Correlation Study Of The Reasons Of Platelet Transfusion Refractoriness And The Effect Of Platelet Cross-matching

ObjectivePlatelet is a kind of blood product commonly used in hospital's blood transfusion therapy,and its infusion is an important part in the treatment of clinical hemorrhagic disease.In recent years,the use of Apheresis platelet has increased dramatically since the clinical demand upgraded.One problem of its widespread use is that it easily causes platele transfusion refractory(PTR).PTR once occurred,will seriously affect the therapy outcome of the platelet transfusion.Moreover,it can cause a waste of blood resources.So,how to reduce the occurrence of PTR and to improve the therapeutic efficacy of platelet transfusion has become an urgent need in the clinical blood transfusion.The causes of PTR were mainly divided into two aspects,non-immunologic factors and immune factors.The main reason of immunological PTR is the allogeneic platelet antibody,including HLA-? and platelet specific antibodies.If the PTR caused by the immune factors occurs,there is no good policy in clinic so far.Therefore,prevention should be given priority.When platelet antibody is produced,the commonly used solution is to carry on the platelet cross-matching,and choose the platelet to infuse.This study mainly aimed to explore the relationship between the non-immune factors,including gender,age,blood type and the occurrence rate of PTR and platelet antibodies.It also planned to discover the correlation between cumulative blood transfusion frequency,disease type and the PTR and platelet antibody positive rate;the correlation between disease type and platelet antibody types,and the differences between disease types and platelet antibody types of the effect of the transfusion with cross-matching platelet.so that the clinical diagnosis and treatment of PTR can be guided,and the infusion effect evaluation can be done.Methods1.Study object and group design? Study object:the case of 119 patients who need platelet transfusion in hospital during January 2015 to December 2016,58 male persons,female 61 cases.Their,age ranged from 18 to 89 years old.?Group design:According to the gender,infusion of patients were divided into two groups of male and female;According to the age,patients were divided into four groups(less than or equal to 30,31 to 50 years old,51 to 70 years old,more than70 years old);According to the blood type,patients were divided into four groups(type A,type B type O and type AB);According to the cumulative platelet transfusion frequency,patients were divided into four groups(1?2 time,3?5 time,>6time);According to the diagnostic criteria of disease,patients were divided into five groups(Aplasticanemia,Acute myelo-genous leukemia,Myelodysplastic syndrome,other blood discases and non blood diseases).According to the results of the test of plateler antibodies,patients were divided into two groups of antibody positive and negative.2.methods2.1 Analysis of the influence factors of the platelet transfusion refractoriness? Platelet antibody test:Use the method of solid-phase agglutination to detect the platelet antibody,record the result of the test.? Collect the clinical records of patients,including gender,age,blood type,weight,platelet count before platelet transfusion,platelet count after transfusion(lhour or 24hour),disease diagnosis,the cumulative frequency of platelet transfusion.? According to the weight of the patient,the amount of the platelet transfused and the platelet count before or after transfusion,we calculate the Percent platelet recovery(PPR)value(lor 24 hours)to determine whether the transfusion is effective.The formulas are:PPR(%)=(Platelet count after-before)(×109/L)xblood volume(L)×100/Total number of platelets transfused(×1011/L)×2/3 Blood volume = Body surface area(m)x2.5= Weight(kg)x0.075According to 1h PPR<30%or 18?24h PPR<20%can affirm as platele transfusion refractory.? Statistic analyze the correlation between gender,age,blood type,infusion frequency,disease diagnosis,platelet antibodies and the effect of platelet transfusion.2.2 Analysis of the influence factors of the platelet antibodyAccording to the result of the platelet antibodies detecting test,we analyzed the relation between the patients'age,gender,blood type,platelet transfusion frequency,disease diagnosis and the positive rate of platelet antibody.2.3 Analysis of the influence factors of the typies of platelet antibodies and the transfusion efficiency by infuse cross-matching platelet.?Platelet antibodies identify:the positive cases of platelet antibody test would further identify the type of the platelet antibodies,use