Predicting donor-related factors for high platelet yield donations by classification and regression tree analysis

Introduction Collecting high-dose (HD) or double-dose (DD) apheresis platelets units from a single collection offers significant benefit by improving inventory logistics and minimizing the cost per unit produced. Platelet collection yield by apheresis is primarily influenced by donor factors, but the cell separator used also affects the collection yield. Objectives To predict the cutoff in donor factors resulting in HD and DD platelet collections between Trima/Spectra Optia and MCS+ apheresis equipment using Classification and Regression Trees (CART) analysis. Methods High platelet yield collections (target ≥ 4.5 × 1011 platelets) using MCS+, Trima Accel and Spectra Optia were included. Endpoints were ≥ 6 × 1011 platelets for DD and ≥ 4.5 to < 6 × 1011 for HD collections. The CART, a tree building technique, was used to predict the donor factors resulting in high-yield platelet collections in Trima/Spectra Optia and MCS+ equipment by R programming. Results Out of 1,102 donations, the DDs represented 60% and the HDs, 31%. The Trima/Spectra Optia predicted higher success rates when the donor platelet count was set at ≥ 205 × 103/µl and ≥ 237 × 103/µl for HD and DD collections. The MCS+ predicted better success when the donor platelet count was ≥ 286 × 103/µl for HD and ≥ 384 × 103/µl for DD collections. Increased donor weight helped counter the effects of lower donor platelet counts only for HD collections in both the equipment. Conclusions The donor platelet count and weight formed the strongest criteria for predicting high platelet yield donations. Success rates for collecting DD and HD products were higher in the Trima/Spectra Optia, as they require lower donor platelet count and body weight than the MCS+.

Platelet Transfusion Strategies for MASPAT-Matched Platelet Transfusion Failed Patient with Allogeneic Hematopoietic Stem Cell Transplantation / 中国实验血液学杂志

OBJECTIVE@#To investigate the causes of ineffectiveness of platelet transfusion with monoclonal antibody solid phase platelet antibody test (MASPAT) matching in patients with allogeneic hematopoietic stem cell transplantation and explore the strategies of platelet transfusion.@*METHODS@#A case of donor-specific HLA antibodies (DSA) induced by transfusion which ultimately resulted in transplantation failure and ineffective platelet transfusion with MASPAT matching was selected, and the causes of ineffective platelet transfusion and platelet transfusion strategy were retrospectively analyzed.@*RESULTS@#The 32-year-old female patient was diagnosed as acute myeloid leukemia (high risk) in another hospital with the main symptoms of fever and leukopenia, who should be admitted for hematopoietic stem cell transplantation after remission by chemotherapy. In the course of chemotherapy, DSA was generated due to platelet transfusion, and had HLA gene loci incompatible with the donor of the first transplant, leading to the failure of the first transplant. The patient received platelet transfusion for several times before and after transplantation, and the results showed that the effective rate of MASPAT matched platelet transfusion was only 35.3%. Further analysis showed that the reason for the ineffective platelet transfusion was due to the missed detection of antibodies by MASPAT method. During the second hematopoietic stem cell transplantation, the DSA-negative donor was selected, and the matching platelets but ineffective transfusion during the primary transplantation were avoided. Finally, the patient was successfully transplanted and discharged from hospital.@*CONCLUSIONS@#DSA can cause graft failure or render the graft ineffective. For the platelet transfusion of patients with DSA, the platelet transfusion strategy with matching type only using MASPAT method will miss the detection of antibodies, resulting in invalid platelet transfusion.

Perioperative administration of recombinant activated factor VII in a Glanzmann's thrombasthenia patient with platelet refractoriness: case report

Abstract Glanzmannʼs Trombasthenia (GT) is a genetic disorder, that develops with a tendency toward bleeding and is characterized by the absence or decrease in platelet aggregation. Surgical bleeding may be difficult to control. Platelet transfusion is the main treatment, albeit refractoriness can occur. We describe the case of a patient with GT and platelet refractoriness, who was submitted to radical prostatectomy and dental extraction. The perioperative treatment with apheresis platelet concentrate and activated recombinant factor seven allowed the procedures to be performed uneventfully. We discuss the complexity of the case and the treatment option.

