2016年台灣血小板輸用概況

2016 Overview of platelet transfusion in Taiwan

背景：血小板輸注是重要醫療處置之一。了解血品的臨床輸用有助於病人用血管理（patient blood management, PBM）的施行及降低不適當用血。研究目的：了解2016年台灣血小板輸用概況。材料方法：本研究自2016年全民健保資料庫中擷取曾經輸用血小板濃厚液或分離術血小板病患的就醫資料。我們以血小板輸用總量除以台灣族群人口數來估計每千人口血小板輸用量。並依據性別年齡、就診科別、疾病診斷／手術處置等來估計分組別血小板用量、使用人數及每人每年輸用量。結果：2016年共53,302人輸用262,257單位血小板，每千人口輸用量為11.0。血小板輸用以分離術血小板為主，占總量95%。輸注者平均年齡61.7，有將近四分之三的血小板輸注者年齡大於50歲。疾病診斷方面，使用比例最高為血液及腫瘤疾病（42.9%），其中有1,316名骨髓性白血病患輸用量達9.6%；其次為心臟手術（5.7%）、消化道手術（4.4%）、敗血症（4.7%）及肺炎（3.6%）。建議：台灣每千人口血小板用量世界最高，比美國、北歐等國高出38-57%。近年台灣人口老化快速且出生率低，未來將面臨血小板供需不平衡。為提早因應，督促各醫療機構進行病人用血管理以降低血品不適當輸注需要及時來推動。 Background: Platelet (PLT) transfusion is a critical clinical therapy used for several medical conditions. Understanding of usage of blood components can facilitate patient blood management and decrease improper blood use. Objectives: To survey the transfusion of platelet in Taiwan in 2016. Material and Method: We identified the recipients ever transfused with platelet concentrate or apheresis platelet from 2016 national health insurance (NHI) database. We retrieved recipients' health care information, including primary diagnoses, surgical procedures and prescriptions. We estimated PLT transfusion per thousand capita by calculating total transfused PLT in apheresis unit divided by Taiwan population. We described the amount of PLT usage, the number of recipients and average unit per recipients according to age, gender, medical specialties and disease diagnoses. Results: A total of 53,302 recipients were transfused with 262,257 units of PLT in 2016. PLT transfusion rate was 11.0 units per thousand capita. Apheresis platelet was a main component, with 95% of PLT transfusion. More than three-fourth of the recipients aged >50, with mean age 61.7. Hematologic and oncologic disorders accounted for 42.9% of PLT transfusions. Specifically, 1316 myeloid leukemia patients alone accounted for 9.6%. The second commonest indication was cardiac surgery (5.7% of the total), followed by sepsis (4.7%), gastrointestinal surgery (4.4%) and pneumonia (3.6%). Suggestion: PLT transfusion per thousand capita in Taiwan was the highest in the world, with 38-57% higher than that in America and Northern Europe. Our country may face the problem of blood insufficiency due to serious situation of population aging and low birth rate. In order to save blood for critical use, patient blood management needs to be implemented in the near future.