New exploratory research of platelet functional classification and hemostatic mechanism
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摘要: 目的:探讨血小板功能分类及临床应用,并试图探讨血细胞冰冻的个体化。方法:将不同浓度的(DMSO)作为保护剂加入血小板中,在-80℃条件下进行冰冻,观察冰冻前后凝血及收缩块形成过程,检测冰冻前后及不同离心条件下血小板的计数、血浆中血小板第3因子(PF3)、血小板第4因子(PF4)、血小板体积分布宽度(PDW)及P-选择素(CD62P)对血小板的聚集、黏附、血块收缩功能的影响。对质控条件合格的冰冻血小板单独或合并新鲜血小板的临床应用进行回顾性分析。结果:血小板阻断后血液不凝集;血浆纤维蛋白收缩块形成过程分两个阶段:第一步血浆凝集,需要5~15 min;第二步纤维蛋白收缩块形成,约在2 h内完。血浆中PF3、PF4及CD62P对血小板的功能有促进凝集和抑制收缩两方面的影响。冰冻血小板和新鲜血小板搭配应用与单独的新鲜血小板的临床效果有明显差异;2%与5%的DMSO冻存血小板质量无明显差别。结论:血小板可进行功能分类,即因子释放类和血块收缩类;止血过程分两步进行,第一步为血浆凝集阶段第二步为血栓形成阶段,两类血小板分别参与不同的止血阶段,经典的止血机理值得商榷;冰冻血小板和新鲜血小板搭配应用效果较好;可用低浓度2%的DMSO做进行冻存。Abstract: By observing in vitro,the platelet concentrates(PC)were always originally jelly-like agglutinate followed by further shrinking.PLTcould release procoagulant factors PF3,PF4 and CD62P,here we studied the plateletic functional classifica-tion and discussed the new Hemostatic Mechanism of PLTs.We used apheresis fresh platelet concentrates(PC)and frozen PC with different concentrations of DMSO under -80 ℃ to observe the platelet(PLT)coagulation process,and tested PLTs count,plasma PLT factors(PF3 and PF4),platelet distribution width(PDW)and Human P-Selectin(CD62P),as well as their influences to the plateletic functions of aggregati-on,adhesion,systolic.We analyzed retrospectively the clinical effects of the qualified frozen PC alone or merger of the fresh PC to clinical application.There was no blood agglutination after blocking the plateletic functions;in vitro,the coagulation process in PC had two phases:the plasma jelly-like agglutination and then forming fibrin pieces,about 15 min and 2 hours.In frozen PC,there were more PF3,PF4 speeding plasma jelly-like agglutination and more CD62P inhibiting shrinking.There was better clinical effects to transfuse mixture of frozen and fresh PCy.Conclusion:PLTs could be functionally classified as cytokine releasing and contraction of blood clot,participating in different hemostatic phases of the plasma jelly-like agglutinati-on stage and thrombus formation stage.The clinical effects of using frozen PC with fresh PC was better in emergency.For freezing PLTs individually,to freeze-stored platelet with 2% DMSO as protectants was feasible.
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Key words:
- platelet /
- functional classification /
- frozen /
- individual /
- cytokine releasing /
- contraction of blood clot /
- clinical application /
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