Manejo de la trombastenia de Glanzmann durante el embarazo: reporte de un caso y revisión de la literatura / Management of Glanzmann's thrombasthenia during pregnancy: a case report and literature review

Resumen Objetivo: Reportar el caso de una paciente con trombastenia de Glanzmann que recibe manejo con transfusión de plaquetas con factor VII activado y realizar una revisión de la literatura referente al tratamiento y el pronóstico de esta patología durante la gestación. Método: Se presenta el caso de una paciente de 27 años con trombastenia de Glanzmann y embarazo de 33 semanas, con cesárea al término sin complicaciones. Se realizó una búsqueda en las bases de datos Medline vía PubMed, Lilacs, SciELO y ScienceDirect; se incluyeron reportes de caso, series de casos y revisiones bibliográficas hasta 2021. Resultados: Se encontraron 21 artículos, con 23 casos reportados. Los embarazos se presentaron entre la tercera y la cuarta décadas de la vida, siendo la mayoría pacientes con anticuerpos frente a antígenos plaquetarios (43,4% de los casos). El principal manejo fue con transfusión plaquetaria. Conclusiones: La trombastenia de Glanzmann durante el embarazo es infrecuente y se asocia a eventos hemorrágicos. La presencia de anticuerpos frente a antígenos plaquetarios condiciona el manejo con mayor riesgo de complicaciones perinatales. No tiene un enfoque terapéutico unificado, siendo el de elección la transfusión de plaquetas y como segunda línea el factor VII activado.

Abstract Objective: To report the case of a patient with Glanzmann's thrombasthenia who receives management with platelet transfusion with activated factor VII and a literature review regarding the treatment and prognosis of this pathology during pregnancy. Method: We present the case of a 27 year old patient with Glanzmann's thrombasthenia and a 33-week pregnancy, with a cesarean section at term without complications. Medline databases were searched via PubMed, Lilacs, SciELO and ScienceDirect; case reports, case series and bibliographic reviews were included until 2021. Results: A total of 21 articles were found, with 23 reported cases; the pregnancies occurred between the third and fourth decades of life, the majority being patients with anti-platelet antigen antibodies in 43.4% of the cases. The main management was with platelet transfusion. Conclusions: Glanzmann's thrombasthenia during pregnancy is rare and is associated with hemorrhagic events. The presence of anti-platelet antigen antibodies conditions management with a higher risk of perinatal complications. It does not have a unified therapeutic approach, with platelet transfusion being the management of choice and activated factor VII as second line.

The Treatment of Newly Diagnosed Primary Immune Thrombocytopenia by Recombinant Human Thrombopoietin Combined with Glucocorticoid / 中国实验血液学杂志

OBJECTIVE@#To evaluate the efficacy and safety of recombinant human thrombopoietin (rhTPO) combined with glucocorticoid in treatment of newly diagnosed adult primary immune thrombocytopenia (ITP).@*METHODS@#Eleven male and 23 female patients with the diagnosis of primary ITP in our hospital from November 2018 to October 2019 were enrolled and randomly divided into test group (17 cases) and control group (17 cases), the median age was 52 years old (range: 20-76 years old). The patients in test group were treated with rhTPO 300 IU/(kg·d) combined with glucocorticoid , while the patients in control group were treated with rhTPO (15 000 IU/d) combined with glucocorticoid. Platelet count, platelet increase, as well as the overall response rate were compared. At the same time, the drug tolerance and any adverse drug reactions were observed.@*RESULTS@#The platelet counts and platelet increase of the patients in the test group were significantly higher than those in control group (P<0.05). There was no significant difference in platelet counts and platelet increase between the patients in the test group and control group at day 3, 7 after treatment. There was no significant difference in overall response rates and complete response rates at day 7, 14 between the two groups either. In test group, there were 13 cases received platelet transfusion, while 12 cases in control group. The muscle aches occurred in one patient, and mild aminotransferase increased in another patient in test group which was self-recovery without treatment.@*CONCLUSION@#RhTPO 300 U/(kg·d) combined with glucocorticoid could rapidly increase the platelet count with a low incidence of tolerable adverse events compared with conventional dose rhTPO with glucocorticoid.

