国际输血及血液学杂志
國際輸血及血液學雜誌
국제수혈급혈액학잡지
INTERNATIONAL JOURNAL OF BLOOD TRANSFUSION AND HEMATOLOGY
2014年
6期
516-519
,共4页
吴远军%吴勇%李惠森%刘艳%陈宝婵%吴月勤%刘兴玲
吳遠軍%吳勇%李惠森%劉豔%陳寶嬋%吳月勤%劉興玲
오원군%오용%리혜삼%류염%진보선%오월근%류흥령
白血病%白细胞去除术%血红蛋白%血小板计数%血液成分分离机
白血病%白細胞去除術%血紅蛋白%血小闆計數%血液成分分離機
백혈병%백세포거제술%혈홍단백%혈소판계수%혈액성분분리궤
Leukemia%Leukapheresis%Hemoglobin%Platelet count%Blood component separator
目的 探讨采用连续流动离心式血液成分分离机,对高白细胞性白血病患者进行高量减除白细胞治疗时,对患者血红蛋白(Hb)水平及血小板计数的影响.方法 选取2008年1月至2013年12月,于中山大学附属东华医院收治的高白细胞性白细胞病患者39例为研究对象.采用COBE Spectra连续流动离心式血液成分分离机MNC程序,以ACD-A配方血液保存液作为抗凝剂,对39例高白细胞性白血病患者进行高量减除白细胞治疗共计56次.每次高量减除白细胞治疗运转该患者2.5～3.0倍总血容量(TBV)血液,采集其1/5～1/4 TBV的白细胞悬液.本研究遵循的程序符合中山大学附属东华医院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意.结果 本研究单次高量减除白细胞治疗的运行时间为(233.6±27.4) min;运转血量为(12 268.8±1 978.3) mL;采集白细胞悬液容量为(922.9±213.3) mL,悬液中白细胞计数为(600.4±321.1)×109/L,白细胞总数为(554.1±281.3)×10 9,Hb水平为(27.3±10.0) g/L,Hb总量为(25.2±12.3)g,血小板计数为240.5×109/L[(90.0～640.0)×109/L],血小板总数为230.2×109[(83.7～593.0)×109];本组高白细胞性白血病患者治疗前、后白细胞计数分别为(261.0±121.4)×109/L与(185.5±111.1)×109/L,二者比较,差异有统计学意义(t=8.50,P＜0.001);Hb水平分别为(94.7±20.9) g/L与(89.4±20.0) g/L,二者比较,差异有统计学意义(t=4.21,P＜0.001);血小板计数分别为123.7×109/L[(55.2～283.8)×109/L]与96.40×109/L[(4.0～254.5)×109/L],二者比较,差异有统计学意义(s=662.50,P＜0.001),其中,12次减除白细胞治疗前血小板计数＜50×109/L的高白细胞性白血病患者治疗前、后血小板计数分别为(29.8±9.7)×109/L与(24.3±12.6)×109/L,二者比较,差异无统计学意义(t=1.29,P＞0.05).结论 采用连续流动离心式血液成分分离机对高白细胞性白血病患者进行高量减除白细胞治疗安全、有效,其虽可导致患者Hb水平及血小板计数有所下降,但Hb水平下降在机体代偿范围内;对血小板计数＜50×109/L患者进行高量减除白细胞治疗,也不会导致其血小板进一步减少而增加出血风险.
目的 探討採用連續流動離心式血液成分分離機,對高白細胞性白血病患者進行高量減除白細胞治療時,對患者血紅蛋白(Hb)水平及血小闆計數的影響.方法 選取2008年1月至2013年12月,于中山大學附屬東華醫院收治的高白細胞性白細胞病患者39例為研究對象.採用COBE Spectra連續流動離心式血液成分分離機MNC程序,以ACD-A配方血液保存液作為抗凝劑,對39例高白細胞性白血病患者進行高量減除白細胞治療共計56次.每次高量減除白細胞治療運轉該患者2.5～3.0倍總血容量(TBV)血液,採集其1/5～1/4 TBV的白細胞懸液.本研究遵循的程序符閤中山大學附屬東華醫院人體試驗委員會製定的倫理學標準,得到該委員會批準,併徵得受試對象的知情同意.結果 本研究單次高量減除白細胞治療的運行時間為(233.6±27.4) min;運轉血量為(12 268.8±1 978.3) mL;採集白細胞懸液容量為(922.9±213.3) mL,懸液中白細胞計數為(600.4±321.1)×109/L,白細胞總數為(554.1±281.3)×10 9,Hb水平為(27.3±10.0) g/L,Hb總量為(25.2±12.3)g,血小闆計數為240.5×109/L[(90.0～640.0)×109/L],血小闆總數為230.2×109[(83.7～593.0)×109];本組高白細胞性白血病患者治療前、後白細胞計數分彆為(261.0±121.4)×109/L與(185.5±111.1)×109/L,二者比較,差異有統計學意義(t=8.50,P＜0.001);Hb水平分彆為(94.7±20.9) g/L與(89.4±20.0) g/L,二者比較,差異有統計學意義(t=4.21,P＜0.001);血小闆計數分彆為123.7×109/L[(55.2～283.8)×109/L]與96.40×109/L[(4.0～254.5)×109/L],二者比較,差異有統計學意義(s=662.50,P＜0.001),其中,12次減除白細胞治療前血小闆計數＜50×109/L的高白細胞性白血病患者治療前、後血小闆計數分彆為(29.8±9.7)×109/L與(24.3±12.6)×109/L,二者比較,差異無統計學意義(t=1.29,P＞0.05).結論 採用連續流動離心式血液成分分離機對高白細胞性白血病患者進行高量減除白細胞治療安全、有效,其雖可導緻患者Hb水平及血小闆計數有所下降,但Hb水平下降在機體代償範圍內;對血小闆計數＜50×109/L患者進行高量減除白細胞治療,也不會導緻其血小闆進一步減少而增加齣血風險.
