Blood：HLA表位抗原错配对输血小板的效果的影响

2020-10-20 星云 MedSci原创

血小板输注无效会导致不良预后和增加医疗费用。处理由于HLA同种异体免疫引起的难治性，需要使用HLA抗原匹配的血小板，但需要大量的血小板捐献者，并且不能保证完全匹配。

血小板输注无效会导致不良预后和增加医疗费用。处理由于HLA同种异体免疫引起的难治性，需要使用HLA抗原匹配的血小板，但需要大量的血小板捐献者，并且不能保证完全匹配。

该研究是一个随机、双盲、非劣势、交叉试验，旨在比较输注HLA表位匹配(HEM)的血小板和HLA标准抗原匹配(HSM)的血小板的预后。

HLA抗体特异性及目标表位鉴定

纳入标准：表现为同种异体免疫、血小板难治性、血小板减少的再生障碍性贫血、骨髓增生异常综合征或急性髓系白血病患者。使用HLAMatchMaker表位匹配(特别是小片段)选择HEM血小板。患者最多接受8次随机顺序提供的预防性HEM和HSM输液。主要结果是在输血后1小时血小板计数的增量(PCI)。

来自英国14家医院的共49名患者被随机分组。在意向治疗中，HEM和HSM的可评估输血次数分别为107次和112次。HEM和HSM的未调整平均PCI(SD)分别为23.9(15)和23.5(14.1)。由于95%可信区间下限不大于预定的非劣效性限制，HEM被宣布为非劣于HSM。

HEM表位错配对一小时PCI的影响

血小板计数、输血要求和出血事件的次要结果没有差异。平均3.2个表位错配时，血小板输注后不足1小时的血小板计数增量即可堪比5.5个表位错配时血小板输注后1个小时的血小板计数增量。每增加一个错配表位，血小板计数增加适当的可能性就降低15%。

因此，HLA同种异体免疫患者应尽可能输注表位抗原匹配的血小板。

原始出处：

Judith C Marsh, et al. An epitope-based approach to use of HLA matched platelets for transfusion: a noninferiority, cross-over, randomised trial. Blood. OCTOBER 16, 2020

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2020-10-22 windight

#输血#

49 0
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2020-10-22 marongnuan

#HLA#

38 0
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2020-10-22 xiaoyeshuang

#抗原#

48 0
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2020-10-20 CHANGE

疗效只是效果的众多方面之一，还要看对患者的获益，包括生活质量等因素共同决定效果的

67 0
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2020-10-20 光辉岁月岁月无声

分享好文章

106 0
[GetPortalCommentsPageByObjectIdResponse(id=1259734, encodeId=ba921259e3457, content=<a href='/topic/show?id=569c9382389' target=_blank style='color:#2F92EE;'>#输血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93823, encryptionId=569c9382389, topicName=输血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ec9955, createdName=windight, createdTime=Thu Oct 22 08:55:40 CST 2020, time=2020-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1502070, encodeId=990e15020e0d6, content=<a href='/topic/show?id=14a6894190' target=_blank style='color:#2F92EE;'>#HLA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8941, encryptionId=14a6894190, topicName=HLA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e72c9501412, createdName=marongnuan, createdTime=Thu Oct 22 08:55:40 CST 2020, time=2020-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1623384, encodeId=54a71623384e4, content=<a href='/topic/show?id=62a655263e9' target=_blank style='color:#2F92EE;'>#抗原#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55263, encryptionId=62a655263e9, topicName=抗原)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f59b20519025, createdName=xiaoyeshuang, createdTime=Thu Oct 22 08:55:40 CST 2020, time=2020-10-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047194, encodeId=304d104e194d4, content=疗效只是效果的众多方面之一，还要看对患者的获益，包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Tue Oct 20 20:55:40 CST 2020, time=2020-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893368, encodeId=7222893368e6, content=分享好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=826e5156795, createdName=光辉岁月岁月无声, createdTime=Tue Oct 20 19:59:08 CST 2020, time=2020-10-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=893351, encodeId=4a7089335194, content=血小板输注无效会导致不良预后和增加医疗费用。, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=言西早, createdTime=Tue Oct 20 18:01:10 CST 2020, time=2020-10-20, status=1, ipAttribution=)]
2020-10-20 言西早

血小板输注无效会导致不良预后和增加医疗费用。

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