红细胞分布宽度在小细胞低色素性贫血中的意义

目的探讨红细胞分布宽度(RDW)-CV和RDWS-D之间结果的关系,以明确RDW-SD的临床应用价值。方法先依据美国临床实验室标准化协会(CLSI)C28-A2指南建立二者的参考区间,分析二者的人群分布曲线,然后对121份随机临床标本、109例地中海贫血标本和25例缺铁性贫血标本同时测定RDW-CV和RDWS-D,并根据参考区间对二者的升高、降低情况进行比较分析。结果RDW-CV在正常人群中接近正态分布,RDWS-D呈偏态分布。RDW-CV和RDW-SD之间的升高或降低并不一致,RDW-CV增高或正常的标本其RDWS-D均可出现增高、正常或降低,RDW-CV降低的标本其RDW-SD也可出现正常或降低,二者在随机患者中符合率为80.0%。缺铁性贫血患者的RDW-CV和RDW-SD平均值均比地中海贫血的高(P<0.001),但地中海贫血患者间2个参数的分布范围均比缺铁性贫血患者间的分布范围宽,并把缺铁性贫血的分布范围包含其中。地中海贫血和缺铁性贫血患者的RDW-CV结果大部分均升高,小部分在正常范围。地中海贫血的RDW-SD结果可升高、正常或降低,并以降低为主,和RDW-CV呈倒挂现象,而缺铁性贫血患者未见降低者...     

XE-2100测定红细胞分布宽度参考区间的建立

目的 对Sysmex XE-2100测定红细胞分布宽度的参考区间进行调查,以建立正确的参考区间.方法 依据NCCLSC28-A2指南,筛选参考个体、采集运送标本、检测标本和分析数据,并通过健康体检者结果 在参考区间内、外的情况以及RDW-CV和RDW-SD结果 符合率的比较对新建的参考区间进行了验证.结果 RDW-CV和RDW-SD在正常人群中呈偏态分布,二者在男性和女性中结果 无显著性差异,可并用参考区间.合并后的参考区间RDW-CV为13.9%;RDW-SD为47.6fl.与厂家提供的参考范围相比,建立新的参考区间后RDW-CV和RDW-SD的符合率得到明显增加.结论 新建立的参考区间比厂家提供的参考范围更适合本实验室.     

血常规检测对贫血病因的判断价值

目的探讨血常规在贫血患者诊断进鉴中的作用和意义。方法对我院2009年门诊及住院贫血患者189例血液进行检查,其中α地中海贫血（α-THAL）患者81例,β地中海贫血（β-THAL）患者62例,缺铁性贫血（IDA）患者46例。同时选定门诊体检血常规正常50例作为对照组。患者均全部做血常规、血清铁蛋白、血红蛋白电泳分析。结果各组患者血常规指标与正常人群比较均具显著性差异。地中海贫血患者的红细胞计数（RBC）、血红蛋白（Hb）与缺铁性贫血患者比较显著增高,具有显著性差异,而红细胞体积分布宽度（RDW）低于缺铁性贫血患者。结论对血常规RBC、Hb、平均红细胞容积（MCV）、RDW等参数进行综合分析,有助于筛查和鉴别贫血,筛查方便快速,而且成本低廉。     

缺铁性贫血对不同基因型α地中海贫血筛查的影响

目的探讨缺铁性贫血对不同基因型α地中海贫血筛查的影响,评估HbA2与红细胞各指标在鉴别缺铁性贫血和各种基因型α地中海贫血中的作用。方法严格筛选正常人群样本、α地中海贫血患者样本、缺铁性贫血患者样本和α地中海贫血合并缺铁性贫血患者样本,进行血红蛋白电泳、血常规、铁蛋白和地中海贫血基因诊断,统计分析不同检测指标在各样本组差异。结果缺铁性贫血的HbA2平均水平低于α地中海贫血,HbH病患者HbA2水平低于缺铁性贫血。鉴别正常人群和单纯α地中海贫血时,MCH比MCV有更高的敏感性。鉴别α地中海贫血和缺铁性贫血时,HbA2和MCV准确度分别只有62.7%和72.4%,RDW-CV准确度为89.8%,RDW-CV在α地中海贫血合并缺铁性贫血组和单纯缺铁性贫血组之间无统计学意义。红细胞各指标在缺铁性贫血和HbH病患者的分布基本相似。结论 HbA2和红细胞指标对于鉴别α地中海贫血和缺铁性贫血的能力欠佳,特别是HbH病和缺铁性贫血很难鉴别。α基因缺失程度对HbA2和红细胞指标影响较大。α地中海贫血筛查时,铁代谢指标的检测非常重要。     