Trombocitopenia neonatal: Revisión. II. Trombocitopenias no inmunes; transfusión de plaquetas / Neonatal thrombocytopenia: A review.II. Non-immune thrombocytopenia; platelet transfusion

Las trombocitopenias de causa no inmunológica son ocasionadas por múltiples patologías; las más frecuentes son las debidas a infecciones extra- o intrauterinas y las secundarias a otras patologías involucradas en la interrelación niño-placenta-madre. En este segundo artículo, se enumeran sus causas y se describen en detalle las distintas patologías. La transfusión de plaquetas es ampliamente utilizada en neonatología, tanto para tratamiento como para profilaxis de hemorragias. Sin embargo, no hay aún consenso generalizado sobre el umbral de recuento plaquetario conveniente para indicar la transfusión ni sobre sus reales indicaciones. Se comentan artículos recientes sobre las distintas estrategias propuestas. Se enfatiza la discusión sobre los múltiples efectos adversos de las transfusiones de plaquetas, cuyo conocimiento está cambiando el paradigma relativo a sus indicaciones, lo que sugiere que se debe aplicar una política mucho más restrictiva al respect

Non-immune thrombocytopenia is caused by multiple pathologies; the most common causes are extra- or intrauterine infections, whereas secondary cases result from other pathologies involved in the fetal-placental-maternal interface. This second article lists its causes and provides details of the different pathologies. Platelet transfusion is widely used in neonatology, both as treatment and as bleeding prophylaxis. However, there is no general consensus about the platelet count threshold that is convenient to indicate a transfusion or actual indications. Recent articles are commented regarding the different proposed strategies. The emphasis is on discussing the multiple adverse effects of platelet transfusions because knowledge about them is changing the paradigm for indications, suggesting that a much more restrictive policy is required

Trombocitopenia neonatal: Revisión. I. Definiciones, diagnóstico diferencial, causas, trombocitopenias inmunes / Neonatal thrombocytopenia: A review. I. Definitions, differential diagnosis, causes, immune thrombocytopenia

La trombocitopenia, definida como recuento plaquetario inferior a 100 x 109/l, es un hallazgo muy frecuente en el período neonatal, que ocurre, en especial, en niños críticamente enfermos y en prematuros. Sus causas son múltiples: puede deberse tanto a enfermedades del niño como a otros factores involucrados en la interrelación niño-placenta-madre. En este primer artículo, se enumeran las causas de trombocitopenia; se plantea el enfoque diagnóstico frente a un neonato trombocitopénico y se describen detalladamente las distintas entidades correspondientes a trombocitopenias de etiología inmune. Se presentan los diferentes mecanismos causales y se revisan las distintas características de la trombocitopenia secundaria a trombocitopenia inmune materna y de la trombocitopenia neonatal aloinmune. Se describen las diversas estrategias terapéuticas disponibles para cada una de ellas, tanto para su manejo posnatal como para el prenatal. Se enfatiza sobre la gravedad de la enfermedad y las serias complicaciones y secuelas asociadas a la trombocitopenia neonatal aloinmune

Thrombocytopenia, defined as a platelet count below 100 x 109/L, is a very common finding in the neonatal period, especially in critically ill infants and preterm newborns. Its causes are multiple: it may be due both to pediatric conditions and to other factors involved in the fetal-placental-maternal interface. This initial article describes the causes of thrombocytopenia, proposes a diagnostic approach to manage a thrombocytopenic newborn infant, and provides a detailed description of the different conditions corresponding to thrombocytopenia of immune etiology. It also describes the different causative mechanisms and reviews the varying characteristics of thrombocytopenia secondary to maternal immune thrombocytopenia and neonatal alloimmune thrombocytopenia. The different treatment approaches to each of the different conditions are described both for their pre- as well as their postnatal management. The severity of thrombocytopenia and the serious complications and sequelae associated with the neonatal alloimmune thrombocytopenia are highlighted.

