网织红细胞参数在聚乙二醇干扰素α治疗慢性丙型肝炎中的应用

目的:通过分析网织红细胞(Ret)参数变化,了解慢性丙型肝炎患者聚乙二醇干扰素α(PEG-IFN-α)治疗过程中及治疗结束后骨髓造血功能的抑制和恢复情况。方法:采用血细胞分析仪检测37例治疗过程中患者外周血白细胞(WBC)、中性粒细胞绝对值(ANC)、网织红细胞百分比(Ret%)、网织红细胞绝对值(Ret#)及未成熟网织红细胞指数(IRF)的变化。20例健康体检者作为正常对照组。结果:HCV患者从PEG-IFN-α治疗第2周开始,Ret%、Ret#、IRF即显著低于治疗前和对照组,WBC、ANC于治疗4周开始显著减低;IRF、Ret%、Ret#在治疗结束后第1周开始恢复,WBC、ANC在治疗结束后第2周开始恢复。结论:Ret各参数用于了解慢性丙型肝炎患者PEG-IFN-α治疗后骨髓造血功能的抑制和恢复情况,其敏感性高于WBC和ANC。     

儿童网织红细胞各参数参考范围调查

近 年来 ,全自动网织红细胞计数分析仪的临床应用价值已被公认。分析网织红细胞各指标与成熟红细胞相应指标的关系 ,对临床诊断、治疗及预后观察起到一定作用。临床上应用网织红细胞各种参数需首先确定其参考范围。我国目前对成年人网织红细胞各参数参考范围调查有过报道[1,2 ] ,而对儿童网织红细胞各参数参考范围未见报道。因此 ,我们对 93例正常儿童网织红细胞相关指标进行检测 ,结果报告如下。1　资料与方法1.1　调查对象福建省浦城县实验中心幼儿园正常儿童 (从体检者中筛出 ,血液化验指标正常 ,血红蛋白测定值大于 12 0 g/l,临床体征均…     

维持性血液透析病人透析前后的网织红细胞参数及C反应蛋白的变化

目的探讨维持性血液透析病人透析前后的网织红细胞参数及C反应蛋白（CRP）的变化。方法分别运用NEPHSTARPlus特定蛋白分析仪和SYSMEXXE-2100全自动血液分析仪检测30例维持性血液透析病人透析前后网织红细胞（RET）参数、血红蛋白（HBG）、红细胞压积（HCT）和CRP。结果患者透析后与透析前比较,网织红细胞绝对数（RET#）、网织红细胞百分数（RET%）、CRP、未成熟网织红细胞指数（IRF）和中荧光强度网织红细胞（MFR）显著升高,差异有统计学意义（P〈0.05）。结论 IRF和MFR能够敏感反映透析后患者的贫血改善程度,可作为患者透析疗效监测的有效手段;C反应蛋白的浓度测定对透析疗效观察及预示贫血有重要的临床意义。     

415例新生儿网织红细胞计数参考范围的探讨

目的探讨18°×4扇形窥盘法正常新生儿网织红细胞计数参考范围的动态变化及其与日龄的关系。方法用18°×4扇形窥盘法对415例1～10d正常新生儿进行网织红细胞计数，并同时用国际血液学标准化委员会（ICSH）所推荐的网织红细胞计数Miller窥盘法进行比较，将两种方法所得结果按日龄与检测方法对数据进行分组．用统计学软件SPSS12．0进行处理。结果18°×4扇形窥盘法的新生儿网织红细胞计数参考范围，1d组（3．09％～6．81％）与2d组（3．00％-6．34％）、7d组（0．27％～1．15％）与8d组（0．32％～1．28％）、8d组与9d组（0.34％-1．38％）、9d组与10d组（0．35％-1．53％）之间分别进行比较，差异无统计学意义（P〉0．05）；2d组与3d组（1．93％～4．03％）、3d组与4d组（1．35％～3．13％）、4d组与5d组（1．26％～1．98％）、5d组与6d组（0．72％-1．45％）、6d组与7d组之间分别进行比较，差异有显著统计学意义（P〈0．01）；所有不同日龄组18°×4扇形窥盘法和Miller窥盘法测定的网织红细胞计数值分别进行比较，差异无统计学意义（P〉0．05）。结论正常新生儿网织红细胞计数参考范围随着日龄的变化而变化，且有低值期的存在；18°×4扇形窥盘法可作为Miller窥盘法的替代方法测定新生儿网织红细胞；该参考范围的确定为网织红细胞计数在实验室操作和临床应用方面提供了依据。     

