RELATIVE IMPORTANCE OF IMMUNE AND NONIMMUNE CAUSES OF PLATELET REFRACTORINESS
RELATIVE IMPORTANCE OF IMMUNE AND NONIMMUNE CAUSES OF PLATELET REFRACTORINESS
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DOI：
10.1111/j.1423-0410.1994.tb00310.x
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发表时间：
1994-01-01
期刊：
影响因子：
2.7
通讯作者：
WATERS, AH
中科院分区：
文献类型：
--
作者：
DOUGHTY, HA;MURPHY, MF;WATERS, AH
在这项前瞻性研究中，观察了26例接受标准（即非白细胞去除）血液成分治疗的血液学恶性肿瘤连续患者发生血小板输注难治性。266例血小板输注中有116例（44%）未能产生令人满意的反应。在102/116（88%）中，反应不良是在存在已知与血小板不应相关的非免疫因素的情况下发生的。78/116例（67%）单独存在非免疫因素，24/116例（21%）与免疫因素联合存在。在29/116例（25%）不成功的血小板输注中存在免疫因子（HLA和血小板特异性抗体）。统计学分析证实，血小板不应性与非免疫因素的存在显著相关。与难治性相关的非免疫因素通常是多种的，最常见的是发热、感染和抗生素治疗的组合。本研究提供的证据表明，免疫机制不是研究患者人群血小板难治性的主要原因。它还表明，预防HLA同种异体免疫的措施，如白细胞耗竭，可能对减少血小板输注无效的发生率影响有限。
In this prospective study, 26 consecutive patients being treated for haematological malignancies receiving standard (i.e. non-leucocyte-depleted) blood components were observed for the development of refractoriness to platelet transfusions. One hundred and sixteen of the 266 (44%) platelet transfusions failed to produce a satisfactory response. In 102/116 (88%), the poor response was in the presence of non-immune factors known to be associated with platelet refractoriness. Non-immune factors were present alone in 78/116 (67%), and in combination with immune factors in a further 24/116 (21%). Immune factors (HLA and platelet-specific antibodies) were present during 29/116 (25%) of unsuccessful platelet transfusions. Statistical analysis confirmed that platelet refractoriness was significantly associated with the presence of non-immune factors. The non-immune factors associated with refractoriness were often multiple, most frequently a combination of fever, infection and antibiotic therapy. This study provides evidence that immune mechanisms were not the predominant cause of platelet refractoriness in the patient population studied. It also suggests that measures for the prevention of HLA alloimmunisation, such as leucocyte depletion, may have a limited impact in reducing the incidence of refractoriness to platelet transfusions.