Comparison of abo antibody levels in apheresis platelets suspended in platelet additive solution and plasma

ABSTRACT Background Transfusion of platelets (PLTs) with high ABO antibody titres can pose a risk of hemolysis if the unit crosses the ABO type. The PLTs stored in the platelet additive solution (PAS) remove asubstantial fraction of plasma and replace it with an isotonicbuffered solution.We aimed to assess the difference in anti-A/B antibody levels in Groups O, A and B apheresis platelets (APs) suspended in plasma and PAS. Methodology Apheresis donors are categorized into two groups, Plasma (Group I) and PAS (Group II), each blood group (A, B and O) had 20 samples. The anti-A/B(IgM)antibody levels were recorded from the AP donor (Group II) and from the AP units for both groups. The reduction in the anti-A/B(IgM) antibody levels in the APs suspended in the PAS for each blood group was determined. Results The median anti-A titres in blood Groups B (p = 0.009) and O (p = 0.005) was significantly lower in Group II. However, the difference in anti-B levels was not significant in the blood groups A (p = 0.057) and O (p = 0.205). The median level of reduction in IgM antibody titres across donor samples and the PAS-stored platelets was two-fold. The regression showed a level of reduction in antibody titres which can be explained by baseline donor antibody titres in blood groups A and B compared to blood group O. Conclusion The medianABO antibody titres were lower in APs suspended in PAS than in plasma. Addition of the PAS significantly lowered the IgM antibody titres by twofold, compared to plasma.

Perioperative considerations in a girl with Glanzmann thrombasthenia. Case report / Consideraciones perioperatorias en niña con trombastenia de Glanzmann. Reporte de caso

Abstract Introduction Glanzmann thromboasthenia is a rare congenital bleeding disorder caused by a mutation in platelet glycoprotein α-IIb and β3 encoding genes (ITGA2B; 607759 and ITGB3; 173470) in chromosomes I7q21.31 and 17q21.32, respectively, which results in a qualitative or quantitative alteration of the platelet integrin αIIbβ3 (glycoprotein IIb/IIIa) receptor. Glanzmann thromboasthenia is classified as type I when less than 5% of glycoprotein αIIbβ3 is expressed, and as type II when more than 5% is expressed. Case presentation Description of the perioperative management of a 13-year-old female patient with Glanzmann thromboasthenia who underwent endoscopic anterior bilateral ethmoidectomy. Management was centered on prophylactic platelet transfusion plus the use of tranexamic acid, as well as thromboelastographic determination of hemostasis. There were no bleeding complications during or after the procedure. Conclusiones Pediatric patients with Glanzmann thromboasthenia are at a high risk of perioperastive bleeding. Platelet transfusion is the best prophylactic and therapeutic alternative; however, even in the absence of anti-platelet antibodies, it may not be effective, and viscoelastic testing must be used for assessment during the surgical procedure in order to improve patient safety.

