高效价冷凝集素合并冷球蛋白对血常规检测结果的影响及纠正方法探讨  

The Effect of High-titer Cold Agglutinin with Cryoglobulin on Routine Blood Test and Its Correction Methods

作　　者：李莉[1] 黄河 洪燕英[1] LI Li;HUANG He;HONG Yanying(Department of Clinical Laboratory,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院检验科,北京100010

出　　处：《标记免疫分析与临床》2020年第10期1750-1755,共6页Labeled Immunoassays and Clinical Medicine

摘　　要：目的探讨高效价冷凝集素合并冷球蛋白对血常规各参数结果的影响,比较四种处理方案的纠正效果,找出最佳的处理方案。方法将含高效价冷凝集素合并冷球蛋白的标本采用以下四种方法:直接上机法、37℃水浴法、血浆置换法、双重加温预稀释法依次处理,在Beckmen Coulter LH 780全自动血液分析仪上检测,结合血涂片染色对四种处理方法结果进行分析。结果四种方法在全自动血细胞分析仪上均出现巨红细胞,红细胞直方图、血小板直方图异常及血小板凝集报警。直接上机法可见红细胞计数(red blood cell count,RBC)和红细胞压积(hematocrit,HCT)显著减低,红细胞平均体积(mean corpuscular volume,MCV)、红细胞平均血红蛋白量(mean corpuscular hemoglobin,MCH)、平均红细胞血红蛋白水平(mean corpuscular hemoglobin concentration,MCHC)显著增高;37℃水浴0.5 h对MCV、MCH、MCHC无法纠正并有相应的报警信息;血浆置换法及双重加温预稀释法均可使MCV、MCH、MCHC结果趋近真实值,而血浆置换法造成白细胞及血小板丢失,操作繁琐;两种方法血涂片检查仍可见部分红细胞凝集。冷球蛋白未对血常规结果产生影响。结论高效价冷凝集素合并冷球蛋白的血常规标本需第一时间进行血涂片检查,用血小板稀释液人工计数血小板并报告。对于高效价冷凝集素抗体的血常规样本,双重加温预稀释法纠正效果相对较好,且易于操作,更利于实验室在短时间内获得相对准确的检测结果。Objective To investigate the effect of high-titer cold agglutinin with cryoglobulin on the results of blood routine parameters,and to further compare the corrective effects of the four methods to identify the optimal treatment scheme.Methods The specimens of high-titer cold agglutinin with cold globulin were detected by the following four methods:direct on-machine method,37℃water bath method,plasma exchange method,dual warming pre-dilution method and then detected by Beckmen Coulter LH 780.The data were combined with blood smear staining to analyze the results of the four processing methods.Results Giant red blood cells,abnormal red blood cell histogram,platelet histogram,and platelet aggregation of the four methods′alarms appeared on the automatic blood cell analyzer.The result of direct on-machine operation showed that the red blood cell count(RBC)and hematocrit(HCT)were significantly reduced.The mean corpuscular volume(MCV),mean corpuscular hemoglobin(MCH),and mean corpuscular hemoglobin concentration(MCHC)were significantly increased;MCV,MCH and MCHC cannot be corrected in the method.37℃water bath method also produced corresponding alarm information within 0.5h.Both plasma exchange method and double warming pre-dilution method were able to make the results of MCV,MCH,and MCHC closer to the true value,while plasma exchange method caused the loss of leukocytes and platelets,and the operation was tedious.Blood smear examination of the two methods still showed agglutination of some red blood cells.Cryoglobulin did not affect the result of routine blood test.Conclusion Specimens of high-titer cold agglutinin with cryoglobulin need to be examined by the way of blood smear immediately,and platelets should be manually counted and reported using platelet diluent.For blood samples with high-titer agglutinin antibodies,double warming pre-dilution method has a relatively good correction effect and can be operated easily,which is more conducive for the laboratory to obtain relatively more accurate results in a short

关 键 词：冷凝集素 冷球蛋白 血常规 血浆置换 双重加温预稀释 

分 类 号：R-331[医药卫生]