| ABSTRACT Objective:The patients with acute leukemia(AL) in the course of disease or chemotherapy and haemopoietic stem cell transplatation often associated with thrombocytopenia.Platelet transfusion as the primary means of treatment had important clinical value.However,The effect of transfusion is not ideal becouse of some influence factors and clinical platelet transfusion threshold is the focus of debate in recent years. To investigate the reasons of platelet transfusion refractoriness(PTR) and to explore the possibility of reduced platelet transfusion threshold in patients with acute leukemia by studying the effect observed after platelet transfusion are significant. Methods: 90 acute leukemia patients were divided into three groups according to platelet count(group 1 PLT<10×109/L 34 cases, group 2 PLT=(10-20)×109/L 33 cases,group 3 PLT>20×109/L 23 cases), Also divided into complications group and without complications group. The diagnoses of all the subjects were identified by bone marrow aspiration and cytological examination. All patients following platelet transfusion indications:①PLT<10×109/L, Whether with bleeding or not;②Complicated by DIC,Blood trandfusion and/or fibrinogen as appropriate in the treatment of primary disease and the low-dose heparin anticoagulation;③PLT between 10×109/L to 20×109/L, With the nose and mouth mucous membrane bleeding heaier and/or visceral bleeding or sustained high fever;④PLT>20×109/L, Transfusion indications as the preceding group. Otherwise, the prevention infusion could not be required. The platelets (the PLT amount≥2.5×1011 for each)were used should be completed within 30 minutes. Manual platelet counts were tested before and after infusion of 1,24 hours and calculated the corrected count increment(CCI) and percentage of platelet recovery(PPR). Judging the improvement of clinical bleeding was as the following criteria:Significant bleeding improved obviously and hyprrhea disappearde were considered. Compared with the results between groups and p<0.05 were considered statistically significant. Results:1) There are 62 cases of thrombocytopenia whose platelet count was increased and bleeding display was improved significantly in 90 cases. the effective rate was 68.89%. Among them there are 55 cases that 1 hour CCI> 7.5 or 24 hour CCI> 4.5; 53 cases 1 hour PPR> 60% or 24 h our PPR>40%.2) The platelet tranfusion refractoriness (PTR) rate was 34.38% in AML group,23.08% in ALL group. There was no significant difference between these two groups(P> 0.05); the effective infusion rate of Plt≤10×109/L group (group 1) was 88.24%, (10～20)×109/L (group 2) was 66.67%,≥20×109/L (group 3) was 43.48%, compared group 1 with group 2&3, there was a significant difference between them(P<0.05); the difference between group 2 and group 3 was not significant (P>0.05).3) The 42 cases with fever as high as 38.5℃, the platelet transfusion effective rate was 54.76%; the 48 cases with lower temperature, the effective rate was 81.25%, difference between the two groups was significant (P<0.05). The 31 cases with splenomegaly the PTR rate was 22.03%, the 55 cases without splenomegaly the PTR rate was 48.39%, the two groups had statistical significance difference (P<0.05); DIC group did not compared with these groups because of fewer cases. Conclusion:1) The supporting treatment of platelet transfusion in patients with AL is effective, but the results of infusion was unstable, because the non-immunological factors like infection, fever, splenomegaly and so on should be the new challenges to clinical treatment; 2) To evaluate the effects of platelet transfusion comprehensively and accurately must be closely integrated with clinical situation and not just rely on CCI, PPR and other simple laboratory indicators; 3)The threshold of 10×109/L as a preventive infusion is safety for AL patients, but sometimes the treatment should be flexible if they were with severe complications. The best management is to do it individually.
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