阻抗法与镜检法检测低值血小板结果比较分析及对临床血小板输血判断的影响

目的分析、比较三台血液分析仪阻抗法与显微镜手工法计数低值血小板结果,并探讨其对血小板输血阈值判断的影响。方法选择本实验室三台血液分析仪（LH750、CD-3700和Sysmex-xt1800i）分别计数低值血小板患者274例,PLT均小于100×109/L,以显微镜手工法为参考,按检测结果将血小板分为0〈PLT≤5×109/L,5×109/L〈PLT≤10×109/L,10×109/L〈PLT≤20×109/L,20×109/L〈PLT〈100×109/L四组,并与手工法结果进行比较分析。结果三台血液分析仪与镜检法计数在PLT≤20×109/L时相关系数（γ）均〈0.8。当20〈PLT〈100×109/L时相关系数（γ）均≥0.8.从ROC曲线分析,三台血液分析仪分别在0〈PLT≤5×109/L和5×109/L〈PLT≤10×109/L两组中AUC均小于0.90,在10×109/L〈PLT≤20×109/L组中AUC均大于0.90（分别为0.913,0.904,0.947）。结论三台血液分析仪计数PLT≤20×109/L的样本与镜检法相关性较低或无直接相关性,故对低值血小板,考虑需要血小板输血时,应慎重对待仪器检测的结果。由ROC曲线可知Sysmex-xt1800i对不同输血阈值的判断要优于LH750和CD-3700。

Comparison of low platelet count by microscopic and impedance methods: estimation of possible inappropriate platelet transfusion

Objective To compare low PLT counts produced by impedance（automated blood analyzer） and microscopic methods and explore their effect on determining to platelet transfusion.Methods A total of 274 samples with low PLT count（100×109/L） were tested by three automated blood analyzers（LH750,CD-3700 and Sysmex-xt1800i）,and then were divided into four groups（0PLT≤5×109/L,5×109/LPLT≤10×109/L,10×109/LPLT≤20×109/L and 20×109/LPLT100×109/L） according to the microscopic method.The results of these two methods were compared.Results The correlation coefficient（γ） of two methods were less than 0.8 when platelet counts were 0×109/L-20×109/L,if platelets were 20×109/L-100×109/L,the correlation coefficient（γ） were more than 0.8.from the ROC cure analysis,three antomated blood analyzers′s ROC curve of areas were less than 0.90 when platelets were between 0×109/L-5×109/L and 5×109/L-10×109/L.Areas were more than 0.90 if platelets were 10×109/L-20×109/L（respectively 0.913,0.904,0.947）.Conclusions Three automated blood analyzers are not directly related to microscopic method when platelets were 0×109/L-20×109/L.For the low platelets,considering the need for platelet transfusions,the patients should be treated with the instrument test′s results strictly.ROC curve indicated the Sysmex-xt1800i was the best in the three automated blood analyzers for the judgments of transfusion thresholds.