缺铁性贫血和地中海贫血在血常规中的鉴别诊断  

Differential diagnosis between IDA and thal in routine hematological Examination

作　　者：陈和平[1] 陈冬[1] 李明[1] 龚彩平[1] 荣卡彬[1] 

机构地区：[1]广东省人民医院,广东广州510081

出　　处：《中国实验诊断学》2006年第1期90-92,共3页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨IDA和THAL在血常规实验中简易的鉴别方法。方法用全自动血细胞分析仪检测血常规，全自动快速电泳分析系统作HB分析（部分标本做A．B—THAL基因分析）以及用化学发光免疫分析仪检测血清铁蛋白。结果共检测595例女性，正常组200例，IDA组50例THAL组共345例，分为3组：轻型α-THAL组177例，轻型β-THAL组124例，HBH组44例。在血常规的RBC．HB．RBC／HB．MCV．MCH．MCHC．RDW—CV等各项检测中，THAL组和IDA组都与正常组有非常显著差异（P〈0．01），其中RBC．HB．及RDW．CV的比较中，IDA组与THAL组有非常显著差异（P〈0．01）。结论以血常规分析鉴别IDA和THAL有几点：①IDA组RBC总数在4．50（×10^12／L）以下，HB在5．0—9．5g／L范围；THAL组RBC总数常在4．30（×10^12／L）以上，HB值在8～11g／L范围。②RBC／HB的比值中，IDA组多在0．054以上，THAL组则在0．048，0．054之问。③RDW-CV比较中，建议修订正常值在〈0．150；轻型THAL组在0．151—0．185；IDA组在0．180-0．238；HBH组在0．220—0．310。THAL组的RDW—CV值并非在正常范围内。④当血常规显示明显小细胞低色索性贫血时，RDW-CV值〉0．23以上，必须做HB电泳分析，以鉴别HBH病还是IDA。以血常规鉴别IDA与THAL，对于暂时无条件开展血清铁蛋白检测的情况下，对小细胞低色素性贫血鉴别诊断有积极的临床意义。Objective To investigate the simple method of differentiation. Between IDA and Thai in routine hematological examination. Methods Routine hematological examination was performed with full automatic hemocyte analyzer, HB analysis with full automatic rapid electrophoresis analysis system（α, βThal genetic analysis was performed in parts of the samples）, and serum iron protein was examined with chemiluminescence immunity analyzer. Results 595 female cases were examined（normal group 200 cases, IDA group 50 cases, and Thai group 345 cases）, who were divided into 3 groups（minor type α-Thal group; 177cases; minor β-Thal group： 124 cases; and HB H group：44cases）. The RBC, HB, RBC/HB, MCV, MCHC and RDW-CV in routine hematological examination in the Thai and IDA groups showed significant difference（P 〈 0.01 ） compared with those in the normal group,of which, the RBC, HB and RDW-CV in the IDA group showed Significant difference compared with those in the IDA group showed Significant difference compared with those in the Thai group（ P 〈 0.01 ）. Conclusion Several points are noted as follows in the differentiation between IDA and Thai in routine hematological examination： 1 ） When the tot number of RBC in IDA group is below 4.50 ×10^12/L, HB is within the range of 5.0 g/L - 9.5 g/L ; when the total number of RBC in the Thai group is above 4.30 ×10^12/L, the HB value is within the range of 8 g/ L - 11 g/L. 2） In the RBC/HB ratio, IDA group is largely above 0.054, and the Thal group, between 0.048 - 0.054. 3） In the comparison of RDW-CV, revision of the normal value is Suggested as 〈 0. 150; 0. 151 - 0. 185 in the minor Thai group： 0.180-0.238 in the minor Thai group; 0.180- 0.238 in the IDA group; and 0.220 - 0.31 in the HB H group. The RDW-CV value in the Thai group is not within the normal range. 4）When microcytic hypochromic anemia is shown in the routine hematological examination and the RDW-CV value is above 0.23, HB eleetrophoresis analysis should be performed to differentia

关 键 词：缺铁性贫血 地中海贫血 血常规 鉴别诊断 

分 类 号：R556[医药卫生—血液循环系统疾病]