EDTA依赖性聚集致小儿血小板假性减少1例  

A case of pseudothrombocytopenia due to EDTA-dependent aggregation in children

作　　者：杨钲 苏桂新[2] 宋光彩[1] 习鹏娇 Zheng Yang;Guixin Su;Guangcai Song;Pengjiao Xi(Department of Laboratory,the First Hospital of Liangshan,Xichang Sichuan 615099,China;School of Medical Laboratory,Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]凉山彝族自治州第一人民医院检验科,四川西昌615099 [2]天津医科大学临检与血液教研室,天津300070

出　　处：《中华临床实验室管理电子杂志》2024年第2期114-117,121,共5页Chinese Journal of Clinical Laboratory Management(Electronic Edition）

基　　金：天津市教委科研计划项目(2020KJ205);中华医学会医学教育分会和中国高等教育学会医学教育专业委员会2020年医学教育研究课题(2020B-N08356)。

摘　　要：目的探讨小儿发生EDTA依赖性假性血小板减少症(EDTA-PTPC)的原因,提高临床对小儿发生EDTA-PTPC的认识,并引起足够重视。方法通过回顾性分析凉山彝族自治州第一人民医院的1例4岁儿童的临床资料,采用EDTA(37℃)、枸橼酸钠及肝素抗凝剂处理血标本,在离体0、15、30、45、60、90、120、150、180 min时测定PLT数量变化。同时,手工镜检涂片以观察PLT的凝集情况。结果该例小儿的血标本在采用EDTA抗凝剂处理时,出现PLT数量减少的现象。采用EDTA抗凝的血标本经37℃水浴后同样出现PLT数量减少,而枸橼酸钠和肝素抗凝管未出现此现象。手工镜检涂片显示EDTA抗凝后外周血中PLT出现大片状聚集,而其他抗凝剂却无聚集,确定为EDTA-PTCP。结论对于采用EDTA抗凝管处理出现PLT减少而无相应临床指征的小儿,应考虑发生EDTA-PTCP,为明确原因需进一步行血涂片复查、人工计数PLT,或改用枸橼酸钠、肝素抗凝管中的外周血样本复查PLT,以避免耽误诊疗。Objective To investigate the causes of ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia(EDTA-PTPC),and to enhance the clinical understanding and attention to the occurrence of EDTA-PTPC in children.Methods The clinical data of a 4-year-old child in the First Hospital of Liangshan were retrospectively analyzed.The blood samples were treated with EDTA(37℃),sodium citrate and heparin anticoagulant.The platelet count changes were measured at 0,15,30,45,60,90,120,150,and 180 minutes.Simultaneously,manual microscopy was performed to observe the agglutination of platelets.Results The number of platelets in this child decreased when EDTA anticoagulant was used to treat blood samples.EDTA also showed a decrease in platelet count after a 37℃water bath,while no such phenomenon was observed in the sodium citrate and heparin anticoagulant tubes.Manual smear microscopy showed that there was large clumping of PLT in the peripheral blood after EDTA anticoagulation,while no clumping was observed with other anticoagulants,confirming the diagnosis of EDTA-PTCP.Conclusions For children who experience thrombocytopenia without corresponding skin,mucosal,and visceral bleeding after anticoagulation with EDTA,EDTA-PTCP should be considered.To clarify the cause,further blood smear examination,manual platelet count,or use of sodium citrate and heparin for blood plate examination should be performed to avoid delaying diagnosis and treatment.

关 键 词：小儿 EDTA 假性血小板减少症 血小板聚集 病例报告 

分 类 号：R558.2[医药卫生—血液循环系统疾病]