一种新型18°×4扇形网织红细胞计数窥盘

目的研制一种新型18°×4扇形网织红细胞计数窥盘。方法使用安瓿刀在玻片上刻制,再与国际血液学标准化委员会(ICSH)推荐的Miller窥盘进行网织红细胞对比分析。结果新型网织红细胞计数窥盘和ICSH推荐的Miller窥盘的准确度是一致的,但新型网织红细胞计数窥盘的精密度显著优于ICSH推荐的Miller窥盘。其参考范围也与其他报道一致。结论新型网织红细胞计数窥盘做法简单,不需特殊设备,值得推广应用。     

静止型β地中海贫血妊娠妇女网织红细胞参数观察

目的探讨网织红细胞6项参数在静止型β地中海贫血（地贫）患者妊娠期的变化情况。方法用Sysmex XE-2100全自动血液分析仪对38例静止型β地贫妊娠妇女进行网织红细胞百分率（RET%）、网织红细胞绝对值（RET#）、未成熟网织红细胞指数（IRF）、低荧光强度网织红细胞（LFR）、中荧光强度网织红细胞（MFR）、高荧光强度网织红细胞（HFR）等6项参数测定,将测定结果与正常妊娠及非妊娠的静止型β地贫妇女的进行比较分析。结果静止型β地贫妊娠妇女IRF、MFR、HFR3项参数较正常妊娠妇女增高;RET%、IRF、MFR、HFR4项参数较非妊娠的静止型β地贫妇女增高,LFR则低于正常妊娠及非妊娠的β地贫妇女（P〈0.05）。结论静止型β地贫妊娠妇女骨髓造血功能较正常妊娠及非妊娠的静止型β地贫妇女更旺盛。网织红细胞IRF、LFR、MFR、HFR4项参数可作为产前筛查静止型β地贫的参考指标。     

静脉补铁治疗缺铁性贫血的疗效观察

目的对比口服、静脉两种途径补铁治疗缺铁性贫血(IDA)的临床疗效及不良反应发生率。方法将118例IDA患者,分为静脉补铁组68例,口服补铁组50例,经口服及静脉补铁治疗后随访四周,并监测血红蛋白、网织红细胞计数、血清铁蛋白,同时观察不良反应。结果静脉补铁组100%有效,口服补铁组86%有效。静脉补铁3日后,网织红细胞计数较治疗前明显升高,一周后血红蛋白及网织红细胞计数较口服补铁组明显上升(P<0.01),4周后静脉补铁组治愈率明显高于口服补铁组(P<0.01)。两组不良反应发生率差异无统计学意义(P>0.05)。结论静脉补铁更能有效提升IDA患者的血红蛋白,血红蛋白达标(男性大于120g/L,女性大于110g/L)时间明显短于口服补铁,且不发生较口服补铁更多的不良反应及并发症。     

输血支持在造血干细胞移植中的应用

背景：接受造血干细胞移植的患者经常需要血液制品输注支持,而患者对红细胞和血小板输注的需求差异非常大,这主要依赖于造血干细胞移植的类型和患者本身的疾病性质。 目的：评价中山大学附属中山医院接受造血干细胞移植患者移植期间输血的需求和数量。 方法：收集中山大学附属中山医院2004-01/2010-06接受造血干细胞移植患者的资料,包括移植的适应证、移植的类型、CD34+细胞的数量、红细胞和血小板的输注数量、费用、脱离输注时间以及中性粒细胞和血小板植入时间;红细胞输注的阈值是血红蛋白计数为70 g/L,而血小板的输注阈值是计数为20×10⁹ L^-1。研究分析了患者移植期间红细胞和血小板输注的需求、输注量、输血费用,以及患者的生存情况。 结果与结论：自体造血干细胞移植组中有14例(93%)患者,而异基因造血干细胞移植组中有35例(90%)患者显示了造血细胞植入和脱离输注证据。自体造血干细胞移植组取得脱离红细胞输注天数为14.6 d,明显短于异基因造血干细胞移植组。与异基因造血干细胞移植组比较,自体造血干细胞移植组红细胞输注单位明显减少;而异基因造血干细胞移植组的红细胞输注费用明显高于自体造血干细胞移植组。输血花费昂贵,但却是造血干细胞移植中必不可少的一部分,异基因造血干细胞移植组需要更多的输血支持。脱离输注时间有望成为评估造血干细胞移植成功的指标。     

