血小板输血:2025 AABB和ICTMG国际临床实践指南
Ryan A Metcalf1,2, Susan Nahirniak3, Gordon Guyatt4
1Department of Pathology, University of Utah, Salt Lake City.
JAMA
|May 29, 2025
概括
对于大多数患者,建议采取限制性血小板输血策略,降低风险和成本,但不增加出血或死亡率. 这些指南为各种临床情景提供了基于证据的建议.
科学领域:
- 血液学
- 输血医学
- 临床实践指南
背景情况:
- 血小板输血是一种常见的医疗程序, 具有相关的好处和风险.
- 需要基于证据的指导方针来优化成人和儿童血小板输血的做法.
研究的目的:
- 在成人和儿童患者中制定血小板输血策略.
- 为了比较限制性与自由的血小板输血方法.
主要方法:
- 对21项随机试验和13项观察性研究进行了系统审查和元分析.
- 推评级开发和评估 (GRADE) 方法的应用.
- 基于血小板数和临床背景的输血策略的比较.
主要成果:
- 在死亡率和出血方面,限制性输血策略与自由的策略相比没有劣势.
- 对于各种疾病,包括化疗,干细胞移植,登革热和手术,建议使用特定的血小板数值.
- 血小板输血不建议在非手术性内出血时,血小板数量大于100×10^3/μL,或在没有严重出血的情况下进行心血管手术时.
结论:
- 限制性血小板输血策略得到了一致的证据支持,在减少不良反应,减轻缺乏和降低成本方面具有优势.
- 在决定血小板输血时,应考虑临床背景和替代疗法.
- 这些建议为优化输血医学的患者护理和资源利用提供了实际指导.
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