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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5～15min;第二步纤维蛋白收缩块形成,约在2h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。
Objective: To investigate the classification and clinical application of platelet function, and try to explore the individualization of blood cell freezing. Methods: Different concentrations of DMSO were added to platelets and frozen at -80 ℃. The formation of coagulation and contractions before and after freezing were observed. The counts of platelets before and after freezing and under different centrifugation conditions were measured. (PF3), platelet factor 4 (PF4), platelet volume distribution width (PDW) and P-selectin (CD62P) on the platelet aggregation, adhesion, clot function. Retrospective analysis of the clinical application of frozen platelets alone or combined with fresh platelets with qualified control conditions was performed. Results: Blood platelets did not aggregate after platelet blocking. The process of fibrin shrinkage in plasma was divided into two stages: the first step of plasma coagulation took 5-15 minutes; the second step was fibrin shrinkage block formed in about 2 hours. Plasma PF3, PF4 and CD62P on platelet function to promote agglutination and inhibition of contraction of both. The clinical effects of frozen platelets and fresh platelets with fresh platelets were significantly different; 2% and 5% DMSO frozen platelet quality no significant difference. Conclusion: Platelets can be functional classification, namely factor release and clot contraction; the process of hemostasis in two steps, the first step is the second phase of the plasma coagulation stage of thrombosis, two types of platelets involved in different hemostasis stage, the classic Hemostatic mechanism is questionable; frozen platelets and fresh platelets with better effect; available low concentration of 2% DMSO for cryopreservation.