BACKGROUND Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia.In recent years,with platelet tran...BACKGROUND Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia.In recent years,with platelet transfusion increasing,ineffective platelet transfusion has become increasingly prominent.Generally speaking,platelet antibodies can be produced after repeated transfusion,thus rendering subsequent platelet transfusion ineffective.We report a case of first platelet transfusion refractoriness(PTR)in a patient with acute myelocytic leukemia(AML).Due to the rarity of such cases in clinical practice,there have been no relevant case reports so far.CASE SUMMARY A 51-year-old female patient attended the hospital due to throat pain and abnormal blood cells for 4 d.Her diagnosis was acute myelocytic leukemia[M2 type Fms related receptor tyrosine kinase 3,Isocitrate Dehydrogenase 1,Nucleophosmin 1,Neuroblastoma RAS viral oncogene homolog(+)high-risk group].She was treated with"IA"(IDA 10 mg day 1-3 and Ara-C 0.2 g day 1-5)chemotherapy.When her condition improved,the patient was discharged from the hospital,instructed to take medicine as prescribed by the doctor after discharge,and returned to the hospital for further chemotherapy on time.CONCLUSION We report a rare case of first platelet transfusion failure in a patient with AML during induction chemotherapy,which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load.This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML.When platelet antibodies are produced,immunoglobulins can be used to block antibodies,thereby reducing platelet destruction.For patients with PTR,both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.展开更多
目的观察血小板自身抗体与同种抗体对血小板交叉配型难易程度及输注效果的影响。方法选择2021年7月—2023年9月在本实验室完成血小板抗体鉴定的106例血小板输注无效(PTR)患者,根据血小板抗体类型将患者分为两组,20例自身抗体阳性患者为...目的观察血小板自身抗体与同种抗体对血小板交叉配型难易程度及输注效果的影响。方法选择2021年7月—2023年9月在本实验室完成血小板抗体鉴定的106例血小板输注无效(PTR)患者,根据血小板抗体类型将患者分为两组,20例自身抗体阳性患者为观察组,86例同种抗体阳性患者为对照组。比较两组患者配型相合次数百分率、配型相合供者百分率、输注交叉配型相合血小板及随机血小板的24 h血小板计数增加指数(CCI)值及输注有效率的差异,并对观察组自身抗体变化情况进行追踪。结果观察组的配型相合次数百分率及配型相合供者百分率均高于对照组(P<0.05)。观察组患者输注交叉配型相合血小板与随机血小板的24 h CCI值及输注有效率均无显著性差异(P>0.05),对照组患者输注交叉配型相合血小板的24 h CCI值及输注有效率均高于输注随机血小板(P<0.001),对照组患者输注交叉配型相合血小板后24 h CCI值及输注有效率比观察组高(P<0.05),对照组和观察组输注随机血小板后24 h CCI值及输注有效率无显著性差异(P>0.05)。观察组多数患者的自身抗体强度呈下降趋势。结论血小板自身抗体对血小板交叉配型难易程度及输注效果的影响比同种抗体小。血小板自身抗体强度随时间推移呈现逐渐下降乃至消失的规律。在临床实践中,对于自身抗体患者的治疗,应当首先查找病因,并进行针对性治疗,如果需要输注血小板,可以选择输注随机血小板。展开更多
基金Supported by Innovation Platform and Talent Program of Hunan Province,No.2021SK4050.