Resumen Introducción La trombastenia de Glanzmann es un trastorno hemorrágico congénito infrecuente, causado por mutación en los genes que codifican las glucoproteínas plaquetarias α-IIb (ITGA2B; 607759) y β3 (ITGB3; 173470) en los cromosomas I7q2i.3i y I7q2i.32, respectivamente, alterando cualitativa o cuantitativamente al receptor plaquetario de integrina αIIbβ3 (glucoproteína IIb/IIIa). La trombastenia de Glanzmann se clasifica como tipo I cuando se expresa menos del 5 % de la glucoproteína αIIbβ3 y como tipo II, cuando es mayor al 5 %. Presentación del caso Se describe el manejo perioperatorio de una paciente de 13 años de edad con trombastenia de Glanzmann, sometida a etmoidectomía anterior bilateral endoscópica. El manejo se centró en la transfusión profiláctica de plaquetas y ácido tranexámico, así como en la evaluación de la hemostasia con tromboelastografía. No hubo complicaciones hemorrágicas durante y después del procedimiento. Conclusiones Los pacientes pediátricos con trombastenia de Glanzmann tienen alto riesgo de hemorragia perioperatoria. La transfusión de plaquetas es la mejor alternativa profiláctica y terapéutica; sin embargo, incluso en ausencia de anticuerpos antiplaquetarios, puede no ser efectiva y debe evaluarse mediante pruebas viscoelásticas durante los procedimientos quirúrgicos para mejorar la seguridad del paciente.

Trombocitopenia imune associada à COVID-19: relato de caso e revisão de literatura / Immune thrombocytopenia associated to Covid-19: case report and literature review

Pacientes com COVID-19 podem apresentar trombocitopenia grave. Esse achado tem importante impacto no aumento de desfechos negativos e mortalidade, representando um importante fator prognóstico da doença. Vários mecanismos etiopatogênicos foram descritos, sendo a trombocitopenia imune um dos fatores mais frequentes. A abordagem terapêutica inclui como opções: corticoterapia, imunoglobulina, transfusão de plaquetas e análogos da trombopoietina. Este estudo tem como objetivo apresentar o relato de caso de uma paciente com PCR positivo para SARS-CoV-2, que desenvolveu queda acentuada e abrupta das plaquetas no 20º dia de internação. Além disso, casos semelhantes na literatura foram analisados e as possibilidades terapêuticas elencadas. Por fim, conclui-se que há a necessidade de estudos mais amplos para auxiliar a criação de protocolos sistematizados para o diagnóstico e abordagem dessa condição.

COVID-19 patients may experience severe thrombocytopenia. Such finding has an important impact on the increase in negative outcomes and mortality, representing an important prognostic factor of the disease. Several etiopathogenetic mechanisms have been described, in which immune thrombocytopenia is one of the most frequent. The therapeutic approach includes as options: corticosteroid therapy, immunoglobulin, platelet transfusion and thrombopoietin analogs. The following study aims to present a case report of a patient with positive PCR for SARSCoV-2 who developed a severe and abrupt drop in platelets on the 20th day of hospitalization. In addition, similar cases reports in the literature were analyzed and the therapeutic possibilities were listed. Finally, it is concluded that there is a need for broader studies to help create systematic protocols for the diagnosis and approach of this condition.

The Effect of Immunized Platelet Transfusion Refractoriness on Allo-HSCT Patients with Malignant Hematological Diseases / 中国实验血液学杂志

OBJECTIVE@#To investigate the characteristics of platelet antibody in patients with hematological diseases, so as to research the effect of immunized platelet transfusion refractoriness (PTR) on the prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recepients with malignant hematological diseases patients.@*METHODS@#The clinical data of platelet antibody positive patients tested by Capture-P in the First Affiliated Hospital of Soochow University from July 1, 2014 to July 1, 2019 were retrospectively analyzed, including sex, age, disease, platelet transfusion assessments, CD34@*RESULTS@#In 5 years, 913 (7.28%) hematologic patients with platelet antibody positive were identified, the detection rate of females (513 cases) were higher than males (400 cases). Among the 913 patients, the antibody positive rates of 520 patients with malignant hematological diseases (acute myeloid leukemia, acute lymphoblastic leukemia and myelodysplastic syndrome) showed significantly statistical different (10.27%, 8.01%, and 7.20%) (P<0.01), and the positive rate of the acute myeloid leukemia of those patients was higher than myelodysplastic syndrome patients(α<0.0125). There were 35 cases diagnosed as immunized PTR before allo-HSCT, the platelet increments, 14 h correct count increment, progression-free survival rate and overall survival rate of those patients were significantly lower than those in negative transfusion effective patients (P<0.01), while the percentage of ABO matching was significantly higher (α<0.0125).@*CONCLUSION@#The positive rate of platelet antibody identification is high in females and acute myeloid leukemia patients, and immunized PTR caused by antibody is a risk factor for poor prognosis of allo-HSCT in malignant hematological disease patients.

