血小板输注指南课件

血小板输注指南GUIDELINESOFPLATELETTRANSFUSTONS血小板输注指南1血小板3由骨髓中的巨核细胞产生生理作用:上血维护血管内皮的完整性;附、聚集、释放形成血小板血栓止血促凝功能。血小板2血板的制备方法手工法浓缩血小板悬液(48x1010机采法单采血小板(25x101)输注止血效果二者相似●保存和保存期:允许在22C2°C持续轻柔震荡下保存5天。血板的制备3血小板抗原与抗体血小板抗原特异性抗原HLA抗原ABO血型抗原特异性同种抗原HPA抗原血小板抗体同种异体抗体主要针对HLA抗原、HPA抗原自身抗体HPA抗原血小板抗原与抗体4适应症防止和治疗血小板减少和血小板功能失调引起的出血或出血倾向:骨髓功能衰竭(由于疾病或细胞毒性的治疗和照射)手术的预防和治疗性输注血小板功能失调大量输血免疫性血小板减少症●弥漫性血管内凝血适应症5忌症血栓性血小板减少性紫癜thromboticthrobocytopenicpurpura,TTP3朋素诱导血小板减少症(heparin-inducedthrombocytopenia,H工T忌症6血小板输注利弊益处:减少微小出血的发病率降低大量出血的发病率/死亡率风险:同种异体免疫反应输血感染过敏反应输血相关的移植物抗宿主病(transfusion-associatedgraft-versus-hostdisease,TAGVHD)血小板输注利弊7证据水平和推荐等级以美国卫生健康政策和研究署的标准为依据。(见后证据水平和推荐等级8StatementsofevidenceEvidenceobtainedfrommeta-analysisofrandomizedcontrolledtrialsabmmⅢEvidenceobtainedfromatleastonerandomizedcontrolledtrialIaEvidenceobtainedfromatleastonewell-designedcontrolledstudywithoutrandomiation.Evidenceobtainedfromatleastoneothertypeofwell-designedquasi-experimentalstudyEvidenceobtainedfromwell-designednon-experimentaldescriptivestudies,suchascomparativestudies,correlationstudiesandcasestudiesEvidenceobtainedfromexpertcommitteereportsoropinionsand/orclinicalexperiencesofrespectedauthoritiesgradesofrecommendationsARequiresatleastonerandomizedcontrolledtrialaspartofabodyofliteratureofoerallgoodqualityandconsistencyaddressingthespecificrecommendation(evidencelevelsla,Ib)BRequirestheavailabilityofwellconductedclinicalstudiesbutnorandomizedclinicaltrialsonthetopicofrecommendation(evidencelevelsIla,Ib,ImcRequiresevidenceobtainedfromexpertcommitteereportsoropinionsand/arclinicalexperiencesofrespectedauthoritiesIndicatesanabsenceofdirectlyapplicableclinicalstudiesofgoodquality,fevidencelevelIvStatementsofevidence9骨鏡功能衰竭Bonemarrowfailure凵慢性持续性血小减少症许多病人血小板持续低于L00P/或甚全低于5x10/L乃无出血最好避免长期的预防性血小板输注,因有产生同种免疫和血小无效输的危险。2血系恶性肿瘤j粒细胞白血病等有凝血障碍时血小板应保持在系恶性肿瘤在无发热或没有新鲜微小出血时其临界值可降至5x109/L。3,造血干细胞移植血小板的临界值降至10X109/L也安全。骨鏡功能衰竭Bonemarrowfailure10血小板输注指南课件11血小板输注指南课件12血小板输注指南课件13血小板输注指南课件14血小板输注指南课件15血小板输注指南课件16血小板输注指南课件17血小板输注指南课件18血小板输注指南课件19血小板输注指南课件20血小板输注指南课件21血小板输注指南课件22血小板输注指南课件23血小板输注指南课件24血小板输注指南课件25血小板输注指南课件26血小板输注指南课件27血小板输注指南课件28血小板输注指南课件29血小板输注指南课件30血小板输注指南课件31血小板输注指南课件32血小板输注指南课件33血小板输注指南课件34血小板输注指南课件35血小板输注指南GUIDELINESOFPLATELETTRANSFUSTONS血小板输注指南36血小板3由骨髓中的巨核细胞产生生理作用:上血维护血管内皮的完整性;附、聚集、释放形成血小板血栓止血促凝功能。血小板37血板的制备方法手工法浓缩血小板悬液(48x1010机采法单采血小板(25x101)输注止血效果二者相似●保存和保存期:允许在22C2°C持续轻柔震荡下保存5天。血板的制备38血小板抗原与抗体血小板抗原特异性抗原HLA抗原ABO血型抗原特异性同种抗原HPA抗原血小板抗体同种异体抗体主要针对HLA抗原、HPA抗原自身抗体HPA抗原血小板抗原与抗体39适应症防止和治疗血小板减少和血小板功能失调引起的出血或出血倾向:骨髓功能衰竭(由于疾病或细胞毒性的治疗和照射)手术的预防和治疗性输注血小板功能失调大量输血免疫性血小板减少症●弥漫性血管内凝血适应症40忌症血栓性血小板减少性紫癜thromboticthrobocytopenicpurpura,TTP3朋素诱导血小板减少症(heparin-inducedthrombocytopenia,H工T忌症41血小板输注利弊益处:减少微小出血的发病率降低大量出血的发病率/死亡率风险:同种异体免疫反应输血感染过敏反应输血相关的移植物抗宿主病(transfusion-associatedgraft-versus-hostdisease,TAGVHD)血小板输注利弊42证据水平和推荐等级以美国卫生健康政策和研究署的标准为依据。(见后证据水平和推荐等级43StatementsofevidenceEvidenceobtainedfrommeta-analysisofrandomizedcontrolledtrialsabmmⅢEvidenceobtainedfromatleastonerandomizedcontrolledtrialIaEvidenceobtainedfromatleastonewell-designedcontrolledstudywithoutrandomiation.Evidenceobtainedfromatleastoneothertypeofwell-designedquasi-experimentalstudyEvidenceobtainedfromwell-designednon-experimentaldescriptivestudies,suchascomparativestudies,correlationstudiesandcasestudiesEvidenceobtainedfromexpertcommitteereportsoropinionsand/orclinicalexperiencesofrespectedauthoritiesgradesofrecommendationsARequiresatleastonerandomizedcontrolledtrialaspartofabodyofliteratureofoerallgoodqualityandconsistencyaddressingthespecificrecommendation(evidencelevelsla,Ib)BRequirestheavailabilityofwellconductedclinicalstudiesbutnorandomizedclinicaltrialsonthetopicofrecommendation(evidencelevelsIla,Ib,ImcRequiresevidenceobtainedfromexpertcommitteereportsoropinionsand/arclinicalexperiencesofrespectedauthoritiesIndicatesanabsenceofdirectlyapplicableclinicalstudiesofgoodquality,fevidencelevelIvStatementsofevidence44骨鏡功能衰竭Bonemarrowfailure凵慢性持续性血小减少症许多病人血小板持续低于L00P/或甚全低于5x10/L乃无出血最好避免长期的预防性血小板输注,因有产生同种免疫和血小无效输的危险。2血系恶性肿瘤j粒细胞白血病等有凝血障碍时血小板应保持在系恶性肿瘤在无发热或没有新鲜微小出血时其临界值可降至5x109/L。3,造血干细胞移植血小板的临界值降至10X109/L也安全。骨鏡功能衰竭Bonemarrowfailure45血小板输注指南课件46血小板输注指南课件47血小板输注指南课件48血小板输注指南课件49血小板输注指南课件50血小板输注指南课件