重视血小板减少标本的血涂片复检及假性减少的纠正方法  

Pay Attention to Blood Smear Reexamination for Thrombocytopenia and Correction Method of Pseudo-reduction

作　　者：朴桂花[1] 张恩颖[1] 李强[1] 徐建华[1] PIAO Guihua;ZHANG Enying;LI Qiang;XU Jianhua(Clinical Laboratory Department,The Fourth Hospital of Jilin University,Changchun Jilin 130000,China)

机构地区：[1]吉林大学第四医院检验科,吉林长春130000

出　　处：《中国继续医学教育》2018年第19期45-46,共2页China Continuing Medical Education

摘　　要：目的通过血涂片复检辨明血小板减少的真伪,提高假性血小板减少的检出率,提高检验结果的准确性,为临床提供可靠的诊断依据。方法对296例首次血小板计数<100×109/L的患者血样进行血涂片染色镜检,确认是否有聚集。对血小板有聚集患者,采用末梢指血采集方式,用两种方法验证并确定血小板数;一是迅速采集并混匀,立即用XS-1000i血细胞分析仪检测,二是手工计数。结果278例为真血小板减少,血涂片染色镜检与血细胞分析仪检测结果相符;18例为假性血小板减少,血涂片镜检有明显聚集;对18例假性血小板减少患者,用两种方法验证,结果差异无统计学意义(P>0.05),与血涂片镜检相符。结论随着全自动血细胞分析仪的广泛应用,假性血小板减少的病例屡见不鲜,原因很多。对首次检测血常规显示血小板减少的,或者在疾病治疗过程中复查血常规,发现血小板与上次检测结果比较,发生了明显减少的,必须按复检规则进行血涂片染色镜检,辨别真伪,及时采取措施复检,为临床医师和患者提供准确、可靠的检验结果,避免假性血小板减少所致的误诊。Objective By rechecking the blood smear to identify the authenticity of thrombocytopenia, increase the detection rate of pseudo thrombocytopenia, improve the accuracy of test results, provide reliable basis for clinical diagnosis. Methods Blood samples were taken from 296 patients with first platelet count 〈100×10^9/L for microscopic examination of blood smear to confirm whether there was aggregation.For patients with platelet aggregation, the peripheral blood collection method was used to verify and determine the number of platelets by two methods; One was to quickly collect and mix, immediately with XS-1000 i blood cell analyzer detection, the other was manual count. Results 278 cases were true thrombocytopenia, the blood smear staining microscopy and the blood cell analyzer test results were consistent; 18 cases were pseudo thrombocytopenia, and there was obvious aggregation in blood smear microscopy; 18 cases of pseudthrombocytopenia were verified by two methods. The difference was not statistically significant（P〈 0.05）, which was consistent with microscopic examination of blood smears, were consistent with the microscopic examination of blood smear. Conclusion In recent years, with the widespread use of automatic blood cell analyzer, pseudo thrombocytopenia cases are common, there are many reasons. For the first time on blood routine examination revealed thrombocytopenia, or during the treatment of disease and review the blood platelet, found last detection results, was significantly reduced, must be carried out according to the standard of blood smear staining microscopy, identify the authenticity, to take timely measures to reexamination, to provide accurate and reliable test results for clinicians and patients, and avoid misdiagnosis caused by pseudo thrombocytopenia.

关 键 词：假性血小板减少 血涂片 复检 染色镜检 聚集 血小板计数 

分 类 号：R446[医药卫生—诊断学]