血常规在鉴别缺铁性贫血和地中海贫血中的临床应用

选取595例女性患者,正常组有200例,缺铁性贫血组(IDA)有50例,地中海贫血组有345例,将地中海贫血组再分为轻型α-THAL组(177例)、轻型β-THAL组(124例)和HB H组(44例)三组。对其使用全自动的血细胞检测仪进行血常规检测。在血常规的MCV,MCH,MCHC,RDW-CV,RBC,HB,RBC/HB等项检测中,缺铁性贫血组和地中海贫血组的患者都与正常组患者有明显差异(P0.01)。血常规检查可以简单快速的鉴别缺铁性贫血和地中海贫血,具有重要的临床诊断意义。     

红细胞参数在早孕患者β地中海贫血筛查中的应用价值

目的:探讨红细胞参数在早孕患者β地中海贫血筛查中的应用价值。方法:收集我院2015年1月至2015年3月产科门诊85例早孕合并小细胞低色素性贫血患者资料。根据β-地中海贫血基因检测和血清铁蛋白检测结果,分为缺铁性贫血组(n=42)和地中海贫血组(n=43)。绘制患者检测特征曲线分析RBC、Hb、MCV、MCH、RDW-CV、RDW-SD对早孕患者β地中海贫血的诊断价值。结果:地中海贫血组患者RBC、Hb、MCV、MCH、RDW-CV、RDW-SD均显著高于缺铁性贫血组。Hb、MCV、RDW-CV、RDW-SD受试者工作特征曲线下面积分别为0.961(0.924-0.998)、0.960(0.913-1.000)、0.888(0.815-0.961)、0.843(0.760-0.926)。当Hb临界值为88.0g/L时,敏感性和特异性分别为88.4%和95.2%。当MCV临界值为60.0fl时,敏感性和特异性分别为100.0%和88.1%。当Hb、MCV分别取临界值为88.0 g/L和60.0fl时,联合敏感性为88.4%,联合特异性为99.4%。结论:Hb、MCV指标可用于早孕患者β地中海贫血早期诊断;Hb、MCV联合试验可提高敏感性和特异性。     

网织红细胞及红细胞相关参数在贫血鉴别诊断中的应用

目的探讨网织红细胞参数联合红细胞参数在临床常见3种贫血鉴别诊断中的价值。方法检测3种贫血患者和体检健康者的红细胞相关参数MCV、MCH、MCHC、RDW-SD及网织红细胞相关参数RET%、RET#、IRF、LFR。结果与健康对照组比较,IDA组MCV、MCH、MCHC、LFR明显减低,RDW-SD、RET%、IRF明显增高;慢性病贫血组,MCHC、LFR明显减低,RED-SD、RET%、IRF明显增高;肾性贫血组MCV、MCH、MCHC、RET#、LFR明显减低,RDW-SD、IRF明显增高。缺铁性贫血组与慢性病贫血组比较,MCV、MCH、MCHC显著减低;缺铁性贫血组与肾性贫血组比较,MCV、MCH、MCHC、LFR显著减低,IRF显著升高;慢性病贫血组与肾性贫血组比较,MCHC、LFR显著降低,而RDW-SD、RET%、RET#、IRF显著升高。结论网织红细胞联合红细胞相关参数对3种类型贫血的鉴别诊断具有一定临床意义。     

