Platelet Transfusion Refractoriness And Treatment In Patients With Hematologic Malignancies

Introduction: Platelet transfusion is one of the important hemostasis measures in patients with hematologic diseases.However,a number of patients may present platelet transfusion refractoriness(PTR)during the course of treatment.PTR may increase the hemorrhagic risk,and lead to poor clinical outcomes.The etiology of platelet transfusion refractoriness in patients with malignant hematological malignancies is relatively complex and generally includes non-immune,immune,and platelet factors according to the currently studies.The efficacy of available measures,which including gamma globulin intravenously in the treatment of PTR is still controversial.The purpose of this study was to analyze the clinical data of patients with platelets transfusion refractoriness in our center and to investigate the risk factors of platelets transfusion refractoriness in patients with hematological malignancy and the efficacy of gamma globulin.Materials and Methods: We retrospectively analyzed the clinical data of 73 patients with malignant hematologic malignancies who were admitted to our hospital during the period from September 2014 to December 2016.The risk factors of platelets transfusion refractoriness were investigated.According to whether the administration of intravenous gamma globulin before platelet transfusion,the patients were divided into the gamma globulin group(n=23)and non-globulin gamma group(n=50).The treatment efficacy of gamma globulin in two groups was analyzed.Results: The risk factors for platelet transfusion refractoriness in patients with hematological malignancies mainly include infection,splenomegaly,disseminated intravascular coagulation(DIC),and graft-versus-host disease(GVHD),with the highest proportion of infection(67.2%).The 24-hour corrected count increment(CCI)in the gamma globulin group was significantly higher than that in the non-gamma globulin group(p=0.037).There was no significant difference in the 48-hour corrected count increment(p=0.912),72-hour platelet(p=0.591)and red blood cell(p=0.358)transfusion volume,as well as bleeding score(p=0.796).Conclusion: Among the risk factors of platelet transfusion refractoriness in patients with malignant hematologic malignancies,the proportion of infection is the highest.Administration of intravenous gamma globulin before platelet infusion may transiently improve platelets transfusion refractoriness.Efficacy of recombinant factor VIIa for bleeding complicated by platelet transfusionrefractorinessIntroduction: Bleeding is a common and important complication in patients with hematological malignancies and has a significantly impact on the prognosis of patients.Recombinant human coagulation factor VIIa(r FVIIa)is a genetically engineered hemostatic drug and is currently approved for the treatment or prevention of congenital hemophilia with FVIII or FIX inhibitors,acquired hemophilia,and congenital FVII deficiency.However,the available literature on r FVIIa in the treatment of hemorrhage with platelet transfusion refractoriness is limited.On the basis of our previous studies of platelet transfusion refractoriness,this article aims to further analyze the therapeutic effect of r FVIIa in severe bleeding with platelet transfusion refractoriness.Patients and Methods: Sixty-four patients suffering from bleeding with PTR hospitalized in our center between June 2012 and December 2016 were enrolled in this study.Thirty-two patients received r FVIIa(r FVIIa group)with or without conventional hemostatic treatments,while the other 32 patients received conventional hemostatic treatments other than r FVIIa(control group).Results: The baseline parameters of patients before treatment were similar in both groups.The total response rates to hemostatic treatment at 24 h and 48 h were significantly higher in the r FVIIa group compared with the control group(p=0.014,p=0.020,respectively).Significantly more patients in the r FVIIa group achieved complete responses(CR)at 24 h(p=0.031),48 h(p=0.039),and 72 h(p=0.021)compared with the control group.The bleeding score(p=0.029),time to control bleeding(p=0.034),and activated partial thromboplastin time(p=0.021)after hemostatic treatment were significantly lower in the r FVIIa group compared with the control group.Patients who achieved a CR to r FVIIa had a significant survival advantage compared with those with a partial response/no response(p=0.020).No complications with venous or arterial thromboembolism were observed during treatment.Conclusions: r FVIIa may provide effective and safe hemostasis in patients suffering from severe bleeding and PTR.The overall survival of patients who achieved CR after hemostasis treatment was better than that of non-CR patients.