文摘BACKGROUND Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia.In recent years,with platelet transfusion increasing,ineffective platelet transfusion has become increasingly prominent.Generally speaking,platelet antibodies can be produced after repeated transfusion,thus rendering subsequent platelet transfusion ineffective.We report a case of first platelet transfusion refractoriness(PTR)in a patient with acute myelocytic leukemia(AML).Due to the rarity of such cases in clinical practice,there have been no relevant case reports so far.CASE SUMMARY A 51-year-old female patient attended the hospital due to throat pain and abnormal blood cells for 4 d.Her diagnosis was acute myelocytic leukemia[M2 type Fms related receptor tyrosine kinase 3,Isocitrate Dehydrogenase 1,Nucleophosmin 1,Neuroblastoma RAS viral oncogene homolog(+)high-risk group].She was treated with"IA"(IDA 10 mg day 1-3 and Ara-C 0.2 g day 1-5)chemotherapy.When her condition improved,the patient was discharged from the hospital,instructed to take medicine as prescribed by the doctor after discharge,and returned to the hospital for further chemotherapy on time.CONCLUSION We report a rare case of first platelet transfusion failure in a patient with AML during induction chemotherapy,which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load.This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML.When platelet antibodies are produced,immunoglobulins can be used to block antibodies,thereby reducing platelet destruction.For patients with PTR,both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.
文摘目的观察血小板自身抗体与同种抗体对血小板交叉配型难易程度及输注效果的影响。方法选择2021年7月—2023年9月在本实验室完成血小板抗体鉴定的106例血小板输注无效(PTR)患者,根据血小板抗体类型将患者分为两组,20例自身抗体阳性患者为观察组,86例同种抗体阳性患者为对照组。比较两组患者配型相合次数百分率、配型相合供者百分率、输注交叉配型相合血小板及随机血小板的24 h血小板计数增加指数(CCI)值及输注有效率的差异,并对观察组自身抗体变化情况进行追踪。结果观察组的配型相合次数百分率及配型相合供者百分率均高于对照组(P<0.05)。观察组患者输注交叉配型相合血小板与随机血小板的24 h CCI值及输注有效率均无显著性差异(P>0.05),对照组患者输注交叉配型相合血小板的24 h CCI值及输注有效率均高于输注随机血小板(P<0.001),对照组患者输注交叉配型相合血小板后24 h CCI值及输注有效率比观察组高(P<0.05),对照组和观察组输注随机血小板后24 h CCI值及输注有效率无显著性差异(P>0.05)。观察组多数患者的自身抗体强度呈下降趋势。结论血小板自身抗体对血小板交叉配型难易程度及输注效果的影响比同种抗体小。血小板自身抗体强度随时间推移呈现逐渐下降乃至消失的规律。在临床实践中,对于自身抗体患者的治疗,应当首先查找病因,并进行针对性治疗,如果需要输注血小板,可以选择输注随机血小板。
文摘目的 探讨免疫性血小板输注无效(PTR)患者HLA/HPA抗体特异性分布特征及其对血小板输注效果的影响。方法 本研究以86例免疫性PTR患者为研究对象,收集其性别、年龄、身高、体重、配血次数、疾病类型、输注前后血小板计数等临床资料,通过微珠法进行HLA特异性抗体的检测,并分析抗体特性对血小板输注效果的影响。结果 86例PTR患者中,单独HLA抗体、单独HPA抗体、HLA+HPA抗体阳性的患者分别为72例(83.72%)、8例(9.30%)、6例(6.98%)。HLA抗体在各位点中检出频率最高的抗体对应等位基因分别为A*25:01、B*15:12、C*02:02(和C*17:01),检出率分别为81.48%、87.04%、48.15%;而对应抗原表位出现频率最高的前三位为163LG、97V、71ATD,检出率分别为87.04%、77.78%、74.07%。仅存在HLA抗体的患者,输注交叉配型相合血小板的24 h血小板计数纠正增加指数(CCI)及输注有效情况均明显优于随机血小板(P<0.01)。在血小板交叉配型阴性结果的患者中,HLA抗体强度与交叉配型相合血小板的24 h CCI值及输注有效情况呈负相关关系,强度越高,输注效果越差(P<0.01)。HLA抗体强度为中、低等水平的患者,输注交叉配型相合血小板的24 h CCI值及输注有效情况均优于输注随机血小板(P<0.05)。结论 本研究所得到的PTR患者HLA/HPA抗体特性及其对血小板输注效果影响的结果,可为血小板库建立时供者的选择提供指导,同时对临床PTR患者的治疗方式选择有一定的参考价值。