96例类风湿性关节炎患者红细胞参数的变化

目的研究类风湿性关节炎(RA)患者红细胞参数的变化情况。方法选择明确诊断的96例RA患者做血常规检查,用SPSS13.0统计软件进行统计处理。结果96例RA患者中贫血有54例(56.25%),RA贫血组的红细胞平均体积(MCV)、红细胞平均血红蛋白浓度(MCHC)值与健康组比较均显著降低,而红细胞体积分布宽度(RDW)RDW-SD、RDW-CV值则显著增高,即RA贫血患者表现为小细胞不均一性贫血。在女性RA非贫血组红细胞平均血红蛋白含量(MCH)、MCHC及RDW-SD、RDW-CV值与健康组比较差异也有统计学意义。结论MCH、MCHC、RDW等指标比传统的红细胞(RBC)、血红蛋白(Hb)指标能更早提示RA患者红细胞特征的改变,可为预测RA贫血的发生,以便临床及时治疗提供实验依据。     

应用综合性铁指标对慢性病贫血及缺铁性贫血的诊断评估

临床上常会遇到某些小细胞和（或）低色素性贫血,其血清铁蛋白（ＳＦ）降低,但血清铁（ＳＩ）及运铁蛋白饱和度（ＴＳ）正常,或ＳＩ和ＴＳ低于正常而ＳＦ正常或升高,这类患者常被误诊为“不典型缺铁性贫血”,而实际上可能大多属于慢性病贫血（ＡＣＤ）,其中有些患者...     

红细胞参数在地中海贫血与缺铁性贫血诊断中的应用价值分析

目的 探究红细胞参数在地中海贫血与缺铁性贫血诊断中的应用价值。方法 选取我院2020年5月1日至2022年4月30日收治的160例贫血患者，根据贫血类型分为地中海贫血组和缺铁性贫血组，各80例。由同一组医生采集患者的空腹静脉血进行血常规检查。然后使用回顾性调查方法分析两组患者的红细胞分布宽度（Red bloodeel distribution width,RDW）、血红蛋白含量（Hemoglobin concentration,HB）、红细胞计数（Red blood cell count,RBC）、平均红细胞血红蛋白量（Mean corpuscular hemoglobin,MCH）、红细胞平均体积（Mean corpuscular volume,MCV）、平均红细胞血红蛋白浓度（Mean corpuscular hemoglobin concentration,MCHC）水平，并进行相关统计学分析。结果 缺铁性贫血组患者的RDW、MCV水平均显著高于地中海贫血组，差异有统计学意义（P<0.05）；缺铁性贫血组患者的HB、RBC、MCHC水平均显著低于地中海贫血组，差异有统计学意...     

XE-2100测定红细胞分布宽度参考区间的建立

目的对Sysmex XE-2100测定红细胞分布宽度的参考区间进行调查,以建立正确的参考区间。方法依据NCCLSC28-A2指南,筛选参考个体、采集运送标本、检测标本和分析数据,并通过健康体检者结果在参考区间内、外的情况以及RDW—CV和RDW—SD结果符合率的比较对新建的参考区间进行了验证。结果RDW—CV和RDW—SD在正常人群中呈偏态分布,二者在男性和女性中结果无显著性差异,可并用参考区间。合并后的参考区间RDW—CV为〈13．9％,RDW—SD为〈47．6fl。与厂家提供的参考范围相比,建立新的参考区间后RDW—CV和RDW-SD的符合率得到明显增加。结论新建立的参考区问比厂家提供的参考范围更适合本实验室。     

