机测后显微镜复检的标准和应用

目的寻求保证白细胞分类准确性的方法,以利临床诊断和治疗。方法根据医院具体情况依据多项病人指标制定白细胞分类显微镜检查标准,通过标准实行后两组共1128份标本结果的数据分析,评价标准的可行性和可靠性。结果标准实行后有31%的仪器血常规CBC结果需要复检,其中33%存在杆状细胞增多、异型淋巴细胞增多或其它种异常细胞。结论制定血细胞显微镜复检标准非常重要,可以加强血细胞检查准确性,为临床提供更有价值的信息,有利诊断和治疗。     

机测后显微镜复检的标准和应用

目的寻求保证白细胞分类准确性的方法,以利临床诊断和治疗.方法根据医院具体情况依据多项病人指标制定白细胞分类显微镜检查标准,通过标准实行后两组共1128份标本结果的数据分析,评价标准的可行性和可靠性.结果标准实行后有31%的仪器血常规CBC结果需要复检,其中33%存在杆状细胞增多、异型淋巴细胞增多或其它种异常细胞.结论制定血细胞显微镜复检标准非常重要,可以加强血细胞检查准确性,为临床提供更有价值的信息,有利诊断和治疗.     

去白细胞血小板的临床应用

白细胞是人体自然防御系统的重要组成部分，但随同血制品异体输注时可产生许多副作用，如非溶血性发热反应(NHFTR)、血小板输注无效(PTR)、输血后移植物抗宿主病(GVHD)以及可能传播细胞相关病毒(GMV、HTLV-Ⅰ／Ⅱ、HIV—Ⅰ等。自20世纪70年代报道用离心法去除白细胞     

Sysmex XN-1000血细胞分析仪计数低值白细胞性能的评估

目的探讨Sysmex XN-1000(后简称XN-1000)全自动血细胞分析仪检测白细胞计数(WBC)及分类的准确性。方法收集该院2015年1~4月门诊及住院患者及健康体检者共206例,根据人工镜检检测WBC结果分为高值组(WBC10.0×109/L),健康组(4.0×109/LWBC≤10.0×109/L)和低值组(1.5×109/LWBC≤4.0×109/L)。再分别用XN-1000与Sysmex XE-5000(后简称XE-5000)进行WBC并分类。采用统计学软件对3种方法的结果进行对比分析,并进行相关性分析。结果 3种方法检测WBC结果比较,高值组和健康组差异无统计学意义(P0.05),结果具有正相关性。低值组中,XN-1000检测结果准确性与XE-5000差异无统计学意义(P0.05),但是白细胞分类结果显著高于XE-5000(P0.05);对于异常细胞,XN-1000和XE-5000不能进行有效分类,仍需人工镜检进行分类。结论 XN-1000全自动血细胞分析仪在WBC与XE-5000及人工镜检比较无差异统计学意义,在测定白细胞分类上XN-1000较XE-5000更准确(XN-1000合格率91%,XE-5000合格率63%),但仍不能完全替代人工镜检。对于异常细胞,XN-1000不能有效分类,需与人工镜检结合。     

Risk of clozapine-associated agranulocytosis and mandatory white blood cell monitoring

OBJECTIVE: To provide information for physicians and patients on which to base a decision as to whether to stop mandatory blood testing. DATA SOURCES: Articles on drug-induced blood dyscrasias were identified by searches of MEDLINE (1966-September 2005) and review of their bibliographies. Novartis was asked to provide additional data on clozapine, leukopenia, agranulocytosis, and suicidality. STUDY SELECTION AND DATA EXTRACTION: Data on the chance of clozapine-induced leukopenia and agranulocytosis were combined with data about possible fatality and compared with the risks associated with other medications and with life in general. DATA SYNTHESIS: The chance of clozapine-induced leukopenia or agranulocytosis decreases exponentially over time. In the US, the chance in the second 6 months of treatment is 0.70/1000 patient-years and, after the first year, 0.39/1000 patient-years. The case fatality rate of clozapine-induced agranulocytosis is estimated as 4.2-16%, depending on whether a granulocyte colony-stimulating factor is used. Nevertheless, treatment with clozapine reduces overall mortality, probably because it reduces suicidality. CONCLUSIONS: After at least 6 months' treatment with clozapine, the mortality involved in stopping white blood cell monitoring is about the same as the mortality associated with other medications, such as mianserin or phenylbutazone, and with life in general (traffic or occupational accident). If the patient has been well informed and wishes to stop the monitoring, it is a medically justifiable option to do so and is preferable to stopping treatment with clozapine since this drug reduces overall mortality.     

The white blood cell differential: three methods compared.