血液回收对非体外循环冠状动脉旁路移植患者红细胞和血液粘度的影响

目的观察血液回收技术对非体外循环冠状动脉旁路移植患者红细胞、血小板和血液粘度的影响。方法2005年8月~2007年10月间,共完成46例非体外循环冠状动脉旁路移植术,随机分为实验组(血液回收组)和对照组(不使用血液回收机组),每组23例。观察两组用血液制品的数量和术后24h的引流量,比较两组术前和术后24h的红细胞计数、血红蛋白、红细胞压积、血小板计数、低切全血粘度和高切全血粘度。结果实验组用浓缩红细胞和血浆的量明显少于对照组,两组术后24h引流量、术前和术后24h的红细胞计数、血红蛋白、红细胞压积、血小板计数、低切全血粘度和高切全血粘度之间的差异无显著性意义。结论血液回收技术在非体外循环冠状动脉旁路移植患者中能减少输血,对红细胞、血小板和血液粘度无不利影响。     

改良网织红细胞染色液的应用评价

目的评价一种改良的网织红细胞染色液。方法对改良网织红细胞染色液进行显微镜镜下观察试验、染色时间试验、有效期试验、准确度试验和精密度试验。结果改良网织红细胞染色液染色后的标本在显微镜镜下具有不易褪色、沉渣少、视野清晰、背景明亮等特点,且改良网织红细胞染色液染色时间短（5min）,有效期长（30个月）,准确度与煌焦油蓝盐水染色液一致（P〉0．05）,精密度好于煌焦油蓝盐水染色液。结论改良网织红细胞染色液是一种优秀的网织红细胞染色液,值得推广应用。     

Changes in platelet functional parameters and CD62 P expression in liver cirrhosis

Background

Hepatic impairment, portal hypertension, and multi-systemic damage could occur during liver cirrhosis''s late stage. Bleeding is a complication of hepatic cirrhosis along with several changes including blood platelet count (BPC), mean platelet volume (MPV), platelet crit (PCT) and expression of platelet CD62P. Blood platelet count (BPC), mean platelet volume (MPV), platelet distribution width, and other indices are indirect reflections of CD62P parameters.

Objective

To investigate the changes in platelet functional parameters and CD62 P expression in liver cirrhosis as a possible guide in clinical treatments and prognoses of liver cirrhosis.

Methods

CD62P was tested by flow cytometry in liver cirrhosis. BPC, MPV, and PCT in peripheral blood were tested using an auto blood cell analyzer. Data were analyzed using SPSS11.0.

Results

The values of CD62P and MPV in patients was significantly higher than those of healthy donors (P<0.01), while the values of BPC and PCT were significantly lower than those of the control group (P<0.01)

Conclusions

CD62P, BPC, MPV, and platelet crit (PCT) show several changes in liver cirrhosis. It is useful to understand the relationship between hepatic cirrhosis severity and CD62P, BPC, MPV, PCT, timely monitoring of CD62P for treatment of hepatic cirrhosis in clinical treatment and prognosis.     

Five fully automated methods for performing immature reticulocyte fraction: comparison in diagnosis of bone marrow aplasia

We performed a parallel evaluation of 5 automated reticulocyte counters to produce the immature reticulocyte fraction (IRF). We analyzed 225 samples from healthy control subjects, 115 from patients with various diseases, 38 with advanced aplasia, and 22 in early erythropoietic recovery after chemotherapy or bone marrow transplantation. The reference intervals were different for each instrument (ADVIA 120, 0.04-0.25; CELL DYN 4000, 0.15-0.35; GEN-S, 0.20-0.37; SE 9500 RET 0.05-0.21; VEGA RETIC: 0.06-0.23). The imprecision, obtained by 1-way analysis of variance on duplicates, was satisfactory for clinical use for all methods (coefficient of variation, 7.6%-20.5% in healthy subjects), although it was higher than the analytic goal based on biologic variability within subjects. The comparison of different methods shows that agreement is good only between SE 9500 RET CELL DYN 4000, and VEGA RETIC (r2 = 0.72-0.78). The study of diagnostic performance in distinguishing aplasia from early bone marrow recovery shows slightly different results (area under the curve from 0.70 for ADVIA 120 to 0.96 for SE 9500 RET). Even with slight differences, the fluorescence-based methods seem to be more robust than other methods for IRF measurement.     

