血细胞分析仪对外周血幼稚细胞漏检的临床分析  

Clinical Analysis of Missed Diagnosis Contained Juvenile Cell in Peripheral Blood by Hematology Analyzer

作　　者：王梅华[1] 庄和[1] 欧海云[1] 林晓岚[1] 朱斌[1] 曹颖平[1] 

机构地区：[1]福建医科大学附属协和医院检验科,福州350001

出　　处：《现代检验医学杂志》2013年第3期87-89,共3页Journal of Modern Laboratory Medicine

基　　金：福建医科大学教授基金（JS11007）,福建省高校新世纪优秀人才计划（项目号：NGETFJ-0701）.

摘　　要：目的 通过对外周血细胞形态学检验,探讨血细胞分析仪对外周血幼稚细胞的漏检情况.方法采用Sysmex XE-2100血细胞分析仪及显微镜,对2011年2月～2012年1月在福建医科大学附属协和医院门诊就诊的12 398例患者,其中男性6 942份,女性5 456份,年龄5天～111岁,静脉血标本应用仪器法分析及模拟应用复检规则结果,与人工显微镜血涂片形态学检验对比分析.结果人工镜检12 398例标本,1 808例检出非正常类型细胞,检出率14.6%（1 808/12 398）;检出原幼细胞921例,占7.4%（921/12 398）;检出异型淋巴细胞770例,占6.2%（770/12 398）;检出有核红细胞（NRBC）159例,占1.3%（159/12 398）.对检出原幼细胞的921例标本数据利用Laboman软件进一步分析,根据＂国际血液学复检专家组制定的41条复检规则＂未被触及,而人工镜检发现原幼细胞的假阴性44例;根据＂Sysmex XE-2100血细胞分析和白细胞分类23条复检规则＂ 未被触及,而人工镜检发现原幼细胞的假阴性57例.其中11例血细胞分析报告参数均落在参考区间,人工镜检发现原幼细胞,后经骨髓穿刺MICM综合分型确诊,分别是慢性粒细胞白血病1例（复发）、骨髓纤维化1例、原发性血小板增多症1例（复发）、急性髓性白血病7例（复发）、急性淋巴细胞白血病1例（小儿初诊）.结论 外周血细胞形态学检验在临床诊疗方面依然占据重要地位,尤其是血液病患者或可疑血液病者,不可用仪器的全血细胞分析结合复检规则来代替人工镜检.Objective To investigate the situation of missed diagnosis contain juvenile cell in peripheral blood by hematology analyzer and compare with cell morphological examination by microscopy. Methods The total 12 398 out-patient peripheral vein blood samples were detected with XE-2100 automated hematology analyzer and used review criteria, compared with blood smear was reviewed including observation of cell morphology and manual WBC differential analysis with microscope. All the patients from the Union Hospital of Fujian Medical University,male 6 942 and female 5 456,at 5 days^lll years of age,since Feb. 2011-Jan. 2012. Results 12 398 samples were performed cell morphology and manual WBC differential analysis with microscope,1 808 samples contained abnormal cell,positive ratio 14. 6 % （1 808/12 398） ; 921 samples e^ntained blast cells and immature cells, positive rate was 7.4% （921/12 398）;770 samples had atypical lymphoeytes, positive rate f was 6.2 % （770/12 398） ;159 samples had nucleated erythroeytes, positive rate was 1.3 % （159/12 398）. To analyze data of 921 samples contained blast cells and immature cells by Sysmex Laboman Sofe,aeeording to ＂the 41 items of International Consensus Review Rules and Slide Review Rule＂ proposed by international hematology expert group,44 samples＇blast cell and immature cell was missed,that confirmed with microscopic examination; According to ＂the 23 items of Sysmex XE-2100 Chinese Consensus Review Rules and Slide Review Rule＂ proposed by Chinese hematology expert group, 57 samples＇ blast cell and immature cell was missed,that also confirmed with microscopic examination. 11 patients had normal result by hema- tology analyzer, but been found blast cell and immature cell with microscopic examination, further confirmed with bone mar- row MICM final diagnosis, 1 chronic myelogenous leukemia （recurrence）, 1 myelofibrosis （recurrence）, 1 primary thrombo- eythemia （recurrence）,7 acute myelogenous leukemia （recurrence）, 1 acute lymphocytic leuk

关 键 词：形态学检验 血细胞分析 临床分析 

分 类 号：R446.111[医药卫生—诊断学]