2018 年第 1 期 第 13 卷

血小板计数降低病例3_045例手工复检分析及其意义

作者：张璐璐刘芸段文冰唐闻李晓莹赵万辉张炳昌

英文作者：

单位：250021济南，山东大学附属省立医院检验医学部

英文单位：

关键词：血小板聚集；乙二胺四乙酸依赖；血小板假性减低

英文关键词：

• 摘要：

• 【摘要】目的    对血常规标本中血小板计数（PLT）低于正常参考范围下限患者进行手工复检并分析其意义。方法    选取2015年12月至2016年6月于山东大学附属省立医院门诊就诊且做血常规检测的PLT低于正常参考范围下限的患者3 045例。分别采用Sysmex XN-9000血细胞分析仪PLT-I通道（电阻抗法）、PLT-F通道（荧光色素染色法）、瑞士染色镜检法以及手工相差显微镜计数法复检PLT并对检测结果进行分析比较。结果    将3 045例血常规标本中PLT低于正常参考范围下限的患者分为PLT（61～124）×109/L组、PLT(21～60)×109/L组和PLT≤20×109/L组。其中PLT（61～124）×109/L组2 212例，镜检可见血小板聚集现象39例，符合率为98.2%（2 173/2 212）；PLT(21～60)×109/L组644例，镜检可见血小板聚集现象18例，符合率为97.2%（626/644）；PLT≤20×109/L组189例，镜检可见血小板聚集现象9例，符合率为95.2%（180/189）。3组患者间符合率比较，差异均无统计学意义（均P＞0.05）。66例血小板聚集患者经PLT-F通道及手工计数复检的PLT结果明显高于PLT-I通道复检结果［（114.6±46.7）×109/L、（148.1±31.2）×109/L比（80.8±31.5）×109/L］，且手工计数复检结果明显高于PLT-F通道复检结果，差异均有统计学意义（均P＜0.05）。在3 045例患者中，PLT假性降低共66例，占2.17%，原因前3位依次为穿刺不顺［28.8%(19/66)］、EDTA-K2依赖［24.2%(16/66)］和输入血液制品［22.7%（15/66）］。结论    对于机检血小板减少的患者标本应进行手工推片染色镜检，排除PLT假性降低以保证检测结果的准确性。由于PLT-F通道在低值血小板测定中应用价值较大，可以纠正镜下血小板小簇聚集的情况，建议对PLT减低的标本先使用PLT-F通道复查，若无法纠正再采用预稀释法手工计数，这样既可保证结果的准确性，也减少了患者取报告的等候时间。

• Manual re-examination of 3 045 cases of thrombocytopenia

  Zhang Lulu, Liu Yun, Duan Wenbing, Tang Wen, Li Xiaoying, Zhao Wanhui, Zhang Bingchang

  Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China

  Corresponding author: Zhang Bingchang, Email: zhangbingchangb@163.com

  【Abstract】Objective     To manually re-check routine blood test in patients with platelet count(PLT) below normal reference range. Methods    Totally 3 045 outpatients whose PLT were below normal reference range in routine blood test from December 2015 to June 2016 were enrolled at Shandong Provincial Hospital Affiliated to Shandong University. Sysmex XN-9000 hematology analyzer PLT-I channel（bioelectrical impedance analysis）, PLT-F channel（fluorescent nucleic acid staining）, Wright′s staining microscope examination and phase-contrast microscope manual counting method were used to retest the level of PLT in patients. Results    Patients with PLT below normal reference range were divided into 3 groups: PLT (61-124)×109/L group, PLT (21-60)×109/L group and PLT ≤ 20×109/L group. Thirty-nine of 2 212 cases in PLT (61-124)×109/L group presented platelet aggregation under microscope with a coincidence rate of 98.2%(2 173/2 212); 18 of 644 cases in PLT (21-60)×109/L group presented platelet aggregation under microscope with a coincidence rate of 97.2%(626/644); 9 of 189 cases in PLT≤ 20×109/L group presented platelet aggregation under microscope with a coincidence rate of 95.2%(180/189). There was no statistically significant difference of the coincidence rate among 3 groups(P＞0.05). In 66 patients with platelet aggregation, re-examination results of PLT via PLT-F channel and manual counting were significantly higher than that of PLT-I channel［(114.6±46.7)×109/L, (148.1±31.2)×109/L vs (80.8 ± 31.5)×109/L］, the re-examination result of PLT via manual counting was significantly higher than that of PLT-F channel(P<0.05). There were 66 cases of pseudothrombocytopenia in 3 045 patients, accounting for 2.17%; top 3 reasons of pseudothrombocytopenia were unsuccessful puncture［28.8%(19/66)］, EDTA-K 2 dependence［24.2%(16/66)］ and transfusion of blood products［22.7%(15/66)］. Conclusions    Manual smear staining microscope examination is necessary for patients with thrombocytopenia to eliminate pseudothrombocytopenia and to assure the accuracy of testing results. PLT-F channel has a great value in determination of low PLT and it can correct tufted aggregation of platelet under microscope; hematology analyzer PLT-F channel reexamination is preferentially suggested for patients with thrombocytopenia; prediluted manual counting is suggested for patients with incorrect results of PLT-F channel.

  【Key words】Platelet aggregation;Ethylene diamine tetraacetic acid dependent;Pseudothrombocytopenia

  【Fund program】Natural Science Foundation of Shandong Province（ZR2016HM52）; Science and Technology Development Project of Shandong Province（2014GGH218041）; Clinical Key Specialty Construction Project of Shandong Province（2013-26）