红细胞分布宽度在儿童过敏性紫癜中的临床价值

目的探讨红细胞分布宽度（RDW）在儿童过敏性紫癜（HSP）中的临床价值。 方法收集2013年1月至2018年5月在广西壮族自治区人民医院儿科住院的HSP患儿的资料,根据是否存在肾脏损害分为紫癜性肾炎（HSPN）组和过敏性紫癜无肾炎（HSPWN）组,同时设置同期健康儿童作为对照组。对HSP患儿和健康儿童,HSPN、HSPWN患儿与健康儿童,血红细胞（RBC）、血小板（PLT）的两组间比较采用两样本t检验,三组间比较采用one-Way ANOVA;年龄,血白细胞（WBC）、血红蛋白（Hb）、红细胞比容（Hct）、红细胞平均体积（MCV）、红细胞分布宽度变异系数（RDW-CV）、红细胞分布宽度标准差（RDW-SD）和血小板平均体积（MPV）的组间比较采用秩和检验;性别分布的组间比较采用χ²检验。任意两组间比较采用Kruskal-Wallis检验（视图中选择pairwise comparisons）。HSP患儿RDW-CV、RDW-SD与其他指标的相关性分析采用Spearman秩相关分析。 结果HSP患儿与健康儿童在性别,年龄,血MCV、PLT、MPV方面差异无统计学意义（P均>0.05）。HSP患儿血WBC,RDW-CV、RDW-SD水平较健康儿童显著增高,差异有统计学意义（Z=-6.838,P<0.001;Z=-5.437,P<0.001;Z=-4.681,P<0.001）;血RBC,Hb、Hct水平较健康儿童显著降低,差异有统计学意义（t=-2.701,P=0.008;Z=-4.396,P<0.001;Z=-4.043,P<0.001）。HSPN、HSPWN患儿与健康儿童在性别,年龄,血MCV、PLT、MPV方面差异无统计学意义（P均>0.05）。HSPN、HSPWN患儿与健康儿童比较,血WBC、RDW-CV、RDW-SD水平明显升高,差异有统计学意义（Z=46.760,P<0.001;Z=32.984,P<0.001;Z=28.343,P<0.001）;而血RBC、Hb、Hct水平明显降低,差异有统计学意义（t=4.375,P=0.014;Z=20.623,P<0.001;Z=18.256,P<0.001）。HSPN患儿与HSPWN患儿比较,血RDW-SD水平明显升高,差异有统计学意义（P<0.05）,其余指标差异无统计学意义（P均>0.05）。HSP患儿血RDW-CV与WBC、RBC和RDW-SD呈正相关（r=0.189,P=0.047;r=0.263,P=0.005;r=0.217,P=0.023）,与Hb、Hct、MCV呈负相关（r=-0.329,P<0.001;r=-0.194,P=0.042;r=-0.447,P<0.001）,未发现RDW-CV水平与CRP、Fib、D-二聚体和总胆固醇水平之间的相关性（r=0.029,0.021,-0.143,0.015,P均>0.05）。HSP患儿血RDW-SD水平与MCV、RDW-CV、总胆固醇水平之间呈正相关（r=0.434,P<0.001;r=0.217,P=0.023;r=0.360,P<0.001）,与RBC、D-二聚体水平呈负相关（r=-0.213,P=0.026;r=-0.301,P=0.003）,未发现RDW-SD与WBC、Hb、Hct、CRP、Fib水平之间的相关性（r=-0.027,0.060,0.139,-0.073,-0.195,P均>0.05）。 结论HSP患儿RDW水平升高,但RDW在评估HSP患儿能否进展为HSPN方面仍有待进一步研究。     

Influence of iron deficiency anaemia on haemoglobin A2 levels: possible consequences for beta-thalassaemia screening

Iron deficiency modulates the synthesis of HbA2, resulting in reduced HbA2 levels in patients with iron deficiency anaemia. The diagnosis heterozygous beta-thalassaemia is based on a raised HbA2 level. Patients with beta-thalassaemia and concomitant iron deficiency can show normal HbA2 levels. It is of clinical importance to know the quantitative effect of iron-deficient erythropoiesis on the levels of HbA2 in order to be able to determine which iron-deficient patients with normal HbA2 levels have to be retested after iron therapy in thalassaemia screening programmes. In this study, HbA2 levels in 150 patients with iron-deficiency anaemia and 71 healthy controls have been measured. A linear correlation is found in the patient group between HbA2 and Hb, HbA2 and MCV, and HbA2 and erythrocyte zinc protoporphyrin (ZPP). In future studies, the correlation between HbA2 and erythrocyte parameters in patients with heterozygous beta-thalassaemia and concomitant iron deficiency has to be examined. We recommend that ZPP be measured in these studies too, as ZPP levels may be a better indicator of concomitant iron deficiency than Hb or MCV in thalassaemic patients.     