The analysis of the automated blood cell count is an essential tool in haematological diagnostics. However, in the case of the white blood cell differential the microscopy method, although tedious, often serves as reference. We evaluated the ABX Pentra 120 Retic haematology analyser in comparison to the Coulter STKS haematology system and the microscopy method with respect to accuracy, precision and reliability. We compared 308 samples (239 samples from adults and 69 from children) including patients with oncological diseases. The comparison of the white blood cell differential revealed strong correlations between the results obtained with the ABX Pentra 120 Retic and the microscopy method, the Coulter STKS and the microscopy method and both automated methods (values of paediatric samples in parentheses; neutrophils: rs > or = 0.933 (rs > or = 0.951), lymphocytes: rs > or = 0.907 (rs > or = 0.945), monocytes: rs > or = 0.584 (rs > or = 0.459) and eosinophils: rs > or = 0.963 (rs > or = 0.966)). The analytical performance of automatic analysers for the detection of the morphological "left shift" was determined for all samples in comparison to the microscopical white blood cell differential. The sensitivity, specificity and efficiency depended strongly on the chosen threshold levels and were different for both analysers. The sensitivity for flagging a left shift increased with an increasing proportion of neutrophil bands, metamyelocytes, myelocytes and promyelocytes. Our study suggests that the ABX Pentra 120 Retic haematology analyser, as well as the Coulter STKS haematology system are useful tools for routine analysis in haematology.     

血小板聚集影响因素在血细胞计数中的临床应用

目的分析血小板聚集影响因素,为降低血小板聚集所致血小板假性减低、实验室规避报告风险及减低误诊误治提供依据。方法对血小板小于80×10~9/L、小于125×10~9/L合并直方图提示血小板凝集标本进行推片、瑞氏-吉姆萨染色后显微镜下观察是否聚集,并采用统计软件SPSS 18.0进行统计分析。结果乙二胺四乙酸依赖性血小板减少症(EDTA-PTCP)共计184例,占0.444‰,其中门诊患者101例,占0.244‰,住院患者66例,占0.159‰,体检者17例,占0.041‰;多重抗凝剂依赖性血小板假性减少共计3例,占0.007‰,假性血小板聚集共计25例,占0.060‰。结论血小板聚集的发现依靠镜检,原因主要来源于EDTA-PTCP,假性聚集主要来源于采样因素,需加强业务技能培训。     

2014年上海地区红、白细胞计数结果一致性的初步调查

目的了解上海地区各级各类医疗机构临床实验室红细胞(RBC)计数和白细胞(WBC)计数结果的一致性,为制定适宜的正确度验证计划提供指导。方法将2个批号弱固定处理新鲜全血样本按要求发放至全市710家临床实验室,并要求在3 d内完成检测,每批号样本重复检测5次,在收到所有上传结果后进行统计分析。结果使用12个品牌57个型号血液分析仪(包括WBC三分类和五分类仪器)的693家临床实验室回报了RBC、WBC结果;所有仪器2个批号RBC计数结果总变异系数(CV)分别为2.06%和1.99%,WBC计数结果总CV分别为4.72%和4.84%;不同仪器组2个批号RBC计数结果的CV为0.76%~3.18%,WBC计数结果的CV为1.73%~6.32%,其均值均在各自总均值的95%可信区间内。结论上海地区临床实验室RBC、WBC结果具有较好一致性;弱固定处理新鲜全血样本可替代新鲜全血用于正确度验证计划。     

Effects of biochemically confirmed smoking cessation on white blood cell count

OBJECTIVES: To determine the relationship between white blood cell (WBC) Indices and several baseline variables In a large cohort of healthy smokers and to assess whether these changed after biochemically confirmed smoking cessation. SUBJECTS AND METHODS: The study consisted of 784 healthy smokers enrolled in a trial of sustained-release bupropion, 300 mg/d, for relapse prevention after smoking cessation from 1995 to 1998. Both WBC counts and absolute neutrophil counts (ANCs) were measured at baseline, week 7, and week 52. Smoking status was assessed at weeks 7 and 52 by self-report and biochemically confirmed with expired air carbon monoxide levels. Multivariate analyses compared changes in WBC count and ANC between smokers who did and did not stop smoking, adjusting for treatment group, age, sex, and body mass index. RESULTS: Of 784 smokers enrolled, 461 had biochemically confirmed tobacco abstinence after 7 weeks of bupropion; 429 were randomly assigned to receive continued bupropion therapy or placebo until week 52. Between baseline and week 7, there was a significantly larger decrease in WBC count in continuously abstinent subjects compared with continuing smokers (adjusted P = .03). At 52 weeks, continuously abstinent subjects, compared with continuing smokers, had a greater decline from baseline in WBC count (1.2 +/- 1.9 x 10(9)/L vs 0.1 +/- 1.9 x 10(9)/L; P < .001) and ANC (1.0 +/- 1.6 x 10(9)/L vs 0.2 +/- 1.5 x 10(9)/L; P < .001). CONCLUSION: Biochemically confirmed tobacco abstinence leads to a rapid and sustained decrease in WBC and ANC, possibly reflecting a decrease In an underlying state of tobacco-induced inflammation.     

