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治疗性血小板输血与血液恶性瘤患者的常规预防性输血:一个开放的,多中心的,随机的研究
Hannes Wandt1, Kerstin Schaefer-Eckart, Knut Wendelin
1Medical Clinic 5, Haematology and Oncology, Klinikum Nüremberg, Nüremberg, Germany. wandt@klinikum-nuernberg.de
Lancet (London, England)
|August 11, 2012
概括
一种新的治疗性血小板输血策略在低增殖性血小板缺血症患者中显著减少了33.5%的输血. 然而,它增加了急性髓性白血病患者的非致命出血风险,需要谨慎实施.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 输血医学 输血医学
背景情况:
- 严重的血小板缺血往往需要常规的预防性血小板输血.
- 低增殖性血小板减少症对输血策略提出了独特的挑战.
- 目前的护理标准包括预防性输血,以防止出血.
研究的目的:
- 评估治疗性血小板输血策略与标准预防方法的对比.
- 评估对所需输血次数的影响.
- 在特定患者群体中确定治疗策略的安全概况.
主要方法:
- 一个多中心的,开放的,随机的试验,涉及398名因急性髓性白血病或自身干细胞移植接受密集化疗的患者.
- 患者被分配到治疗 (在出血时输血) 或预防 (在血小板计数≤10×10(9) /L时输血) 策略中.
- 主要终点是血小板输血次数,安全性分析包括出血事件和死亡率.
主要成果:
- 治疗策略使所有患者的血小板输血平均减少了33.5% (p<0.0001).
- 在急性髓性白血病 (31.6%) 和自身干细胞移植 (34.2%) 组中都观察到显著的减少.
- 移植后没有增加重大出血风险,但急性髓性白血病患者的非致命4级出血 (CNS) 增加. 在治疗策略的两名患者中发生了致命的大脑出血.
结论:
- 治疗性血小板输血策略可能是自身干细胞移植患者的新标准.
- 预防性血小板输血仍然是急性髓性白血病患者的标准.
- 实施治疗策略需要经验丰富的员工和对中枢神经系统出血的警监测.
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