Platelet transfusions in the neonatal intensive care unit: factors predicting which patients will require multiple transfusions
Platelet transfusions in the neonatal intensive care unit: factors predicting which patients will require multiple transfusions
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DOI：
10.1046/j.1537-2995.2001.41060803.x
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发表时间：
2001-06-01
期刊：
影响因子：
2.9
通讯作者：
Christensen, RD
中科院分区：
文献类型：
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作者：
Del Vecchio, A;Sola, MC;Christensen, RD
背景：以前的研究表明，重组血小板生成素(RTPO)会增加血小板减少新生儿的血小板生成。然而，应该确定最有可能受益的新生儿的目标人群。研究表明，RTPO在治疗开始后5天内不会升高血小板计数。因此，可能受益于RTPO的新生儿是那些需要多次输注血小板超过5天的新生儿。研究设计和方法：对佛罗里达大学新生儿重症监护病房(NICU)1997年1月1日至1998年12月31日期间所有接受血小板输注的患者进行了历史性的队列研究。结果：在研究期间，1389名NICU患者中，131名(9.4%)接受了血小板输注。17例患者接受了体外膜肺氧合治疗，排除在进一步分析之外。在其余114名患者中，55名(48%)接受了一次输血，59名(52%)接受了一次以上输血(21例)。接受检查的人口统计学因素中没有一项可以预测多次血小板输注。然而，有两种临床情况有影响：接受一次血小板输注的肝脏疾病和肾功能不全新生儿的相对死亡风险是未接受一次血小板输注的新生儿的10.4倍(p=0.0001)。接受>；4血小板输注的新生儿死亡风险是未输血的新生儿的29.9倍(p=0.0001)。结论：NICU合并肝病或肾功能不全的患者如果接受一次血小板输注，很可能需要额外输血。因此，这些患者构成了I/II期RTPO试验的可能研究人群。
BACKGROUND: Previous studies suggest that recombinant thrombopoietin (rTPO) will increase platelet production in thrombocytopenic neonates. However, the target populations of neonates most likely to benefit should be defined. Studies suggest that rTPO will not elevate the platelet count until 5 days after the start of treatment. Therefore; the neonates who might benefit from rTPO are those who will require multiple platelet transfusions for more than 5 days. This study was designed to find means of prospectively identifying these patients.STUDY DESIGN AND METHODS: A historic cohort study of all patients in the neonatal intensive care unit (NICU) at the University of Florida who received platelet transfusions from January 1, 1997, through December 31, 1998, was conducted.RESULTS: Of the 1389 patients admitted to the NICU during the study period, 131 (9.4%) received platelet transfusions. Seventeen were treated with extracorporeal membrane oxygenation and were excluded from further analysis. Of the remaining 114 patients, 55 (48%) received one transfusion and 59 (52%) received more than one transfusion (21 had >4). None of the demographic factors examined predicted multiple platelet transfusions. However, two clinical conditions did; liver disease and renal insufficiency Neonates who received one platelet transfusion had a relative risk of death 10.4 times that in neonates who received none (p = 0.0001). Neonates who received >4 platelet transfusions had a risk of death 29.9 times that in those who received no transfusions (p = 0.0001).CONCLUSION: NICU patients with liver disease or renal insufficiency who receive one platelet transfusion are likely to receive additional transfusions. Therefore, these patients constitute a possible study population for a Phase I/II rTPO trial.