移植物中过客白细胞的研究进展

移植物中的过客白细胞是主要的MHC-Ⅱ类分子表达细胞,是引起排斥反应的重要原因。本文讨论过客白细胞含义、种类,并归纳其在器官移植中的作用及机制和去除手段等,介绍了移植物中的过客白细胞的研究进展。     

Interference by cryoglobulins with white blood cell measurements on Coulter Counter

By using the Coulter Counter S-Plus IV erroneous measurements of leukocytes, platelets and red cells were experienced in blood from two patients with cryoglobulinaemia. Leukocyte levels were estimated too high owing to contamination of the leukocyte counting chamber by unlysed erythrocytes. One of the patients had leukopenia, but the Coulter Counter reported white blood cell counts within normal limits. Rewarming of the sample to 37 degrees C eliminated the problem.     

Reduced plasma and white blood cell selenium levels in haemodialysis patients

Selenium concentrations have been measured in plasma and in blood leucocytes from 29 haemodialysis patients and from 25 healthy men. The selenium contents of the plasma and white blood cells of the dialysis patients were significantly reduced (p less than 0.001). Selenium deficiency in humans results in a congestive cardiomyopathy and is associated with increased risks of accelerated atherosclerosis and cancer. Each of these is found with abnormal frequency in haemodialysis patients.     

Elevated white blood cell count in subjects with impaired glucose tolerance

OBJECTIVE: Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) differ in their risk of all-cause and cardiovascular mortality, but previous cross-sectional studies have suggested little difference in their levels of lipids or blood pressure. We compared the white blood cell (WBC) count between subjects with IFG and IGT. RESEARCH DESIGN AND METHODS: The subjects were 4,720 nondiabetic Japanese men aged 24-84 years. Based on the 75-g oral glucose tolerance test, the subjects were classified into the following four groups: normal fasting glucose/normal glucose tolerance (n = 3,753), isolated IFG (n = 290), isolated IGT (n = 476), and IFG/IGT (n = 201). We compared the WBC count among the four groups and investigated variables that showed a significant association with the WBC count. RESULTS: The isolated IGT group had a significantly higher WBC count than the isolated IFG group (6,530 vs. 6,210/mm(3), P < 0.05). By stepwise analyses, age, triglycerides, HDL cholesterol, fasting insulin, and 2-h postchallenge plasma glucose (PG) showed an independent association with the WBC count (adjusted R(2) = 0.057). In the analysis stratified by smoking status, the WBC count was independently associated with 2-h PG and triglycerides, irrespective of smoking status. CONCLUSIONS: Individuals with isolated IGT had a significantly higher WBC count than those with isolated IFG. The WBC count was associated with 2-h PG and various components of the metabolic syndrome.     

脑外伤患者外周血CD34~+细胞及白细胞含量的动态变化

目的动态观察并探讨不同损伤程度的颅脑损伤患者外周血白细胞及CD34+细胞的变化及同预后的关系,以及二者升高的机制和临床意义。方法选取30例脑外伤患者为研究对象,条件为:伤后6h内入院;通过询问病史、查体及辅助检查确定无其他部位严重损伤、感染及血液系统疾病;按入院时格拉斯哥昏迷评分(GCS)分为轻重两组,同时选择同期体检中心健康成年人15例作为对照组,向患者组家属及对照人员详细解释本研究的目的与方法,签署知情同意书。于入院第1、3、5、7、11、14天抽取患者组及对照组静脉血,用流式细胞仪检测外周血CD34+细胞含量;用血细胞分析仪常规检测白细胞计数,并对所得数据进行统计学分析,同时观察患者病情变化,追踪预后,按照患者预后不同情况分成死亡组和生存组,比较分析相关数据。结果 30例颅脑损伤患者外周血白细胞及CD34+细胞数量随病程的发展均有不同程度的升高,损伤越重、GCS评分越低、白细胞及CD34+细胞计数越高,预后越差,白细胞升高持续时间越长,预后愈差。外周血CD34+细胞在颅脑损伤后轻、重两组患者,各时间段逐步升高。重症患者自第3天与正常对照组出现统计学差异,明显高于轻症组患者,轻、重症两组间比较,在第7、11、14天有统计学差异(P<0.05)。白细胞计数在伤后迅速升高并逐步下降,同CD34+细胞变化未见正相关。结论外周血白细胞及CD34+细胞在颅脑损伤患者急性期均有不同程度的升高,计数增高越明显,持续时间越长,结果预后越差,可以作为判断其预后的一个指标。     

尿白细胞、红细胞干化学法检测与人工显微镜检查的比较

目的通过尿液干化学法检测白细胞(WBC)、红细胞(RBC),与人工显微镜检查作比较,对干化学法产生假阳性及假阴性结果原因进行探讨。方法随机收集本院门诊患者新鲜尿液标本500份,分别采用干化学法检测及人工显微镜检查其尿液中WBC、RBC。结果以人工显微镜检查为对照,干化学法WBC检测结果的阳性符合率为84.23%,阴性符合率为95.68%,假阳性率为4.31%,假阴性率为15.77%;RBC检测结果的阳性符合率为93.7%,阴性符合率为86.27%,假阳性率为13.72%,假阴性率为6.29%。结论干化学法检测尿液WBC、RBC快速简便,适用于检测尿液WBC、RBC的过筛,但此法假阳性与假阴性较高,不能完全取代人工显微镜检查。