【正文】 個(gè) ? 交 叉 配 血 同型輸注，不需配血 最好交叉配血 ? 血 小板 配 型 可 能 幾乎不可能 ? 輸 注 無 效 出 現(xiàn) 遲 易發(fā)生，且出 現(xiàn)早 ? 保 存 期 5～ 7 天 1～ 3 天 ? 止 血 效 果 好 差 ? ──────────────────────────── 2022/6/23 輸 血 科 陸 志 剛 35 與時(shí)俱進(jìn)，客觀評價(jià) WBDPs ? 制品質(zhì)量與臨床療效 ? 同種免疫血小板輸注無效 ? 細(xì)菌污染反應(yīng) ? 輸血傳播疾病 ? 同種異體蛋白反應(yīng) ? 供需矛盾和血液資源 ? 新技術(shù)與成本效益 /效率 2022/6/23 輸 血 科 陸 志 剛 36 DelaflorWeiss E, Mintz PD. The evaluation and management of platelet refractoriness and alloimmunization. Transfus Med Rev. 2022。14:180196. ? HLA alloantibodies developed in 45% of the patients in the control arm and in 17% to 21% of the patients in the treated arms, and this pares with rates of alloimmune plt refractoriness of only 13% and 3% to 5%,respectively. In addition, it has been documented that HLA antibodies may not persist in up to 42% of patients, even with continued transfusions. 2022/6/23 輸 血 科 陸 志 剛 37 Slichter SJ. Understanding the effects of different types of white cells on patient’s responses to transfusion: immunization versus tolerization. Vox Sang. 2022。83:421424. there is some evidence from animal studies that prevention of plt alloimmunization may not just be related to a quantitative reduction in the number of transfused white cells. Rather, it may be important to document both what types of white cells are removed and which types remain. 2022/6/23 輸 血 科 陸 志 剛 38 Slichter SJ. Evidencebased platelet transfusion guideline. Hematology Am Soc Hematol Educ Program.. 2022,2022:1728 ? The actual effectiveness of the current methods of leukoreduction in preventing plt alloimmunization may very well be dependent on the immunopetence of the patients who receive transfusions. As all of these trials were done in patients with AML undergoing induction。 the role of leukocyte reduction in other patient populations remains to be determined. 2022/6/23 輸 血 科 陸 志 剛 39 Use of random versus apheresis platelet concentrates We can conclude that there is now good evidence that the prevention of HLA immunization cannot be a criterion to favour the use of APC as a first line therapy . Of course, the use of HLA patible APC remains the best solution to provide efficient platelet transfusion in case of HLA immunized patients , but this situation concerns nowadays only a small minority of patients. — G. Andreu et al. / Transfusion Clinique et Biologique 14 (2022) 514– 521 2022/6/23 輸 血 科 陸 志 剛 40 從血液需求與血液資源、醫(yī)療安全，再認(rèn)識 WBDPs ? 從血液的可得性和安全性來看，國家之間的差距懸殊。 ? 在富裕國家中，據(jù)統(tǒng)計(jì)每 10個(gè)進(jìn)入醫(yī)院的人中就有一人需要血液。 ? 隨著人口的老齡化，在需要進(jìn)行輸血的醫(yī)學(xué)治療和操作方面的進(jìn)展，富裕國家中對血液的要求不斷增長。 ? 在低收入國家中，婦女和兒童是對血液最有需求的人群。 ? 發(fā)展中國家的人們繼續(xù)面臨著來自不安全血液和血液制品的最大風(fēng)險(xiǎn)。 ? —— 血液、安全性和獻(xiàn)血全球觀 ? 世界衛(wèi)生組織（實(shí)況報(bào)道第 279號 2022年 6月修訂稿） 2022/6/23 輸 血 科 陸 志 剛 4