论对病情稳定且无明显危险因素的血液病患者,采用10×109/L作为预防性血小板输注的阈值是安全的。     

血液病患者预防性血小板输注阈值的依从性调查研究

目的:调查我院血液病患者预防性血小板输注阈值的依从性,并探讨血小板输注在更高阈值中使用的原因。方法:本研究调查了230例患者438次临床血小板输注事件,观察了将血小板计数10×109/L设定为阈值时的输注依从性情况,分析了血小板输注在更高阈值水平使用的原因。结果:82.2%的血小板输注严格遵循了输注阈值,96.3%的输注前血小板计数≤20×109/L。输注前血小板计数>20×109/L,其非依从性原因通常为出血。结论:绝大多数血小板输注严格遵循了血小板计数为10×109/L的输注阈值,在危险因素存在的情况下,输注阈值则相应提高。     

成人急性髓细胞白血病血小板输注阈值的探讨

目的　探讨急性髓细胞白血病诱导缓解化疗期间血小板输注的阈值。　方法　分析本院 3年来急性髓细胞白血病 (M3除外 )诱导缓解期间出血危险因素、预防性血小板输注及临床出血情况。　结果　 1 1 7例患者诱导缓解化疗1 78次 ,共输注机采血小板 1 61次。在患者血小板计数 <5× 1 0 9/L时输注血小板 ,临床主要出血症状增加。　结论　在患者状态稳定情况下 ,5× 1 0 9/L作为血小板输注的阈值是安全的 ,有高危出血因素时 (如患者发热 >3 8.5℃或有严重感染或化疗前高白细胞等 )血小板输注的阈值应为 1 5× 1 0 9/L或更高     

特发性血小板减少性紫癜106例血小板输注疗效分析

本文回顾性分析我院106例特发性血小板减少性紫癜（ITP）患者治疗方法和输注血小板的疗效,以探讨ITP患者急症输注血小板制剂的临床适应证。1临床资料1.1一般资料本组男19例,女87例,年龄10～76（平均43）岁。诊断标准：（1）多次实验室检查血小板计数减少;（2）脾脏不肿大或仅轻度肿大;（3）骨髓检查巨核细胞增多或正常,表现成熟障碍,即产板巨核细胞小于巨核细胞总数的30%;（4）以下5项中应具有其中1项。     

降低预防性血小板输注剂量对慢性血小板减少症患者出血风险的影响

目的 探讨降低预防性血小板输注剂量对慢性血小板减少症(chronic thrombocytopenia)患者出血的影响.方法 选择2008年10月至2010年12月在本院住院的80例因造血干细胞移植(hematopoietic stem cell transplantation,HSCT)、血液系统肿瘤和实体瘤化疗引起...     

病毒感染与特发性血小板减少性紫癜

病毒感染与自身免疫笥疾病的关系日益受到,特发性血小板减少性紫癜的发与病毒感染密切相关,不同病毒感染引起的ＩＴＰ可能具有不同的细胞分子机制。     

慢性特发性血小板减少性紫癜患者细胞免疫功能的研究

我们通过检测慢性特发性血小板减少性紫癜（ITP）患者的T淋巴细胞亚群、NK细胞活性、白细胞介素2（IL-2）活性和IL-2分泌细胞（IL-2SC）水平,以探讨慢性ITP患者细胞免疫功能。对象和方法1研究对象慢性ITP,患者16例,男7例,女9例,年龄5～24岁,均为初诊患者。符合首届中华血液学会全国血栓与止血学术会议有关出凝血疾病的诊断标准。正常对照53名,男33名,女20名,年龄5～60岁。2试剂和方法2．1主要试剂、仪器：冻干SPA菌体试剂为上海生物制品研究所产品;CD。、C凤、C民由卫生部武汉生物制品研究所提供;’251－UDR、’H－…     

特发性血小板减少性紫癜患者血小板再生功能的测定及临床意义

为了解特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)患者血小板再生功能的改变,本文以平均血小板体积(mean platelet volume,MPV)和网织血小板(reticulated platelets,RP)反映血小板的更新状况,分析比较血小板数量与血小板再生功能的关系,以期从血小板再生功能的改变阐述ITP的发生机制。并为ITP的诊断、预后判断提供灵敏可靠的实验室指标。     