Analysis of Related Factors of Adverse Transfusion Reactions / 中国实验血液学杂志

OBJECTIVE@#To investigate the related factors of adverse reactions of blood transfusion, and clinical precautions so as to reduce the adverse reactions.@*METHODS@#Data of 2108 patients with allogeneic transfusion in our hospital from January 2017 to June 2017 collected and analyzed.@*RESULTS@#These patients received 15 244 time of blood transfusion, and 213 time of adverse reactions occurred in 178 patients in totality, the incidence is 1.4%, and there was no significant difference between the male (1.31%) and female (1.53%). The main type of transfusion reaction were allergy (73.23%), FNHTR (11.74%) and TACO (10.80%). Among all kinds of blood components, the incidence of adverse reactions of apheresis platelet transfusion was the highest (4.31%), significantly higher than that of cryoprecipitate and other blood components. The incidence rate of adverse reactions of blood transfusion in the hematopathy patients was 2.56%, significantly higher than that of immune diseases (1.48%), cancer diseases (1.28%) and other diseases (1.08%), (P＜0.01). The rate of transfusion history of apheresis platelets was 42.67% (the incidence of adverse reactions was 4.31%), significantly higher than other groups (P＜0.01); the rate of transfusion history of cryoprecipitate was 4.11% (the incidence of adverse reaction was 0.45%), significantly lower than other groups (P＜0.05). Among the disease types, the rate of transfusion history in the hematopathy patients was 48.79% (the incidence of adverse reaction was 2.56%), significantly higher than that of other groups (P＜0.01). The incidence of drug allergy in patients with the adverse reactions to blood transfusion was 11.25%, significantly higher than that of patients without adverse reactions (4.71%) (P＜0.01).@*CONCLUSION@#The main risk factors of adverse reactions of blood transfusion are as follows: blood varieties, disease type, transfusion history and drug allergy history. For the patients with transfusion, multiple factors should be controlled, so as to reduce the adverse reactions.

Evaluation of platelet concentrate prescription in pediatric patients at a tertiary care hospital / Avaliação da prescrição de concentrado de plaquetas em pacientes pediátricos em hospital terciário

ABSTRACT Objective: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. Methods: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. Results: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. Conclusion: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

RESUMO Objetivo: Verificar a adequação na prescrição de concentrado de plaquetas por pediatras em diferentes setores da pediatria de um hospital geral. Métodos: Estudo transversal avaliando 218/227 fichas de requisição de concentrado de plaquetas de crianças e adolescentes (zero a 13 anos), de janeiro de 2007 a abril de 2015 pelos pediatras do pronto-socorro, enfermaria e unidade de terapia intensiva. Excluíram-se as requisições em portadores de doenças hematológicas e aquelas sem o número de plaquetas. Resultados: Crianças com menos de 12 meses receberam 98 prescrições de concentrado de plaquetas (45,2%). A maioria das transfusões foi profiláticas (165; 79%). Em relação ao local da transfusão, 39 (18%) foram no pronto-socorro, 27 (12,4%) na enfermaria e 151 (69,6%) na unidade de terapia intensiva. O gatilho, o volume prescrito e o subtipo de concentrado de plaquetas foram adequados em 59 (28,2%), 116 (53,5%) e 209 (96,3%) das transfusões, respectivamente. Prescrições para pacientes com hemorragia apresentaram adequação em 42 (95,5%) transfusões, enquanto para crianças sem hemorragia houve adequação em 17 (10,3%) vezes. A inadequação mais comum em relação ao volume foi a prescrição acima da recomendação (95; 43,8%). Foram prescritos oito concentrados de plaquetas sem indicação de solicitação de subtipos. Conclusão: Os resultados obtidos nesse estudo mostraram que a prescrição de transfusão de concentrado de plaquetas foi mais adequada em crianças com hemorragia ativa em comparação com a transfusão profilática. Houve tendência à prescrição de volumes elevados e de subtipos de plaquetas, o que não se justifica segundo os protocolos atuais. O ensino da medicina transfusional deve ser mais valorizado na graduação e na residência médica.

