EDTA依赖的假性白细胞减少的实验分析与纠正对策  

作　　者：陈龙[1] 徐旭栋[1] 张永为[1] 陆新建[1] 肖湘阳 王剑超[1] 

机构地区：[1]浙江中医药大学附属第二医院检验科,310005

出　　处：《浙江临床医学》2017年第8期1527-1528,共2页Zhejiang Clinical Medical Journal

摘　　要：目的 研究EDTA依赖的白细胞聚集对血液分析仪检测结果的影响,探讨抗凝剂介导的白细胞聚集的可能机制和白细胞计数纠正方法 .方法统计与分析2014年10月至2016年10月345600例门诊、住院血常规标本发生EDTA诱导的白细胞聚集导致假性白细胞减少例数的相关情况.结果 共发生EDTA依赖的白细胞聚集7例,其它原因导致白细胞聚集27例,发生率分别为0.002%和0.008%.由于白细胞聚集导致仪器自动白细胞计数结果假性偏低,与人工显微镜计数结果比较差异存在统计学意义（P〈0.01）,进一步的实验表明EDTA诱导的白细胞聚集在37℃水浴30min和更换枸橼酸钠抗凝剂后白细胞聚集情况未得到纠正,相较于白细胞人工镜检计数差异有统计学意义（P〈0.01）,而标本采用仪器稀释液与标本血浆等量置换以及标本中加入卡那霉素20mg/ml方法后,标本中白细胞聚集现象得到部分纠正,但仪器结果与人工镜检计数差异仍存在统计学意义（P〈0.01）.结论 EDTA抗凝剂诱导的假性白细胞减少发生率为0.002%,极易漏诊.发现有白细胞聚集的情况应采用人工显微镜计数进行检测结果纠正,以防发生误诊误治.Objective To study the influence of EDTA Dependent Leukoagglutination on the white blood cell counting result by automated blood analyzer,the possible reason of WBC aggregation caused by EDTA anticoagulant and the way to correct its influence. Methods Statistics and analysis,from October 2014 to October 2016,345600 cases of outpatient and inpatient blood routine specimens,EDTA induced leukocyte accumulation,leaded to the number of cases of false white blood cells. Results It revealed that the incidence was 0.002%（7 cases among 345,600） of which had EDTA induced Leukoagglutination,27 cases（0.008%）had WBC clumping caused by other reasons. These 34 samples had spuriously low WBC counts due to WBC clumping compared to manual differential results（P〈0.01）. The Leukoagglutination caused by EDTA could not be corrected by incubating samples in 37℃ water bath for 30 mints or by replacing the EDTA by sodium citrate. The leukoagglutination caused by EDTA could be partially be corrected by diluting the sample with instruments diluent at a dilution of 1：1 and by adding kanamycin 20 mg/ml to samples,but still influence the white blood cell counting resulted by automated blood analyzer（P〈0.001）. Conclusion EDTA can induce WBC aggregation,and thus spuriously low WBC counts,our study shows that the incidence is 0.002%. Examination of a well prepared peripheral blood smear is mandatory for every case of leukoagglutination.

关 键 词：假性白细胞减少 EDTA 白细胞聚集 

分 类 号：R453[医药卫生—治疗学]