The Clinical Analysis Of Platelet Transfusion Refractoriness

Platelet transfusion can effectively prevent and therapy hemorrhage caused by thrombocytopenia. In spite of application widely, some patients have a tendency frequently and largely, namely refractoriness to platelet transfusion (PTR). To investigate the cause of PTR, we collected 171 patients who were diagnosed as aplastic anemia, acute leukemia, idiopathic thrombocytopenic purpura and treated by platelet transfusion. The time of platelet transfusion is 398 together, and we anayzed these cases with some questions as follows: ①The opportunity of platelet transfusion, ②The cause of PTR ,including immune and non-immune factors, ③The effect of high dose of intravenous gammaglobulin (HDIG) associated with corticosteriod in treating severe ITP. we drew conclusions as follows: In aplastic anemia, acute leukemia, idiopathic thrombocytopenic purpura, if bleeding is not serous, it is safe when platelet count is 10×109/L or less than as prevent transfusion. when decide the opportunity of platelet transfusion, we should think about the patients, the degree of bleeding not only lies in the count of platelet, but also the type of leukemia, infection, the function thrombocyte and whether we use the medicine that effects platelet. The article show that the non-immune factors include fever and splenmegaly. in290 case, the rate of platelet uneffective transfusion in fever group is 79.2%, while it is 40.9% in non-fever group. there is serous different in them. in 290 case, the rate of uneffective transfusion in spleomegaly group is 75.0%, while it is 49.6% in non-splenomegaly group.About immune factors ,excluding non-immune factors, in 180 case of ANLL, PTR% is 70.3% when the amont of blood transfusion is more than 2000ml. PTR% is 48.4% when the amout of blood transfusion is less than 2000ml, there is serous different between them.We think the important reason is immunity and white call antibodies .since blood transfusion is frequent. If the patients make platelet transfusion for less than four times, the rate of uneffective platelet transfusion is low. while when it is more than twelve times, the rate is 85.7%. the reason of uneffective transfusion is the interrelated antibodies. The therapy of uneffective platelet transfusion: we should first think about the itself. The platelet should be the same type and not be storage. If there are factors that destroy the platelet, for example, fever, infection, splenomgaly, DIC, ect. we should treat the primary affection. and increase the amout of transfusion. If there are antibodies, we should choose the platelets from HLAand HPA matched donors. or we should use hormone or HDIG. If it is non-effective for platelet transfusion, and we can't find the clearreason, we should think about the antibodies because of the medicine. Stop or change the corre lative medicines may be improved. We use HDIG and hormone to treate 52 patients with severe ITP, compared with 37 patients that we use hormone only, the total effect rate are 87% and 90%, respectively. There is no difference between them. it is for 2.7 days to reach for platelt normal. in hormone group. There is serous different between them. So HDIG can prevent the important viscera from bleeding.