Reticulocyte maturation parameters are reliable early predictors of hematopoietic engraftment after allogeneic stem cell transplantation.

Early detection of donor-derived hematopoietic restoration after allogeneic stem cell transplantation (allo-SCT) is a crucial issue in the management of heavily immunocompromised patients. The aim of this prospective study was to validate our previously defined cutoff values for reticulocyte maturation parameters as early predictors of hematopoietic engraftment. Importantly, the effect of clinical variables in reticulocyte engraftment was also sought. For this purpose, we prospectively studied 136 consecutive patients undergoing allo-SCT from related (n = 89) or unrelated (n = 47) donors. High fluorescence reticulocytes (RETH), immature reticulocyte fraction (IRF), mean fluorescence index (MFI), and mean reticulocyte volume (MRV) were automatically measured in peripheral blood samples drawn on a daily basis. We previously defined reticulocyte engraftment when MFI > or =10, RETH > or =3%, IRF > or =10%, and MRV > or =110 fL. Median neutrophil engraftment was 18 days (range, 10-35 days); for reticulocyte parameters, the values were 14 days for IRF (range, 7-45 days), 14 days for MFI (range, 7-43 days), 15 days for RETH (range, 7-43 days), and 21 days for MRV (range, 9-74 days). These differences reached statistical significance for MFI and IRF when compared with standard neutrophil recovery, even when analyzing siblings or unrelated donors separately. In univariate analysis, donor-recipient ABO disparity adversely influenced erythroid engraftment (P = .04 for IRF, P = .03 for MFI), but the infusion of >2.9 x 10(6)/kg of CD34+ cells was associated with a shorter time to reach erythroid engraftment (P = .02 for IRF and MFI). In Cox regression analysis, > or =100/microL neutrophils and IRF > or =10% were predictive parameters for standard neutrophil engraftment. Based on these findings, we suggest that serial measurement of IRF or MFI should be routinely used to trace hematopoietic restoration after allo-SCT because these preceded standard neutrophil recovery by a median of 4 days and are therefore very useful to make clinical decisions.     

肝移植围术期EPO应用的效果及安全性研究

目的 评价重组人促红细胞生成素在肝移植围术期中的效果及安全性。方法 回顾分析我院2015年9月~2016年12月原位肝移植89例患者的化验检查、用药情况及围术期输血情况,排除二次肝移植手术患者、死亡患者、术中输血＞50 U患者,根据围术期是否应用rHuEPO,分为EPO组和对照组。EPO组入院后根据围术期贫血情况皮下注射 rHuEPO 10000 U/次,1 次/d或1次/2 d;对照组入院后未用rHuEPO。观察两组患者术后血红蛋白、红细胞计数、网织红细胞计数以及输血量的对比情况。结果 ①EPO组患者经治疗后,术后3 d（T1）、术后7 d（T2）、术后15 d（T3）及术后1个月（T4）与术前基础值（T0）比较,Hb变化不大,差异无统计学意义（P＞0.05）;对照组Hb T1、T2、T3、T4与T0比较明显降低,差异有统计学意义（P＜0.01）;EPO组T0时点Hb明显低于对照组,差异有统计学意义（P＜0.01）,在T3、T4时点Hb高于对照组,差异有统计学意义（P＜0.05）。②EPO组患者经治疗后,T1、T2、T3、T4与T0比较,RBC计数差异无统计学意义（P＞0.05）;对照组RBC T1、T2、T3、T4与T0比较降低,差异有统计学意义（P＜0.05）;对照组T1、T2、T3、T4时点RBC低于EPO 组,差异有统计学意义（P＜0.05）。③EPO组患者经治疗后,网织红细胞计数（RET）T3、T4时点较对照组明显上升,差异有统计学意义（P＜0.01）; EPO组T3、T4时点与T0比较,RET升高,差异有统计学意义（P＜0.01）;对照组RET 在 T1、T2、T3、T4与T0比较差异无统计学意义（P＞0.05）;组间比较,EPO组T3、T4时点RET 明显高于对照组,差异有统计学意义（P＜0.01）。结论 肝移植贫血患者在围术期皮下注射rHuEPO,术后1个月患者的贫血改善好于对照组,提示rHuEPO对肝移植贫血的重症患者安全、有效。     

