血小板制剂的制备及临床应用.pptVIP

Platelet Concentrates ? Prophylactic to prevent bleeding – Severe thrombocytopenic patients ? Treat active bleeding – PLT 5 – 10万/μL – PLT dysfunction Platelet Concentrates Biggest Issues for Transfusion Service 1.Increasing Need 2.Availability ? Short storage time (5 days) ? Sensitivity to low donations – Apheresis = donor recruitment – “Pooled platelets”: 4-6 whole blood / pool Platelets ? Prophylactic transfusions ( 50% ) – Severe thrombocytopenia – Prevent major bleeding – Clinical research ? Transfusion response ? Transfusion trigger ? Transfusion dose Transfusion Response: Platelet Kinetics circulating life span 8-10 days Impact of Spleen on Transfusion Response Expected platelet recovery = 60% - 65% Splenic pool size ?platelet recovery Factors Impacting Transfusion Response ? Spleen size ? Platelet Dose – Total number of platelets infused – Patient size Factors Impacting Transfusion Response ? Spleen size ? Platelet Dose ? Patient pre-transfusion platelet count ? Clinical factors Platelets Transfusion Guidelines Prophylactic: severe thrombocytopenia ? PLT 0.5-1万/μL – Stable patient, no coagulopathy ? PLT 2万K/μL – Fever, infection, coagulopathy, heparin, minor bleeding ? PLT 3万/μL – VOD（静脉闭塞病）, bleeding unresponsive to PLT 2-3万 Platelet 5万/μL – Active bleeding or prior to invasive procedure ? Includes lumbar puncture in adults – Stable, sick infant ( 37 weeks) Platelet 8万/μL – Anesthesia guidelines – Epideral anesthesia Platelet 10万 ? Extracorporeal Membrane Oxygenation (ECMO)体外膜肺氧合 – Adults and children ? Neurosurgery ? +/- Opthamology/airway surgery ? Cardiac Surgery – CABG（冠脉搭桥术）with microvascular bleeding nl coag tests – Ventricular assist device placement (VAD)体外心室辅助装置 ? Sick infants ( 37 wks gestation, *↑ risk ICH) ? Infant, bleeding, DIC or other coagulapathy Normal Platelet Count ? Inherited qualitative defect (ex. Bernaud-Soulier) ? Factor V Inhibitor, active bleeding ? Acquired defect – Uremia, acti