38例EDTA-K2抗凝剂引起血小板假性减少患者四种方法复检结果对比分析  

Contrastive analysis of the re- inspection results by several methods in 38 cases of patients with pseudo- thrombocytopenia caused by EDTA- K2 anticoagulation

作　　者：黄亮[1] 刘祉琳 

机构地区：[1]广东省肇庆市第二人民医院检验科,广东肇庆526060

出　　处：《吉林医学》2015年第11期2200-2202,共3页Jilin Medical Journal

摘　　要：目的:对比分析EDTA-K2抗凝剂引起血小板假性减少患者用枸橼酸钠抗凝静脉血、肝素锂静脉抗凝血、末梢血、手工显微镜计数法、涂片法进行复检结果对比及分析。方法:对38例EDTA-K2抗凝、血液分析仪mindray BC-5180测定血小板明显减低,涂片染色镜检均发现血小板聚集且体表检查无出血、淤点、淤斑等症状符合诊断为EDTA依赖性血小板减少症患者,采用1枸橼酸钠抗凝静脉血、肝素锂抗凝静脉血复检血小板;2采末梢指血用不含任何抗凝剂的稀释液稀释后用血细胞分析仪测定血小板;3手工显微镜计数法计数血小板;4每例患者分别制作抗凝标本和末梢指血合格涂片用瑞氏-姬姆萨染液染色后显微镜镜检。结果:38例EDTA依赖性血小板减少症患者35例能用枸橼酸钠、肝素锂抗凝标本同时纠正,两者纠正数值和手工显微镜计数法、末梢指血计数结果相接近,血涂片镜检观察血小板呈散在分布;2例用肝素锂抗凝标本能纠正枸橼酸钠抗凝标本不能纠正,手工显微镜计数法、末梢指血计数结果和肝素锂抗凝标本纠正结果相接近而和枸橼酸钠抗凝标本不符,血涂片镜检肝观察肝素钠抗凝血血小板呈散在分布而枸橼酸钠抗凝血成片聚集;1例枸橼酸钠、肝素锂抗凝标本均不能纠正,两者纠正结果和手工显微镜计数法、末梢指血计数结果不符,血涂片血小板均出现成片聚集。结论:大多数EDTA依赖性血小板减少患者能用枸橼酸钠、肝素锂抗凝标本加以纠正,极少数不能纠正的可以采集患者末梢指血直接置于不含任何抗凝剂的稀释液中用血细胞分析仪计数血小板值或用手工显微镜计数法计数血小板值。Objective To contrastive analyze the re -inspection resuhs using sodium citrate anticoagulated venous blood,intravenous anti- coagulant heparin lithium, peripheral blood, manual microscope counting method and smear method in patients with pseudo -thrombocytopenia caused by EDTA - K2 anticoagulation. Method For 38 cases of patients who used EDTA - K2 for anticoagulation and detected a obviously re- duced platelet counting by blood analyzer mindray BC -5180 and platelet aggregation by smear staining microscopy ,yet had no bleeding, brui- ses ,petechiae and other symptoms according with EDTA dependent thrombocytopenia by surface inspection, measures in the following were carried out ：① using sodium citrate antieoagulated venous blood,lithium heparin anticoagulant venous blood to re - inspect platelets;② collec- ting peripheral blood and diluting it with dilution which do not contain any anticoagulant ,then determining platelets by blood cell analyzer;③ using manual microscope counting method to count blood platelet number;④ making qualified smear of the specimens of each patient with an-ticoagulants and peripheral blood respectively, dyeing by ray＇s -JiM staining and then examining them with microscope. Results In 38 cases of patients with EDTA dependent thrombocytopenia,35 cases could be corrected using sodium citrate and heparin lithium, which had a similar corrected value with manual microscope counting method and peripheral blood method, and blood smear microscopy observed the scattered dis- tribution of platelets ;2 case could by corrected by heparin lithium while could not be corrected by sodium citrate,manual microscope counting method,peripheral blood results and lithium heparin anticoagulant had similar corrected results,which unconfirmed with sodium citrate, the heparin anticoagulant blood platelets showed diffused distribution and sodium citrate anticoagulant showed flakiness aggregation in blood smear;1 case could not be corrected by sodium citrate and heparin lithium, the corrected results o

关 键 词：血小板假性减少 抗凝剂 EDTA 枸橼酸钠 肝素锂 

分 类 号：R446.1[医药卫生—诊断学]