开展品管圈活动提高单克隆浆细胞遗传学异常检出率  

Improving detection rate of cytogenetic abnormalities of monoclonal plasma cells through quality control cycle activities

作　　者：丁静 郭孟乔 柳敏 龚胜蓝[1] 张春玲 黄崇媚[1] 王健民[1] 杨建民[1] 唐古生[1] DING Jing;GUO Meng-qiao;LIU Min;GONG Sheng-lan;ZHANG Chun-ling;HUANG Chong-mei;WANG Jian-min;YANG Jian-min;TANG Gu-sheng(Department of Hematology,Institute of Hematology and Blood Diseases of PLA,Changhai Hospital,Navy Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院血液科,全军血液病研究所,上海200433

出　　处：《第二军医大学学报》2018年第10期1161-1164,共4页Academic Journal of Second Military Medical University

摘　　要：目的通过开展品管圈活动,提高单克隆浆细胞遗传学异常检出率。方法成立品管圈小组,收集海军军医大学(第二军医大学)长海医院血液科2014年6月至2014年12月所有疑诊多发性骨髓瘤并进行浆细胞相关免疫荧光原位杂交(FISH)检测的骨髓标本,分析单克隆浆细胞遗传学异常检出率的状况,并与文献对比发现异常检出率差异及可能原因,制定改进措施、实践并回顾分析、判断改进效果。结果现况调查发现初发标本内肿瘤负荷低、检测结果在临界值附近无法判断是本次活动改善重点。品管圈活动小组通过头脑风暴,根据实验室现有条件,提出了先用流式分选浓缩异常细胞,提高肿瘤细胞密度、降低背景值,再进行遗传学检测等关键手段。最终将我院单克隆浆细胞遗传学异常检出率从61.3%(95/155)提高至92.1%(174/189)。结论通过开展品管圈活动,优化了疑诊多发性骨髓瘤患者骨髓FISH检测流程,有效提高了浆细胞遗传学异常检出率。Objective To improve the detection rate of cytogenetic abnormalities of monoclonal plasma cells through quality control cycle(QCC)activities.Methods A QCC team was established to collect the bone marrow samples of patients suspected with multiple myeloma,who undergoing plasma cell-associated fluorescence in situ hybridization(FISH)in Department of Hematology,Changhai Hospital of Navy Medical University(Second Military Medical University)from Jun.2014 to Dec.2014.The detection rate of cytogenetic abnormalities of monoclonal plasma cells was analyzed and compared with literatures to find out the difference and related causes,and then the improvement measures were formulated and practiced to evaluate the improvement effect.Results We found that low tumor load in the initial specimen and the detection result could not be judged due to that value is very close to the critical value were the two key points to be improved in the QCC activity.Based on the brainstorming and the existing laboratory conditions,the QCC team chose to sort abnormal cells by flow cytometry to increase tumor cell density and reduce background value before genetic testing.Finally,the detection rate of cytogenetic abnormalities of monoclonal plasma cells increased from 61.3%(95/155)to 92.1%(174/189)in our hospital.Conclusion The FISH detection process of bone marrow of patients suspected with multiple myeloma is optimized through QCC activities,and the detection rate of cytogenetic abnormalities of monoclonal plasma cells is effectively improved.

关 键 词：品管圈 多发性骨髓瘤 细胞遗传学异常 单克隆浆细胞 荧光原位杂交 

分 类 号：R733.3[医药卫生—肿瘤]