血细胞检测流水线系统对白细胞形态的影响

目的探讨XN-9000全自动血细胞检测流水线系统对白细胞形态的影响。方法采用乙二胺四乙酸二钾(EDTA-K 2)专用负压管对空军军医大学西京医院和西安培华学院医学院收集的238例受试者(其中淋巴细胞性白血病26例、粒细胞性白血病17例、单核细胞性白血病15例、健康儿童80例、健康成人100例)采集静脉血2 mL,采用XN-9000全自动血细胞检测流水线系统在1 h内完成推片、瑞姬染色、阅片,同时采用手工推片、手工瑞姬染色,由两位经验丰富的主管技师进行显微镜分类计数。结果238例受试者EDTA-K 2抗凝血仪器推片后分别采用仪器染色和手工染色分类计数Ⅱ型反应性淋巴细胞结果(8.65±2.35)%、(8.55±2.45)%]明显高于手工推片仪器染色和手工推片手工染色结果(4.57±2.55)%、(4.67±2.45)%],差异有统计学意义(P<0.05)。健康对照者(健康儿童及成人)、粒细胞性白血病和单核细胞性白血病患者抗凝血经仪器推片分类计数Ⅱ型反应性淋巴细胞分别为(3.2±0.5)%、(3.5±0.4)%、(3.6±0.5)%,与手工推片结果(3.1±0.8)%、(3.2±0.6)%和(3.4±0.8)%]比较,差异无统计学意义(P>0.05)。淋巴细胞性白血病患者淋巴细胞形态有明显改变:淋巴细胞体积增大,外形不规则,着色不均,边缘蓝色较深,细胞核不规则,染色质细致,细胞质呈淡紫红色,似Ⅱ型(不规则型/单核细胞型)反应性淋巴细胞。淋巴细胞性白血病患者Ⅱ型反应性淋巴细胞的仪器推片结果为(85.2±5.6)%,与手工推片结果(3.5±0.9)%]比较,差异有统计学意义(P<0.05)。结论XN-9000全自动血细胞检测流水线系统对EDTA-K 2抗凝血活化膨胀的白细胞无法调节推片力度,加之白血病患者的血细胞密度高、阻力大而致细胞形态改变,使淋巴细胞似Ⅱ型反应性淋巴细胞,影响临床对疾病的诊断。手工推片可调节角度、速度及力度,细胞形态不易改变。当Ⅱ型反应性淋巴细胞多时,必须手工推片手工染色,显微镜检查确证后方可发报告。

The effect of blood cell detection pipeline system on the morphology of leukocytes

Objective To investigate the effect of the XN-9000 automatic blood cell detection assembly line system on the morphology of leukocytes.Methods The special negative pressure tube for ethylenediaminetetraacetic acid dipotassium(EDTA-K 2)was used to collect 2 mL venous blood in 238 subjects(including 26 cases of lymphocytic leukemias,17 cases of granulocytic leukemias,15 cases of monocytic leukemia,80 healthy children and 100 healthy adults)collected in Xijing Hospital and Xi′an Peihua University Medical School.The XN-9000 automatic blood cell detection assembly line system was adopted to complete the instrumental push piece,Rui-Ji staining and reading within 1 h.Meanwhile the manual push piece and manual Rui-Ji staining were adopted,and the two experienced technologists-in-charge detected the classification and count of microscope inspection.Results The instrumental staining and manual staining were respectively adopted to conduct the classification count of the typeⅡreactive lymphocytes after the EDTA-K 2 anticoagulant instrumental push piece in 238 subjects.Their results were(8.65±2.35)%and(8.55±2.45)%,which were significantly higher than(4.57±2.55)%and(4.67±2.45)%by manual push piece instrumental staining and manual push piece and manual staining,and the differences were statistically significant(P<0.05).After instrumental push piece in anticoagulation blood of healthy controls(healthy children and healthy adults),granulocytic leukemias and monocytic leukemia,the classification counts of the typeⅡreactive lymphocytes were(3.2±0.5)%,(3.5±0.4)%and(3.6±0.5)%respectively,and which by manual push piece were(3.1±0.8)%,(3.2±0.6)%and(3.4±0.8)%,the differences between them had no statistical significance(P>0.05).The morphology of lymphocytes in the patients with lymphocytic leukemia had obvious change.The volume of lymphocytes was enlarged,the appearance was irregular,the coloring was uneven,the edge was darker,the nucleus was irregular,the chromatin was delicate,and the color of the cytoplasm was light purple,which seemed to be typeⅡ(irregular/monocyte type)reactive lymphocytes.The instrumental push piece results of lymphocytic leukemias patients in typeⅡreactive lymphocytes was(85.2±5.6)%,which of manual push piece was(3.5±0.9)%,and the difference was statistically significant(P<0.05).Conclusion The XN-9000 automatic blood cell detection assembly line system cannot adjust the push piece force of EDTA-K 2 anticoagulant activated and swollen white blood cells.In addition,the blood cell density in the patients with leukemia patients is high,and resistance is great,which cause the cell morphology changes,make lymphocytes seem to be typeⅡreactive lymphocytes,thus affect the clinical diagnosis of diseases.Manual push piece can adjust the angle,speed and strength,so the cell morphology is not easy to change.When there are many theⅡtype reactive lymphocytes,the report should be issued after the confirmation by manual push piece and staining microscopic examination.