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目的探讨儿童血液肿瘤患者血小板无效输注的分子学机制及治疗。方法回顾性分析2013年至2014年收治的4例血小板无效输注患儿的临床特征及实验室检查资料,评估血浆置换对儿童血小板无效输注的疗效。结果 4例患儿中男2例、女2例,年龄2岁~11岁9个月,其中3例为急性单核细胞白血病(M5),1例为重型再生障碍性贫血(SAA)。1例M5患儿首次化疗后、2例M5患儿造血干细胞移植后发生血小板无效输注,1例SAA患儿入院时即表现为血小板无效输注。免疫磁珠流式液相芯片技术(Luminex)检测,3例患儿HLA-I类抗体阳性,1例患者HLA-I类阴性。血浆置换后,血小板无效输注得到明显改善。结论 HLA-I类抗体阳性与血小板无效输注密切相关,血浆置换术可治疗血小板无效输注。
Objective To investigate the molecular mechanism and treatment of invalid platelet transfusion in children with hematological tumor. Methods The clinical features and laboratory data of 4 children with ineffective platelet transfusion admitted from 2013 to 2014 were analyzed retrospectively to evaluate the effect of plasma exchange on invalid platelet transfusion in children. Results There were 2 males and 2 females in the 4 cases, ranging in age from 2 years to 11 years and 9 months. Three of them were acute monocytic leukemia (M5) and one was severe aplastic anemia (SAA). One patient with M5 had an invalid infusion of platelet after hematopoietic stem cell transplantation after initial chemotherapy, and one patient with SAA presented with ineffective infusion of platelet on admission. Immunomagnetic bead flow cytometry (Luminex) detection, 3 cases of HLA-I antibodies positive, 1 patient’s HLA-I negative. After plasma exchange, ineffective platelet transfusion was significantly improved. Conclusions The positive HLA-I antibody is closely related to invalid platelet transfusion, and plasmapheresis can be used to treat invalid platelet transfusion.