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目的为了解白血病患儿输注血小板后血小板抗体产生规律及其临床意义,通过检测急性白血病(AL)患儿血小板抗体,探讨血小板抗体产生与血小板输注无效(PTR)的关系。方法收集2010年4月至2011年10月在四川大学华西第二医院儿童血液/肿瘤科住院诊治的急性白血病患儿56例,治疗过程中依据血小板输注次数不同分为3组:患儿在入院后未输注血小板(Ⅰ组)、第2次输注血小板(Ⅱ组)及第5次输注血小板(Ⅲ组)后1 h内采集血液标本。同期收集我院门诊健康正常体检儿童20名作为对照组,均无输血史。先用血小板抗体检测试剂检测所有标本,再将检测阳性标本用PAKPLUS试剂确定HLA-Ⅰ、HPA抗体,并观察抗体阳性患儿血小板输注效果。结果 20名正常对照组检测结果均为阴性。Ⅰ、Ⅱ、Ⅲ组抗体阳性率比较,各组间抗体总体阳性率差异有统计学意义(χ2=8.313,P<0.05)。Ⅱ组抗体阳性率高于Ⅰ组,差异无统计学意义(χ2=3.116,P=0.078)。Ⅲ组抗体阳性率高于Ⅰ组,差异有统计学意义(χ2=13.057,P<0.05)。Ⅲ组抗体阳性率高于Ⅱ组,差异无统计学意义(χ2=1.286,P=0.257)。Ⅱ、Ⅲ组抗体表达阳性组的PTR发生率高于抗体表达阴性组,但差异无统计学意义(χ2=1.163,P>0.05)。Ⅲ组PTR发生率高于Ⅱ组,差异有统计学意义(χ2=10.469,P<0.05)。结论急性白血病患儿血小板抗体阳性率随着血小板输注次数的增多而增加,但血小板抗体阳性患儿不一定发生血小板输注无效。
Objective To investigate the regularity and clinical significance of platelet antibodies after platelet transfusion in children with leukemia and to explore the relationship between platelet antibody production and platelet transfusion failure (PTR) by detecting platelet antibodies in children with acute leukemia (AL). Methods Fifty-six children with acute leukemia admitted to Children’s Hematology / Oncology department of Huaxi No.2 Hospital of Sichuan University from April 2010 to October 2011 were divided into 3 groups according to the number of platelet transfusions: After admission, blood samples were collected within 1 h after transfusion of platelet (group Ⅰ), platelet 2 (group Ⅱ) and platelet 5 (group Ⅲ). During the same period, we collected 20 healthy children in our hospital as normal control group without any history of blood transfusion. The first detection of all specimens with platelet antibody test kit, and then test positive samples with PAKPLUS reagent to determine HLA-Ⅰ, HPA antibodies, and to observe the antibody-positive children with platelet transfusion. Results 20 normal control group test results were negative. The positive rates of antibodies in groups Ⅰ, Ⅱ and Ⅲ were significantly different (χ2 = 8.313, P <0.05). The positive rate of antibody in group Ⅱ was higher than that in group Ⅰ, the difference was not statistically significant (χ2 = 3.116, P = 0.078). The positive rate of antibody in group Ⅲ was higher than that in group Ⅰ (χ2 = 13.057, P <0.05). The positive rate of antibody in group Ⅲ was higher than that in group Ⅱ, the difference was not statistically significant (χ2 = 1.286, P = 0.257). The incidence of PTR in group II and group III antibody positive group was higher than that in antibody negative group (χ2 = 1.163, P> 0.05). The incidence of PTR in group Ⅲ was higher than that in group Ⅱ, the difference was statistically significant (χ2 = 10.469, P <0.05). Conclusion The positive rate of platelet antibody in children with acute leukemia increased with the increase of platelet transfusion, but platelet antibody-positive children may not be ineffective in platelet transfusion.