ELIS A method,identify the ype of the platelet antibodies,including anti-HLA,anti-GP ? b/?a,anti-GP ? a/? a,anti-GP ? b/?,and anti-GP?.Then we analyzed wether there are differences between the typies of platelet antibodies relating to different kinds of diseases.? Platelet cross-matching test:the positive cases of platelet antibody test are performed the platelet cross-matching experiment by solid-phase agglutination.The negative ones are chosed for platelet transfusion.Then we recorded the platelet count before and after the transfusion,count PPR value,determined wether the matched transfusion was effective.Statistical analysis the differences between disease type,antibody type and the effect of platelets transfusion with negative platelet by the test of platelet cross-matching.Results1.Analysis of the influence factors of the platelet transfusion refractoriness? The incidence of PTR in male was 17.2%,and female was 34.4%,the rate was higher in females than males.The difference was statistically significant(P<0.05).? The rate of the platelet transfusion refractoriness between the groups of the cumulative platelet transfusion frequency(1?2 times?3?5 times?>6 times)were 5.3%,60.0%,64.3%,The difference was statistically significant(P<0.05).?The inefficiencies of the platelet infusion in the five categories:aplastic anemia(AA),acute myeloid leukemia(AML),Myelodysplastic syndrome(MDS),other blood disease,non blood disease were 11.1%,26.3%,52.0%,22.9%,12.9%.The difference was statistically significant(P<0.05).? The rate of the platelet transfusion refractoriness in the groups of antibody positive was 76.5%,more than the groups of antibody negative.The difference was statistically significant(P<0.05).? The differences between age,blood types and the platelet transfusion refractoriness were not statistically significant.2.Analysis of the influence factors of the platelet antibody? The rate of the platelet antibody positive between the groups of the cumulative platelet transfusion frequency(1?2 times?3?5 times?>6 times)were 4.0%,66.7%,78.6%.Platelet infuse more frequently the rate more higher(P<0.05).? The rate of the platelet antibody positive in the five categories:aplastic anemia(AA),acute myeloid leukemia(AML),Myelodysplastic syndrome(MDS),other blood disease,non blood disease were 22.2%,31.6%,48.0%,31.4%,9.7%.The rate of the platelet antibody positive of MDS was more higher(P<0.05).?The differences between gender,age,blood types and the rate of platelet antibody positive were not statistically significant.3.Analysis of the influence factors of the typies of platelet antibodies and the transfusion efficiency by infuse cross-matching platelet.?34 platelet antibodies positive,the rate of the platelet transfusion efficiency with the cross-matching platelet was 79.4%,more than the transfusion with the random platelet(P<0.05).? The differences between the disease types and the platelete antibody types(anti-HLA,anti-GP ? b/?a,anti-GP ? a/? a,anti-GP ? b/?,and anti-GP?)were not statistically significant.? The differences between the disease types,the platelete antibody types((anti-HLA,anti-GP ? b/?a,anti-GP ? a/? a,anti-GP ? b/?,and anti-GP?))and the platelet transfusion efficiency with the cross-matching platelet was not statistically significant.Conclusion1.Analysis of the influence factors of the platelet transfusion refractoriness:gender,the cumulative platelet transfusion frequency,disease types and the platelet antibody can affect the platelet transfusion efficiency.Women,patients of the cumulative platelet transfusion frequency more than 6 times,MDS patients and patients of platelet antibody positive were more likely to produce PTR..It is suggested that the clinic should pay more attention to this types of patients and take corresponding measures in advance to prevent or delay the occurrence of PTR.2.Analysis of the influence factors of the platelet antibody:the cumulative platelet transfusion frequency and disease types can affect the platelet antibody,patients of the cumulative platelet transfusion frequency more than 6 times and MDS patiens were more likely to produce platelet antibody.It was suggested that these patients should be screened and identified for platelet antibody in time,detected and treated PTR in time.3.Analysis of the relation between the typies of platelet antibodies and the efficiency after platelet cross-matching test:transfusion with the cross-matching platelet can improve the effect of platelet transfusion,but the effect of platelet transfusion with the cross-matching platelet was not related to antibody types and disease types.Antibody types was not related to disease types.