Multi-Factor Analysis Of Efficacy Of Platelet Transfusion

Purpose:Platelet transfusion therapy can effectively prevent thrombocytopenia or bleeding tendency of patients with dysfunction and improve its anticoagulant function,which would save the lives of countless patients.However,due to the complexity of blood donors and the different constitutions of patients,platelet transfusion is often ineffective in clinical application.The platelet transfusion refractoriness not only causes platelet waste,but also seriously threatens the lives of patients.To minimize or avoid the incidence of platelet transfusion refractoriness,the current study will analyze the factors affecting the efficacy of platelet transfusion,study the distribution characteristics of platelet antibodies and explore the role of combined infusion for the effect of platelet transfusion,which may provide evidences for improving the efficiency of platelet transfusion in clinics.Methods:The corrected count of increment(CCI)at 1h and 24h after platelet transfusion were achieved by calculating 583 patients who received platelet transfusion from July 2016 to October 2017 in our hospital,and the patients were divided into effective infusion group and invalid infusion group(CCI<7.5 in 1 hour or CCI<4.5 in 18~24 hours)based on CCI values.Platelet antibodies were detected by solid phase agglutination.The factors that may affect the efficacy of platelet transfusion were recorded by reviewing the medical records,which include gender,age,number of infusions,type of diseases,blood type,and antibodies.Univariate analysis was performed using thec~2 test to eliminate the ineffective factors,and then the logistic regression equation was used to comprehensively analyze the factors affecting the efficacy of platelet transfusion.A total of 113 patients with platelet antibody-positive patients were randomized to receive combined infusion(60 patients)or random infusion(53 patients).Thec~2 test was used to analyze the inefficiency of combined infusion and random infusion,and to explore the significance of combined infusion.Results:1.In the 583 patients who received platelet transfusion,200 patients received ineffective platelet transfusion,and the platelet transfusion refractoriness rate was 34.30%.According to thec~2 test analysis,among the possible influencing factors of platelet transfusion effect,there was no significant difference in the incidence of platelet transfusion using different blood types(c~2=0.00,P>0.05),while there was a significant difference in the incidence of platelet transfusion between the different genders(c~2=18.86,P<0.05)),ages(c~2=37.67,P<0.05),cumulative infusion times(c~2=65.02,P<0.05),platelet antibodies(c~2=67.53,P<0.05)and different diseases(c~2=15.46,P<0.05).Compared with the male patients,the ineffective rate of platelet transfusion was significantly higher in the female patients(P<0.05).The inefficiency of platelet transfusion increased with age,as the older the patients,the worse the effects of platelet transfusion,and the difference was significant(P<0.05).The invalid rate of platelet transfusion significantly increased when the number of infusions increased(P<0.05).The patients with positive platelet antibody had significantly higher infusion efficiency than the patients with negative platelet antibody(P<0.05).The invalid rates of platelet transfusion had a significant difference between different diseases(P<0.05).According to the logistic regression equation,gender,age,number of infusions and antibodies were independent risk factors for PTR(P<0.05).2.In the 583 patients who received platelet transfusion,113 patients had positive platelet antibodies,with a positive rate of 19.38%.According to the?~2 test,there was no significant difference in the positive rate of platelet antibody among patients of different genders and ages(P>0.05),while the positive rate of patients with hematologic malignancies and ITP was significantly higher than other diseases(P<0.05).In addition,with the increase in the number of infusions,the positive rate of platelet antibodies significantly increased(P<0.05).3.In the 113 patients with positive platelet antibody,60 were randomly selected for combined infusion with matched platelets.Only 4 of the 60 patients had invalid platelet transfusion,accounting for 6.67%of the matched patients.In the 53 patients with positive platelet antibody and randomized platelet transfusion,46 patients had invalid platelet transfusions,accounting for 86.79%of unmatched patients.The difference was significant(P<0.01).Conclusions:1.In addition to blood type,other characteristics like gender,age,cumulative infusion times,disease,and platelet antibodies can all affect the platelet transfusion effects,and gender,age,number of infusions,and antibodies are independent risk factors.2.The positive rates of platelet antibody in patients with malignant hematological diseases,tumors and ITP are higher,and the positive rates of platelet antibodies are significantly higher with the increased number of infusions.3.Platelet antibody detection before platelet transfusion and combined infusion can effectively reduce the incidence of invalid platelet transfusion,avoid waste of resources,and improve blood transfusion safety.