A multivariate analysis of the risk of iron deficiency in plateletpheresis donors based on logistic regression

BackgroundThe purpose of this study was to analyze the application of individual factors, blood cell related indicators, and blood donation frequency in predicting the risk of iron deficiency of plateletpheresis donors.MethodsA total of 801 plateletpheresis donors were included in this study. The relationship between risk factors and iron deficiency was retrospectively analyzed by univariate analysis and logistic regression analysis. The application of Hb, MCHC, RDW-CV and blood donation frequency combined prediction of iron deficiency risk among plateletpheresis donors was evaluated.ResultThe rate of iron deficiency in this study was 31.5 % (241/766). The age, gender (the ratio of male donors), red blood cell related indicators, blood donation frequency were statistically different between the normal and iron deficiency group (all P < 0.05). Age, gender, the reciprocal of Hb and MCHC, RDW-CV, total number of blood donation and number of plateletpheresis donation in the past year, these indicators to predict the risk of iron deficiency area under the curve (AUC) were 0.558, 0.672, 0.785, 0.717, 0.599, 0.621, 0.646, respectively. The AUC of these indicators combined to predict the risk of iron deficiency was 0.877, higher than all single indicators. The sensitivity and specificity of these indicators combined in prediction of iron deficiency were 88.89 % and 81.57 %, respectively.ConclusionAge, gender, the reciprocal of Hb and MCHC, RDV-CV, blood donation frequency are associated with the risk of iron deficiency in plateletpheresis donors. The combination of these indicators has high value in predicting the risk of iron deficiency.     

红细胞分布宽度及中性粒细胞/淋巴细胞比值在IE患者中的临床意义

目的探究红细胞分布宽度(RDW)和中性粒细胞/淋巴细胞比值(NLR)在感染性心内膜炎(IE)患者中的水平与临床意义。方法选取2014年12月至2018年3月该院感染科收治,诊断为“IE”的患者为IE组,同期体检的健康人群为健康对照组,同期住院的冠状动脉粥样硬化性心脏病(CHD)患者为CHD组,收集统计患者的影像学检查资料、病历资料、化验检查资料进行统计学分析。结果NLR在IE组与健康对照组之间比较差异有统计学意义(P<0.05);红细胞分布宽度变异系数(RDW-CV)在IE组与健康对照组、IE血培养阳性组与IE血培养阴性组之间比较差异有统计学意义(P<0.05);红细胞分布宽度标准差(RDW-SD)在IE组与健康对照组、IE血培养阳性组与健康对照组之间比较差异有统计学意义(P<0.05)。受试者工作特征曲线(ROC曲线)下面积(AUC)0.926,灵敏度89.2%,特异度86.3%,提示联合应用NLR和RDW-CV可以使诊断效能提高。结论NLR、RDW在感染相关疾病的预后方面有较广阔的应用前景,但在IE患者的诊断作用有限,在预后方面的作用,需要更大样本量、多中心的临床队列研究证实。     

贫血病儿血清铁蛋白（SF）测定及骨髓细胞外铁与SF的关系

本文用放免法测定了贫血病儿血清铁蛋白含量。其中lDA、lDE组儿童SF含量显著降低(P<0.005)。骨髓细胞外可染铁与SF含量的关系表明:lDA、溶血性贫血儿童SF含量随骨髓细胞外铁的增加而增加。上述结果表明;SF是诊断缺铁的一个灵敏指标;SF可以发现隐性缺铁。     

