Substitutes and alternatives to platelet transfusions in thrombocytopenic patients
Substitutes and alternatives to platelet transfusions in thrombocytopenic patients
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DOI：
10.1046/j.1538-7836.2003.00332.x
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发表时间：
2003-07-01
影响因子：
10.4
通讯作者：
Blajchman, MA
中科院分区：
文献类型：
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作者：
Blajchman, MA
在过去的十年中，液体储存的同种异体血小板浓缩物的安全性和质量都有了许多改善。然而，这类产品的临床使用仍然存在重大问题。克服其中一些问题的努力已经导致开发了一系列用于制造血小板产品和血小板替代品的新型治疗策略，以及使用血小板浓缩物替代品的其他方法。这些不同的产品或程序处于临床开发的不同阶段。本文综述了近年来液体血小板和冷冻血小板的制备方法以及病原体灭活血小板的方法。因此。讨论了冻干血小板、可输注血小板膜、携带RGD配体的红细胞（RBC）、纤维蛋白原包被的白蛋白微胶囊和基于脂质体的试剂的状态。临床前研究和1 - 3期临床试验对其中几种药物是令人鼓舞的;然而，到目前为止。很少有药物被批准用于临床。潜在的替代异体血小板输注，包括纠正贫血的红细胞输注，重组活化因子VII和HLA减少血小板也进行了审查。随着这些不同产品的不断技术和科学发展。这些试剂具有止血功效所必需的那些性质将变得明显。然而，在新型血小板浓缩物、血小板替代品和血小板替代品可用于血小板减少症患者之前，必须在临床前研究和临床试验中证明安全性和有效性。
Over the past decade, there have been many improvements in both the safety profile and quality of liquid-stored allogeneic platelet concentrates. However, significant problems with the clinical use of such products remain. Efforts to overcome some of these have resulted in the development of an array of novel therapeutic strategies for the manufacture of platelet products and platelet substitutes, as well as other approaches using alternatives to platelet concentrates. These various products or procedures are at various stages of clinical development. This review summarizes some recent advancements in the preparation of liquid and frozen stored platelets, as well as approaches used for the pathogen inactivation of platelets. Thus. the status of lyophilized platelets, infusible platelet membranes, red blood cells (RBCs) bearing RGD ligands, fibrinogen-coated albumin microcapsules, and liposome-based agents are discussed. Pre-clinical studies and phase 1-3 clinical trials have been encouraging for several of these; however, to date. very few have been licensed for clinical use. Potential alternatives to allogeneic platelet transfusions including correction of anemia by RBC transfusions, recombinant activated factor VII and HLA-reduced platelets are also reviewed. With the ongoing technical and scientific development of such diverse products. those properties that may be necessary for such agents to have hemostatic efficacy will become apparent. However, safety and efficacy must be demonstrable in preclinical studies and clinical trials, before novel platelet concentrates, platelet substitutes and alternatives to platelets can be used in patients with thrombocytopenia.