关键词: 免疫性血小板输注无效, HLA抗体, HPA抗体, 抗体强度, 血小板输注效果

Abstract: Objective To exploring the clinical significance of changes in human leukocyte antigen (HLA) and human platelet antigen (HPA) antibodies in the serum of patients with ineffective immune platelet transfusion, and to analyze the effects of antibody strength and transfusion frequency on platelet transfusion efficacy. Methods A retrospective study was conducted on 95 patients, who were grouped according to antibody type (HLA type, HPA type, HLA+HPA type) and intensity (HLA low/medium/high, HPA low/high). The transfusion efficacy rate (defined as a 24-hour corrected count increment [CCI]≤4.5 indicating refractoriness) and CCI level were compared, and the correlation between transfusion frequency and antibody intensity was analyzed. Results Among the 95 patients, 84.21% were positive for HLA antibody, 9.47% for HPA antibody and 6.32% for HLA+HPA antibody. In HLA patients, the effective rate of cross-matched platelet transfusion and the 24-hour CCI level were significantly higher than those of random platelet transfusion (P＜0.05). There was no significant difference in the effective rate and 24-hour CCI level between HPA type and HLA+HPA type patients (P＞0.05). With the increase of HLA antibody strength, the effective rate of cross-matched platelet transfusion and 24-hour CCI decreased gradually (P＜0.05). The effective rate and 24-hour CCI of cross-matching transfusion in patients with moderate and low-intensity HLA antibodies were significantly higher than those of random transfusion(P＜0.05), but there was no significant difference between the two transfusion methods in patients with high-intensity HLA antibodies (P＞0.05). The average number of times in random transfusion group was significantly higher than that in cross-matching group (P＜0.05), and the number of times of random transfusion was positively correlated with the strength of HLA antibody(P＜0.05). Conclusions HLA antibody strength is the key factor affecting the transfusion effect, and cross-matching can improve the curative effect of patients with different HLA antibody strength. Repeated random transfusion may promote the increase of HLA antibody, and the effect of HPA antibody requires validation in large cohorts.

Key words: ineffective immune platelet transfusion, HLA antibodies, HPA antibodies, antibody strength, platelet transfusion effect