外周血细胞假性危急值标本分析

目的分析外周血细胞假性危急值标本,为临床诊疗提供准确可靠的结果。方法收集2013年1月1日—2017年12月31日曲靖市第二人民医院检验科438 527例外周血细胞检测标本,对出现白细胞计数(WBC)和血小板计数(PLT)危急值的标本经手工计数及涂片染色复查,对假性血红蛋白(Hb)危急值标本37℃预温20 min,再次上机复检。统计假性危急值数据,并进行临床分析。结果 438 527例血液标本中,共发生假性危急值32例,发生率为0.73/万。假性血小板危急值共16例(占50.0%),其中假性血小板减少12例,包括EDTA依赖性假性血小板减少症(EDTA-PTCP)11例、巨大血小板综合征(Bernard-Soulier综合征)1例;假性血小板增多4例,包括临床既往确诊地中海贫血2例(具体不详)、α-地中海贫血(-SEA,α3.7双重缺失)1例、β-地中海贫血(CD41/CD42突变)1例。假性白细胞危急值共14例(占43.75%),其中假性白细胞增多11例,包括溶血性贫血7例、系统性红斑狼疮3例、急性红白血病1例;假性白细胞减少3例(占9.37%),包括舌根部弥漫大B细胞淋巴瘤化疗后1例、原发性浆细胞白血病1例、1例因转院未随访。假性Hb减少2例(占6.25%),包括多发性骨髓瘤IgA-κ型Ⅲ期1例、多发性骨髓瘤IgA-κ型ⅡA期1例。结论外周血细胞分析出现假性危急值是由血细胞分析仪检测原理的局限性以及患者病情的特殊性导致,因此,报告审核人员除了掌握检测仪器的基本性能、维护保养及质量控制外,还应具备血液病的相关知识,及时甄别真假危急值,并对假性危急值病例进行追踪分析,最大限度减少临床误诊误治。

Analysis of peripheral blood cell pseudo-critical value specimen

Objective In order to provide accurate and reliable results for clinical diagnosis and treatment, the pseudo-critical value of samples of peripheral blood cells were analyzed. Methods From January 1, 2013 to December 31, 2017, 438 527 samples of periphery blood cells were collected from the Department of Laboratory of the Second People's Hospital of Qujing City. The samples with white blood cell count (WBC) and platelet count (PLT) critical values were checked by manual counting and smear staining for re-examinations. The samples with false hemoglobin (Hb) critical value were preheated at 37 ℃ for 20 min, and again they were examined by the instrument. The pseudo critical value data were calculated and clinically analyzed. Results In the 438 527 blood samples, there were 32 cases with false critical value, the incidence being 0.73 samples per ten thousand. There were 16 cases [50.0%(16/32)] of false platelet critical values, including 12 cases of pseudothrombocytopenia containing 11 cases of EDTA dependent pseudothrombocytopenia (EDTA-PTCP) and 1 caseof giant platelet syndrome (Bernard-Soulier Syndrome);4 cases of pseudothrombocytosis, including 2 cases of clinically diagnosed thalassemia in the past (detailed situation unknown), 1 case of α-thalassemia (double deletion of -SEA,α3.7), 1 case of β-thalassemia (CD41/CD42 mutation). There were a total of 14 cases with white blood cell critical values (43.75%), among them 11 cases with pseudo leucocytosis, including 7 cases of hemolytic anemia, 3 cases of systemic lupus erythematosus and 1 case with acute red leukemia;pseudoleucocytopenia occurred in 3 cases (9.37%), including 1 case with diffuse large B cell lymphoma in the base of tongue after chemotherapy, 1 case of primary plasmacytic leukemia, and 1 case without followed up due to transfer to other hospital. There were 2 cases (6.25%) with pseudo reduction of Hb, including 2 cases with multiple myeloma: 1 case at IgA-κtype Ⅲ stage and 1 case at IgA-κⅡA stage. Conclusions The false critical value in peripheral blood cell analysis is caused by the limitation of the detection principle of blood cell analyzer and the particularity of the patient's condition. Therefore, in addition to mastering the basic performance, maintenance and quality control of the testing instrument, the audit staff of the report should also have the relevant knowledge of hematological diseases to screen the real and false critical values in time, and the cases with false critical value should be followed up and analyzed in order to minimize the misdiagnosis and mistreatment.