Inefficiency Of Platelet Transfusion In Patients With Hematologic Diseases

Objective To identify the clinical reasons of refractoriness to platelet transfusion and study how to increase the effective rate of platele transfusion.Methods 131 patients with hematologic diseases(male, 82 cases; female, 49 cases; age, 8～80years; weight, 27Kg～91Kg) were selected as the study objects. 659 platelets were transfused in these patients (aplastic anemia(AA), 28 cases; acute leukemia(AL), 38 cases; idiopathic thrombocytopenic purpura(ITP), 28 cases; hematopoietic stem cell transplantation(HSCT), 37 cases). If peripheral blood platelet count was less than 20×10⁹/L or there were hemorrhagic events, which included intracranial, gastrointestinal, vagina, gum, hemorrhagic cystitis, petechiae, ecchymoses and so on, the patients received ABO identical platelets provided by Wuhan Blood Center. The volume of a bag platelet was about 200 milliliter, and there were more than 2.5×10¹¹ platelets. Some clinical parameters were collected through reviewing the case history, such as peripheral blood platelet count before and after transfusion, temperature, splenmegaly, activated partial thromboplastin time, prothrombin time, transfusion of crossmatch-compatible platelet, scheme of hematopoietic stem cell transplantation and complications. The correlations between the kind of disease, splenmegaly, temperature, disseminated intravscular coagulation, transfusion of crossmatch -compatible platelet, type of hematopoietic stem cell transplantation, complications and the efficacy of platelet transfusion were analyzed. Results 1. The relation between the kind of disease and the efficacy of platelet transfusion: The effective rate were 66.49%, 71.19% and 51.39% in acute leukemia,aplastic anemia , idiopathic thrombocytopenic purpura respectively(P <0.05). 2. The relation between temperature and the efficacy of platelet transfusion: For patients with aplastic anemia, acute leukemia or hematopoietic stem cell transplantation, the effective rate of fever group was lower than non-fever group (P <0.05). 3. The relation between the splenomegaly and the efficacy of platelet transfusion: In acute leukemia patients, there was significant difference in splenomegaly group and non-splenomegaly group (P <0.05). 4. The relation between disseminated intravscular coagulation and the efficacy of platelet transfusion: There was significant difference between the patients with disseminated intravscular coagulation (DIC) group and the group without DIC in acute leukemia patients (P <0.05). 5. The relation between the type of hematopoietic stem cell transplantation and the efficacy of platelet transfusion: The effective rate of peripheral blood stem cell transplantion group and bone marrow transplantion were 52.54%, 38.22% (P <0.05). 6. The relation between the outcome of hematopoietic stem cell transplantation and the efficacy of platelet transfusion: Death group and survival group were 23.21%, 52.41% respectively(P <0.05). 7. The relation between the crossmatch-compatible platelet and the efficacy of platelet transfusion: For 9 hematopoietic stem cell transplantation patients using leukocyte filter, there was significant difference between 5 cases received crossmatch-compatible platelet and 4 cases received non-crossmatching platelet (P <0.05).Conclusions The results suggested that many factors could induce refractoriness to platelet transfusion. The kind of disease, temperature, disseminated intravscular coagulation, splenmegaly, transfusion of crossmatch-compatible platelet, scheme of hematopoietic stem cell transplantation and complications have closely relations with the efficacy of platelet transfusion. The platelet crossmatching is an available method for refractoriness to platelet transfusion. Whether patients will be given platelet transfusion depends on the patients'diagnosis, clinical condition, treatment modality and peripheral blood platelet counts. Doctors should avoid or decrease all inducing factors so as to prevent the inefficiency of platelet transfusion.