Objective: To investigate the transfusion effectiveness of suspended leucocyte depleted red blood cells (sld RBC) and fresh and irradiated apheresis platelets (fia Plt) in patients with myelodysplastic syndromes (MDS), and to explore the causes and mechanisms of ineffective platelet transfusion in patients with MDS.
Methods: Clinical data of 37 patients with confirmed MDS (WHO standard) such as the sex, age, Hb levels, Plt count, hemorrhage and coagulation functions, TEG and so on, were retrospectively analyzed.
Results: Among the 37 patients, 15 patients (40.5%) received only sld RBC transfusion, 9 patients (24.3%) received only fia Plt transfusion, and 13 patients (35.1%) received both transfusion. Among the 15 patients with only red blood cell transfusion, 3 patients were ineffective and the ineffectual transfusion rate was 20.0%. Among the 9 patients with only received platelet transfusion, 5 patients were ineffective and the ineffectual transfusion rate was 55.6%, there were significant statistical differences between the two groups (P﹤0.01). The red blood cell transfusion ineffective were 3 patients (23.1%) , the platelet transfusion ineffective were 8 patients (61.5%) and the both transfusion ineffective were 2 patients (15.4%) among the patients both transfusion . The positive rate of platelet antibody in MDS patients with ineffective platelet transfusion was 23.1%. Compared with the normal control group, Human P selectin (P-SelectinCD62P) (P＜0.001) and human anti-thrombin 3 antibody (AT-III Ab) (P＜0.001) significantly increased and human tissue factor pathway inhibitor (TFPI) significantly decreased (P＜0.05) in MDS patients with ineffective platelet transfusion.
Conclusion: In the process of component transfusion for MDS patients, compared with the transfusion of red blood cells, the inefficiencies of platelet transfusion significantly increased, mainly due to the disorder of blood coagulation and the generation of platelet antibodies in MDS patients with ineffective platelet transfusion. Compared with the normal control group, human P selectin and human anti-thrombin 3 antibody significantly increase and human tissue factor pathway inhibitor significantly decreases in MDS patients with ineffective platelet transfusion. Human P selectin, human anti-thrombin 3 antibody and human tissue factor pathway inhibitor in molecular markers and fibrinolytic markers can be used as indicators of platelet transfusion time and efficiency in patients with MDS.
题目: 骨髓增生异常综合征患者输血治疗有效性分析.
目的: 研究悬浮少白细胞的红细胞和新鲜辐照单采血小板在骨髓增生异常综合征（myelodysplastic syndromes, MDS）患者中输注的有效性, 探讨MDS患者血小板输注无效的原因和机制.
方法: 回顾性分析37名确诊MDS（WHO标准）患者的性别、年龄、Hb水平、Plt计数、出凝血常规指标、TEG等临床资料.
结果: 37名患者中, 仅采用悬浮少白细胞的红细胞输注的患者15例（占40.5%）, 仅进行新鲜辐照单采血小板输注的患者9例（占24.3%）, 2者均输注的患者有13例（占35.1%）。在只接受悬浮少白红细胞输注的15例患者中有3例输注无效（20.0%）, 在只接受血小板输注的9例患者中有5例输注无效（55.6%）, 两者之间具有显著的统计学差异（P＜0.01）。2者均输注的13例患者中悬浮少白红细胞输注无效的有3例（23.1%）, 血小板输注无效的有8例（61.5%）, 2者都无效的有2例（15.4%）。血小板输注无效的MDS患者中血小板抗体阳性率为23.1%。与正常对照组比较, 血小板输注无效的MDS患者人P-选择素（P-SelectinCD62P）（P＜0.01）和人抗凝血酶3抗体（AT-III Ab）（P＜0.01）显著升高, 而人组织因子途径抑制物（TFPI）显著下降（P＜0.05）.
结论: 在MDS患者进行成分输血过程, 与输注悬浮少白细胞的红细胞相比, 血小板输注无效率显著增高, 主要原因为血小板输注无效的MDS患者出凝血功能紊乱以及产生血小板抗体。与正常对照组相比, 血小板输注无效的MDS患者人P-选择素和人抗凝血酶3抗体显著升高, 人组织因子途径抑制物显著下降。分子标记物及纤溶指标中P-选择素和人抗凝血酶3抗体以及人组织因子途径抑制物可以作为MDS患者血小板输注时间和效率的指标.