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    Impact of platelet transfusions in children with post-diarrheal hemolytic uremic syndrome

    发布于：2013年4月29日    文字：【大】【中】【小】

    Pediatr Nephrol. 2013 Jun;28(6):919-25. doi: 10.1007/s00467-013-2414-y. Epub 2013 Feb 6.

    Balestracci A, Martin SM, Toledo I, Alvarado C, Wainsztein RE.

    Abstract

    BACKGROUND: Platelet transfusions should be avoided in children with post-diarrheal hemolytic uremic syndrome (D + HUS) because they might increase microthrombi formation, thereby aggravating the disease. As this possibility has not yet been explored, we investigated whether platelet transfusion in patients with D + HUS would lead to a worse disease course compared to that in patients who did not receive platelet transfusion.

    METHODS: This was a case-control study in which data from D + HUS children who received platelet transfusions (cases, n? = ?23) and those who did not (controls, n? = ?54) were retrospectively reviewed and compared.

    RESULTS: Both patient groups were similar in age (p?=?0.3), gender (p? =? 0.53), weight (p? = ?0.86), height (p? = ?0.45), prior use of non-steroidal anti-inflammatory drugs (p? = ?0.59) or antibiotics (p ?= ?0.45) and presence of dehydration at admission (p? = ?0.79). The two groups also did not differ in initial leukocyte count (p? = ?0.98), hematocrit (p? = ?0.44) and sodium (p? = ?0.11) and alanine aminotransferase levels (p? = ?0.11). During hospitalization, dialysis duration (p? = ?0.08), number of erythrocyte transfusions (p? =? 0.2), serum creatinine peak (p? = ?0.22), presence of severe bowel (p? = ?0.43) or neurologic (p? = ?0.97) injury, arterial hypertension (p? = ?0.71), need for intensive care (p? = ?0.33) and death (p? = ?1.00) were also comparable.

    CONCLUSION: Our findings suggest that platelet transfusion does not aggravate the course of the disease. Conversely, no hemorrhagic complications were observed in the group of patients who did not receive a platelet transfusion. Until these observations are confirmed by further studies, the benefits and risk of platelet transfusion should be thoughtfully balanced on an individual case basis.

    D+HUS发病与志贺样毒素与肾脏内皮细胞表现Gb3结合后，对内皮细胞有毒性及促进凋亡作用，同时志贺样毒素也可以干扰H因子功能、引起旁路过度活化并介导内皮细胞损伤；内皮细胞损伤后激活凝血、血小板系统，血栓形成，引起急性肾损伤。从发病机制来看，对D+HUS患者输注血小板会加重血栓形成，从而恶化病情。本研究回顾性分析两组患者，接受血小板输注组（23例）和未输注血小板组（54例）基线资料基本相同；最后结果为输注血小板组患者病情较另外一组无明显恶化，而未输注血小板组出血风险也未见增加。而结论为：对于D+HUS患者是否输注血小板仍需个体化分析。

    http://www.ncbi.nlm.nih.gov/pubmed/23386110