Successful Treatment of Severe Heparin-induced Thrombocytopenia with Intravenous Immunoglobulin, Platelet Transfusion and Rivaroxaban: A Case Report / 中国医学科学杂志(英文版)

Heparin-induced thrombocytopenia (HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin (IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.

Analysis of Clinical Blood Use in Emergency Blood Loss Patients / 中国实验血液学杂志

OBJECTIVE@#To explore the blood transfusion data of emergency hemorrhage patients, so as to provide the basis for improving the quality of emergency blood transfusion and guiding clinic rational blood transfusion.@*METHODS@#one thousand emergency blood loss patients once transfused RBC suspension were collected by Recipient Epidemiology and Donor Evaluation Study-III internationals Site range from November 2012 to November 2015. The clinical data including age, sex, clinical diagnosis etc were analyzed retrospectively. According to the quantity of blood transfusion the 1 000 patients were divided into 3 groups: low transfusion volume group(834),moderate transfusion volume group(116) and high transfusion volume group(50), difference was compared among the 3 groups，the transfusion predicting index and risk factor were analyzed by unvariate and multivoriate analyses using SPSS 23.0 software.@*RESULTS@#High volume transfusion group was different from moderate and low volume transfusion in sex, pathogenesis, systolic pressure, hemoglobin level, with or without surgical operation, infusion volume of blood products, the retention time of ICU, total hospitalzed stay and mortality(P＜0.05), but there were no differences in age, respiration frequency, temperature before transfusion and creatinine level. The multivarate analysis showed that with or without surgical operation(OR=7.515，95% CI: 3.289-17.174, P=0.000), bleeding volume in surgery(OR=2.626, 95% CI: 1.428-4.828, P=0.043), the amount of transfused red blood cells(OR=2.574, 95% CI: 1.306-5.073, P=0.015), plasma transfusion or no(OR=2.118, 95% CI: 1.184-3.789, P=0.011), cryoprecipitate transfusion or no(OR=5.296, 95% CI: 2.164-12.960, P=0.000) were the independent risk factors for death resulted from emergency blood loss.@*CONCLUSION@#The probability of massive transfusion in the trauma patients is higher，and the massive transfusion associates with increased mortality in the emergency blood loss patients. Surgery operation, bleeding volume in operation, amount of transfused red blood cells, plasma transfusion and cryoprecipitate transfusion may predict the mortality of patients with blood transfusion.

Discharge and Contents of Exosome from Leukocyte-Reduced Apheresis Platelet Stored for Different Storage Time / 中国实验血液学杂志

