血小板输注指南.ppt

血小板输注指南
GUIDELINES OF
PLATELET TRANSFUSTONS
血小板
3由骨髓中的巨核细胞产生
生理作用:上血
维护血管内皮的完整性;
附、聚集、释放形成血小板血栓止血
促凝功能。
血板的制备
方法
手工法浓缩血小板悬液(48x1010
机采法单采血小板(25x101)
输注止血效果二者相似
●保存和保存期:
允许在22C2°C持续轻柔震荡下保存5天。
血小板抗原与抗体
血小板抗原
特异性抗原
HLA抗原
ABO血型抗原
特异性同种抗原
HPA抗原
血小板抗体
同种异体抗体主要针对HLA抗原、HPA抗原
自身抗体
HPA抗原
适应症
防止和治疗血小板减少和血小板功能失调引起的出血或
出血倾向:
骨髓功能衰竭(由于疾病或细胞毒性的治疗和照射)
手术的预防和治疗性输注
血小板功能失调
大量输血
免疫性血小板减少症
●弥漫性血管内凝血
忌症
血栓性血小板减少性紫癜 thrombotic
throbocytopenic purpura, TTP
3朋素诱导血小板减少症( heparin- induced
thrombocytopenia,H工T
血小板输注利弊
益处:减少微小出血的发病率
降低大量出血的发病率/死亡率
风险:同种异体免疫反应
输血感染
过敏反应
输血相关的移植物抗宿主病( transfusion-
associated graft-versus-host disease, TA
GVHD)
证据水平和推荐等级
以美国卫生健康政策和研究署的标准为依据。
(见后
Statements ofevidence
Evidence obtained from meta-analysis of randomized controlled trials
abmmⅢ
Evidence obtained from at least one randomized controlled trial
Ia Evidence obtained from at least one well-designed controlled study without randomi ation.
Evidence obtained from at least one other type of well-designed quasi-experimental study
Evidence obtained from well-designed non - experimental descriptive studies, such as comparative
studies, correlation studies and case studies
Evidence obtained from expert committee reports or opinions and/or clinical experiences of
respected authori ties
grades of recommendations
A Requires at least one randomized controlled trial as part of a body of literature of oerall good quality
and consistency addres sing the specific recommendation (evidence levels la, Ib)
B Requires the availability of well conducted clinical studies but no randomized clinical trials on the
topic of recommendation (evidence levels Ila, Ib, Im
c Requires evidence obtained from expert committee reports or opinions and/ar clinical experiences of
respected authorities
Indicates an absence of directly applicable clinical studies of good quality, fevidence level Iv
骨鏡功能衰竭 Bone marrow failure
凵慢性持续性血小减少症
许多病