丙种球蛋白抢救危重型特发性血小板减少性紫癜

我科于1992年11月至1993年6月．应用成都生物制品研究所生产的冻干低PH人血丙种球蛋白(低PHIVIG)静脉输注抢救5例危重型特发性血小扳减少性紫癜(ITP)患儿．现报告如下。     

静注中剂量丙种球蛋白治疗特发性血小板减少性紫癜

特发性血小板减少性紫癜(ITP)是一种由血小板自身抗体所致的血小板减少性疾病,经典治疗多采用肾上腺皮质激素、免疫抑制剂及脾切除等,上述方法无效或不宜行脾切除及免疫抑制剂而临床出血严重急需紧急提高血小板时,国内外多用大剂量丙种球蛋白(IVIG)(0.4g/kg·d)连续5天静滴治疗。我们采用中剂量IVIG(0.2g/kg·d)静滴5天治疗19例成人ITP,取得了与大剂量IVIG相似疗效,报道如下。     

免疫性血小板减少症中血小板生成与清除研究进展

免疫性血小板减少症(immune thrombocytopenia,ITP)是机体对血小板抗原免疫失耐受,从而导致血小板生成受抑和破坏过度的一种获得性自身免疫性疾病,主要临床特征是血小板计数降低。血小板数量的维持与血小板生成和清除两方面机制有关。ITP中抗血小板自身抗体、CD8⁺ T细胞等多种免疫因素抑制血小板生成或介导血小板破坏,最终导致血小板数量减少。该文将对血小板生成与清除机制及其在ITP中的作用进行综述。     

Prophylactic Platelet Transfusions in Children with Acute Leukemia: A Dose Response Study

A study of the value of small doses of platelets given prophylactically in thrombocytopenic patients was carried out. Transfusions of two dose levels of platelets were compared: 0.03 units/1b (low dose) and 0.06 units/lb of body weight (high dose). The incidence of bleeding in nontransfused patients seen here prior to this study was also determined. The difference in incidences of bleeding among patients transfused with low or high dose was not significant. The differences between the transfused and nontransfused patients were highly significant.     

Management of Platelet Disorders and Platelet Transfusions in ICU Patients

Thrombocytopenia or receipt of antiplatelet drugs, with or without bleeding, is a common indication for platelet transfusions in the ICU. However, there is almost no evidence base for these practices other than expert opinion. Also common is use of platelet transfusions prior to invasive procedures or surgery in patients with thrombocytopenia. Likewise, there is no high-quality evidence that such practices are efficacious or safe. Recently, it has become clear that, whether causal or not, patients receiving prophylactic platelet transfusions experience high rates of nosocomial infection, thrombosis, organ failure, and mortality, which increase the urgency and need for randomized trials to assess these practices. Investigational methods of improving the safety and efficacy of platelet transfusions include use of alternate strategies such as antifibrinolytics; use of ABO-identical, leukoreduced, and washed platelet transfusions; and improved storage solutions.     

佛山地区血小板输注无效患者的血小板输注策略及应用

目的 建立一种适用于佛山地区临床客观情况的免疫抗体致血小板输注无效输血策略与技术路线.方法 采用PCR-SSP法对佛山地区无偿机采血小板捐献者600人进行HLA-1 （A,B位点）基因分型,其中100人进行HPA-1～15基因分型,建立HLA、HPA供者库.使用3种不同输血策略（HLA/HPA供者库配合输注、血小板交叉配血试验配合输注、随机输注血小板）为血小板输注无效患者提供血小板,并比较其输血效果.结果 HLA/HPA供者库配合输注策略和血小板交叉配血试验配合输注策略获得相合供者率分别为100.0％、80.0％,两者差异无统计学意义（P＞0.05）;HLA/HPA供者库配合输注策略、血小板交叉配血试验配合输注策略和随机输注血小板策略的输注有效率分别为100.0％、62.5％、10.0％,前两者间及前两者分别与后者比,差异均有统计学意义（P＜0.05）;HLA/HPA供者库配合输注策略和血小板交叉配血试验配合输注策略的平均实验时间分别为（7.5＆#177;1.6）h、（13.3＆#177;6.1）h,两者差异均有统计学意义（P＜0.05）;平均费用分别为（365＆#177;47）元、（696＆#177;343）元,两者差异均有统计学意义（P＜0.05）.结论 HLA/HPA供者库配合输注策略比血小板交叉配血试验配合输注策略更易寻找到相合的供者,平均实验时间更短,平均费用更少,输注有效率更高,输血效果良好,是为佛山地区血小板输注无效患者寻找相合血小板较为理想的输注策略,建议在临床输血中应用.     