Evaluation of QT and P wave dispersion and mean platelet volume among inflammatory bowel disease patients

Background: In inflammatory bowel disease (IBD) number of thromboembolic events are increased due to hypercoagulupathy and platelet activation. Increases in mean platelet volume (MPV) can lead to platelet activation, this leads to thromboembolic events and can cause acute coronary syndromes. In IBD patients, QT-dispersion and P-wave dispersion are predictors of ventricular arrhythmias and atrial fibrilation; MPV is accepted as a risk factor for acute coronary syndromes, we aimed at evaluating the correlations of these with the duration of disease, its localization and activity.Methods: The study group consisted of 69 IBD (Ulcerative colitis n: 54, Crohn''s Disease n:15) patients and the control group included 38 healthy individuals. Disease activity was evaluated both endoscopically and clinically. Patients with existing cardiac conditions, those using QT prolonging medications and having systemic diseases, anemia and electrolyte imbalances were excluded from the study. QT-dispersion, P-wave dispersion and MPV values of both groups were compared with disease activity, its localization, duration of disease and the antibiotics used.Results: The P-wave dispersion values of the study group were significantly higher than those of the control group. Duration of the disease was not associated with QT-dispersion, and MPV levels. QT-dispersion, P-wave dispersion, MPV and platelet count levels were similar between the active and in mild ulcerative colitis patients. QT-dispersion levels were similar between IBD patients and the control group. No difference was observed between P-wave dispersion, QT-dispersion and MPV values; with regards to disease duration, disease activity, and localization in the study group (p>0.05).Conclusions: P-wave dispersion which is accepted as a risk factor for the development of atrial fibirilation was found to be high in our IBD patients. This demonstrates us that the risk of developing atrial fibrillation may be high in patients with IBD. No significant difference was found in the QT-dispersion, and in the MPV values when compared to the control group.     

肾综合征出血热患者血小板功能,肝素样物质,AT—Ⅲ：…

测定了５５例肾综合征出血热患者血压小板计数、血小粘附功能，血小板聚集功能，血浆肝素样物质含量及抗凝血酶－Ⅲ活性。结果表明，ＨＦＲＳ患者有显著的 小板计数降代，血小板粘附，聚集功能减弱，血肝素祥物质含量增高号ＡＴ－Ⅲ：α下降，在产现程的极期与危重型患者，上述改变更为显著。     

The measurement of immature reticulocyte fractions and clinical significance

We evaluated automated analysis for the measurement of immature reticulocyte fraction(IRF) in 222 blood samples. IRF was performed by R-3000 & XE-2100(Sysmex), VEGA RETIC LC141(Horiba), ADVIA 120(Bayer medical), CELL DYN4000(Abbott) or GEN'S(Coulter), and compared with measurements obtained by visual counting. A subfraction of IRF was also determined using different modalities on all analyzers. The values of IRF were stable after blood storage for 48 hours at 4 degrees C and 8 hours at room temperature. A good correlation of IRF among these analyzers was obtained(r = 0.629-0.869), but the normal ranges in the percentage of IRF varied according to analyzers. However, an elevation in the percentage of IRF is the first sign of bone marrow recovery after chemotherapy and the bone marrow transplantation in the majority of leukemic patients. We suggest that IRF counting is useful for the estimation of early phase erythropoiesis in patients who have successful bone marrow engraftment following bone marrow transplantation.     

Kinetics of erythrogenesis after bone marrow transplantation.

To determine the kinetics of bone marrow erythrogenesis after bone marrow transplantation, the authors counted reticulocytes (by blood smear and flow cytometry) and compared those data with neutrophil and platelet recovery in 23 consecutive bone marrow transplant patients. The earliest indication of marrow recovery after allogeneic and autologous bone marrow transplantation was defined as the second increasing cell count after the lowest recorded count, provided that the trend continued upward. Recovery of marrow function was detected earlier in 10 of 23 patients using reticulocyte counts than by either neutrophil or platelet count alone. Specifically, in 8 of these 10 patients, recovery of erythropoiesis was determined earlier by flow cytometric examination than by the blood smear method. On the other hand, combining the data using the earliest value of platelet, neutrophil, and reticulocyte counts indicated that the mean day of recovery in our patient population was determined to be 12.1 +/- 4 days after marrow infusion. In patients undergoing autologous and allogeneic bone marrow transplantation, serial neutrophil and reticulocyte count determinations are complementary in early clinical detection of successful engraftment.