OBJECTIVE@#To explore the effect of storage time on discharge and content of exosome from leukocyte-reduced apheresis platelets (LRA-Plt).@*METHODS@#Exosome (EXO) from LRA-Plt were acquired by ExoQuick, and its' morphology, immunological marker and particle size distribution were detected by transmission electron microscopy (TEM), Western blotting and dynamic light scattering (DLS), respectively. The changes in particle size distribution of EXO from LRA-Plt with different storage time were detected by DLS. The changes in content of protein and RNA of EXO from LRA-Plt with different storage time were detected by Nanodrop® ND-2000.@*RESULTS@#EXO from LRA-Plt was acquired successfully, which was characterized by cup-like shape, CD63/TSG101 enriched and Calnexin negative, and the particle size of which ranged from 30 to 200 nm. At early stored stage (stored for 1 day and 2 days), particle size of EXO from LRA-Plt was small and ranges from 30 to 40 nm. Meanwhile, the contents of protein and RNA were low. The particle size distribution, contents of protein and RNA of EXO from LRA-Plt were not significanty different ammg groups (P＞0.05). At middle-late stored stage (stored for 3, 4 and 5 days), the particle size of EXO from LRA-Plt was larger than that of early stored stage, which ranges was from 130 to 200 nm. Meanwhile, the contents of protein and RNA were higher than those of early stored stage. Particle size distribution, contents of protein and RNA of EXO from LRA-Plt stored for middle-late stage were significant higher than those of early stored stage (P＜0.05).@*CONCLUSION@#Morphology of EXO from LRA-Plt stored for middle-late stage was different from that stored for early stored stage. Moreover, the particle size distribution, contents of protein and RNA of EXO from LRA-Plt stored for middle-late stage were higher than those of early stored stage. A large amount of protein and RNA contained in EXO from LRA-Plt may participate in the multiple functions caused by platelet transfusion.

Long-Term Efficacy and Safety of Partial Splenic Embolization in Hepatocellular Carcinoma Patients with Thrombocytopenia Who Underwent Transarterial Chemoembolization

BACKGROUND: Performing transarterial chemoembolization (TACE) is difficult with the occurrence of thrombocytopenia in cirrhotic patients with hepatocellular carcinoma (HCC). We aimed to evaluate the long-term efficacy and safety of partial splenic embolization (PSE) combined with TACE in patients with HCC with severe thrombocytopenia related to splenomegaly. METHODS: We conducted a case–control study consisting of 18 HCC patients with severe thrombocytopenia (< 50 × 109/L) who underwent PSE concurrently with TACE (PSE group) and 72 controls who underwent TACE alone (non-PSE group). RESULTS: Mean platelet counts at 1 month and 1, 3, and 5 years after concurrent PSE and TACE significantly increased compared with baseline (all P < 0.05), whereas the platelet count did not significantly increase after TACE alone. In addition, the platelet count at several time points after treatment in the PSE group was significantly higher than that in the non-PSE group, although the baseline platelet count in the PSE group was significantly lower than that in the non-PSE group. The platelet increase after PSE significantly reduced the need for platelet transfusions (P = 0.040) and enabled the subsequent TACE procedures in time (P = 0.046). The leukocyte counts and hemoglobin concentrations after concurrent PSE and TACE were also significantly increased, without deterioration of Child-Turcotte-Pugh score and unexpected side effects. CONCLUSION: PSE combined with TACE is effective in inducing and maintaining long-term thrombocytopenia improvement which reduces the need for the platelet transfusion and helps to perform initial and serial TACE, and is well-tolerated in patients with HCC and thrombocytopenia. PSE may be a promising treatment option for HCC patients with severe thrombocytopenia associated with splenomegaly who will undergo TACE.

Neonatal Thrombocytopenia: Diagnostic Approach and Platelet Transfusion Guideline / 임상소아혈액종양

Neonatal thrombocytopenia, defined as platelet counts of less than 150,000/µL, is a frequent hematologic abnormality in neonatal period. Differential diagnosis of neonatal thrombocytopenia may be challenging to pediatric hematologists and neonatologists because neonatal thrombocytopenia is associated with diverse maternal or neonatal clinical conditions. An accurate diagnosis for neonatal thrombocytopenia will lead to appropriate evaluation and management. Platelet transfusion is the primary management of neonatal thrombocytopenia. Most thrombocytopenic newborns received platelet concentrates to prevent major hemorrhage or treat ongoing bleeding according to institutional policy. However, scientific evidences for benefit and consistent guideline for platelet transfusion in neonates are lacking, further investigation to establish the standard recommendation for platelet transfusion is needed. This article reviewed the diagnostic approach and current guideline for platelet transfusion management for neonatal thrombocytopenia.