Evaluation of bleeding and thrombotic events during long‐term use of romiplostim in patients with chronic immune thrombocytopenia (ITP)

Summary. Background: Romiplostim is a peptibody protein that raises platelet counts during long‐term treatment of patients with chronic immune thrombocytopenia (ITP). Clinical outcomes related to increased platelet counts include a reduced risk of bleeding and a potential risk of thrombosis. Objective: To evaluate bleeding and thrombotic events occurring in chronic ITP patients during two phase 3, randomized, placebo‐controlled, 24‐week studies of romiplostim and during subsequent treatment in an open‐label extension study. Patients/Methods: In the phase 3 trials, 125 patients were randomized to romiplostim or placebo; romiplostim dose was adjusted to maintain platelet counts of 50–200 × 10⁹ L^?1. Patients who completed the phase 3 trials could enroll in the extension study in which all patients received romiplostim. Results: In the phase 3 trials, a significantly greater percentage of patients treated with placebo (34%) had bleeding adverse events of moderate or greater severity than did patients treated with romiplostim (15%, P = 0.018). In the extension study, the incidence of bleeding adverse events of moderate or greater severity decreased from 23% of patients in the first 24 weeks to 12% after 24–48 weeks, remaining ≤ 6% thereafter. The exposure‐adjusted incidence of thrombotic events was 0.1 per 100 patient‐weeks in the phase 3 studies, and 0.08 per 100 patient‐weeks in the extension study where patients received romiplostim for up to 144 additional weeks. Conclusions: The incidence and severity of bleeding was decreased in chronic ITP patients treated with romiplostim compared with placebo, and the incidence of thrombotic events was not different between the two groups.     

The Anticoagulants of Choice for Platelet Transfusions

A study was made of the recovery of Cr⁵¹-labeled platelets transfused to normal recipients using various anticoagulant solutions. With ethylenediamine-tetra-acetate (EDTA) recoveries averaged 27 per cent (range 15% to 35%). With ACD (N.I.H. formula A) recoveries averaged 37 per cent (range 34% to 41%). With a citrate solution containing additional acid so as to reduce the p H of platelet-rich plasma to 6.5 before concentration of cells, recoveries averaged 62 per cent (range 37% to 81%). Platelet clumping, usually a problem when platelets are concentrated in citrate, was prevented at p H 6.5. It is suggested that a citrate solution containing sufficient acid to buffer platelet-rich plasma at p H 6.5 will increase the effectiveness of platelet concentrates.     

多抗甲素注射液加小剂量脾区放疗ITP43例疗效观察

目的 探讨难治性特发性血小板减少性紫癜(ITP)的治疗方法。方法 多抗甲素注射液加小剂量脾区放疗，总剂量800—1200cGy。结果 43例患接受2个疗程的多抗甲素静滴及2个疗程的脾区照射，显效26例，良效9例，进步6例，无效2例，总有效率95．3％。结论 多抗甲素注射液作为一种免疫制剂，能直接提升血小板，使破坏了的血小板得到新生，而脾区照射可减少血小板的破坏和PAIgG的产生，因此认为2种方法合用对顽固性ITP的治疗提供了新的治疗途径。     

ABCC4基因多态性与ITP患者糖皮质激素疗效的相关性分析

目的探讨ABCC4(ATP-binding cassette,subfamily C member 4)基因多态性rs10508022位点与ITP患者糖皮质激素疗效的相关性。方法收集我院2013年6月至2015年6月确诊的75例ITP住院患者作为病例组,其中46例糖皮质激素敏感型,29例糖皮质激素耐药型,并同期收集60例健康体检者作为对照组。采用SNa Pshot法对所有受试者进行rs10508022位点基因分型,判断其与激素治疗ITP疗效的关系。结果 rs10508022位点基因型频率分布在病例组与对照组间差异无统计学意义(P=0.15),但在ITP患者糖皮质激素敏感组和耐药组间差异有统计学意义(P=0.003),且G等位基因是ITP患者糖皮质激素耐药的风险等位基因(OR=3.17,95%CI=1.55-6.47)。结论 ABCC4基因多态性与ITP患者糖皮质激素抵抗有关,且G等位基因可能是风险基因。