목적 탐토채용련속류동리심식혈액성분분리궤,대고백세포성백혈병환자진행고량감제백세포치료시,대환자혈홍단백(Hb)수평급혈소판계수적영향.방법 선취2008년1월지2013년12월,우중산대학부속동화의원수치적고백세포성백세포병환자39례위연구대상.채용COBE Spectra련속류동리심식혈액성분분리궤MNC정서,이ACD-A배방혈액보존액작위항응제,대39례고백세포성백혈병환자진행고량감제백세포치료공계56차.매차고량감제백세포치료운전해환자2.5～3.0배총혈용량(TBV)혈액,채집기1/5～1/4 TBV적백세포현액.본연구준순적정서부합중산대학부속동화의원인체시험위원회제정적윤리학표준,득도해위원회비준,병정득수시대상적지정동의.결과 본연구단차고량감제백세포치료적운행시간위(233.6±27.4) min;운전혈량위(12 268.8±1 978.3) mL;채집백세포현액용량위(922.9±213.3) mL,현액중백세포계수위(600.4±321.1)×109/L,백세포총수위(554.1±281.3)×10 9,Hb수평위(27.3±10.0) g/L,Hb총량위(25.2±12.3)g,혈소판계수위240.5×109/L[(90.0～640.0)×109/L],혈소판총수위230.2×109[(83.7～593.0)×109];본조고백세포성백혈병환자치료전、후백세포계수분별위(261.0±121.4)×109/L여(185.5±111.1)×109/L,이자비교,차이유통계학의의(t=8.50,P＜0.001);Hb수평분별위(94.7±20.9) g/L여(89.4±20.0) g/L,이자비교,차이유통계학의의(t=4.21,P＜0.001);혈소판계수분별위123.7×109/L[(55.2～283.8)×109/L]여96.40×109/L[(4.0～254.5)×109/L],이자비교,차이유통계학의의(s=662.50,P＜0.001),기중,12차감제백세포치료전혈소판계수＜50×109/L적고백세포성백혈병환자치료전、후혈소판계수분별위(29.8±9.7)×109/L여(24.3±12.6)×109/L,이자비교,차이무통계학의의(t=1.29,P＞0.05).결론 채용련속류동리심식혈액성분분리궤대고백세포성백혈병환자진행고량감제백세포치료안전、유효,기수가도치환자Hb수평급혈소판계수유소하강,단Hb수평하강재궤체대상범위내;대혈소판계수＜50×109/L환자진행고량감제백세포치료,야불회도치기혈소판진일보감소이증가출혈풍험.
Objective To explore the effect on hemoglobin (Hb) level and platelet count of high proportion of white blood cell deduction therapy for patients with hyperleukocytic leukemia by continuous flow centrifuge for blood component separator.Methods From January 2008 to December 2013,a total of 39 cases with hyperleukocytic leukemia who hospitalized in Affiliated Donghua Hospital,Sun Yet-sen University were enrolled into this study.By using ACD-A preservation solution as blood anticoagulant,56 times of white blood cell deduction treatment were performed on 39 patients with hyperleukocytic leukemia in MNC program performed by COBE Spectra type of continuous flow centrifuge for blood component separator.In each treatment,2.5-3.0 times of total blood volume (TBV) was circulated,and 20 ％-25 ％ TBV white blood cell suspension was collected.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Affiliated Donghua Hospital,Sun Yet-sen University.Informed consent was obtained from all participants.Results For a single white blood cell deduction treatment,(233.6±27.4)min was took,(12 268.8±1 978.3)mL blood was circulated,and (922.9±213.3) mL white blood cell suspension was collected,in which white blood cell count was (600.4 ±321.1)×109/L,the total number of white blood cell was (554.1±281.3)×109,Hb level was (27.3±10.0) g/L,the amount of Hb was (25.2±12.3) g,platelet count was 240.5× 109/L(90.0× 109/L-640.0× 109/L),and the total number of platelet was 230.2 × 109 (83.7 ×× 109-593.0 ×× 109).For patients before and after treatment,white blood cell count were (261.0 ± 121.4) ×× 109/L and (185.5 ± 111.1) ×109/L,respectively,and the differences were statistically significant between before and after treatment (t=8.50,P＜0.001); Hblevels were (94.7±20.9) g/L and (89.4±-20.0) g/L,respectively,and the difference were statistically significant between before and after treatment (t=4.21,P＜0.001); platelet count were 123.7×× 109/L(55.2 × 109/L-283.8 × 109/L) and 96.4 ×× 109/L(41.0×× 109/L-254.5×× 109/L),respectively,and the differences were statistically significant between before and after treatment (s =662.50,P＜0.001).In 12 times of white blood cell deduction therapy for patients with platelet count ＜50× 109/L,platelet counts in patients before and after treatment were (29.8±9.7)×× 109/L and (24.3±12.6)× 109/L,respectively,and there were no significant differences between before and after treatment (t=1.29,P＞ 0.05).Conclusions It is safe and efficient to use continuous flow centrifuge for blood component separator for high proportion of white blood cell depletion therapy for patients with hyperleukocytic leukemia.Though it can make Hb level and platelet count decreased,the reduction of Hb is within the ability of body compensation.And white blood cell deduction therapy for hyperleukocytic leukemia patients with platelet count ＜50×× 109/L will not lead to further reduction of platelet or increase the risk of hemorrhage.