Haematological laboratory findings in the elderly: influence of age and sex

The effects of age and sex on haematological laboratory parameters were studied in connection with a population study in people over the age of 65 years (n = 347). Serum vitamin B12 was the only parameter which decreased significantly with advancing age. Blood leucocyte count, haemoglobin concentration, haematocrit, erythrocyte count, mean erythrocyte volume, mean erythrocyte haemoglobin and serum ferritin values were significantly higher in males than in females. Serum iron, serum transferrin, and plasma and erythrocyte folate levels did not differ between males and females. Thirteen subjects were anaemic and three of them had iron deficiency anaemia. Five subjects had iron deficiency based on serum iron and transferrin but no anaemia. Serum ferritin measurement did not reveal any further subjects with iron deficiency. No case of folate deficiency anaemia was revealed. Although many of the participants were on medication, most of them were living at home and taking care of themselves and represent relatively fit elderly people. Therefore we suggest that these laboratory data can also serve as reference values for the elderly people.     

Recovery from post-operative anaemia

Acceptance of lower transfusion thresholds and shorter post-operative stays results in patients leaving hospital after surgery with lower haemoglobin (Hb) than previously. We undertook a prospective observational study to assess the haematological response to post-operative anaemia and to determine the utility of quality of life (QoL) measures in assessing the impact of anaemia on such patients. Thirty patients undergoing unilateral hip arthroplasty had blood samples taken and QoL questionnaires administered pre-operatively and at 7, 28 and 56 days post-operatively. Increased erythropoiesis was evident at day 7 post-operatively. Approximately two-thirds of the post-operative Hb deficit was corrected by day 28. There was evidence of functional iron deficiency in more than one-quarter of patients at day 56. QoL scores used did not show any relationship with Hb in the post-operative period. Red cell 2,3-diphosphoglycerate (2,3DPG) levels increased in proportion to the degree of post-operative anaemia. We concluded that substantial recovery of Hb occurs between day 7 and day 28 post-operatively. Complete recovery of Hb may be delayed beyond day 56 due to development of iron deficiency. Patients are at significant risk of developing post-operative iron deficiency depending on operative blood loss and pre-operative iron stores. Increased red cell 2,3DPG may offset the effect of anaemia on oxygen delivery. We found no evidence that anaemia produces a measurable effect on chosen QoL scores in the post-operative period.     

P11A Trial of Preoperative IV Iron Sucrose (Venofer) Supplementation in Patients with Iron Deficiency Anaemia Undergoing Hip Arthroplasty at the Royal Bournemouth Hospital

We present the protocol and initial results for a trial of preoperative IV iron in anaemic patients presenting for hip arthroplasty at The Royal Bournemouth Hospital (RBH). A review of audit data at RBH has revealed 30% of primary hip replacements receive blood transfusion of at least 2 units of red cells. These patients often present to preoperative assessment clinic with a low haemoglobin (Hb). A proportion of patients with a low Hb are iron deficient. In patients with iron deficiency anaemia, oral iron therapy is frequently poorly tolerated and a rise in Hb following oral iron is slow making it unsuitable to use in the preoperative setting. IV Iron Sucrose (Venofer, Synermed Pharmaceutical Products Limited) provides predictable bioavailable iron and has an low allergenic potential. It is safe and quick to give in an outpatient setting. In addition it is a cheap alternative to allogeneic blood. At RBH approximately 20 anaemic patients present monthly to orthopaedic pre‐assessment clinic for hip arthroplasty. These patients have a Hb <120 g dL^?1 (female) or Hb <130 g dL^?1 (male) and currently proceed to surgery with no further investigation unless Hb <10 g dL^?1. A proportion of these patients will have iron deficiency anaemia and are therefore amenable to preoperative treatment with IV iron therapy. Study protocol flags up anaemic patients for further investigation to the Haematology Specialist Registrar (SpR) who sends a further blood form and patient information about the IV iron replacement trial. Blood tests include FBC and blood film, iron studies (ferritin, serum Fe, TIBC, transferrin saturation), coagulation screen, ESR, renal and liver function tests. Patients found to have iron deficiency anaemia are consented for the trial at an appointment with the SpR and are randomised to receive IV Iron (Venofer) or ‘standard treatment’ (no therapy). Venofer patients receive 2–3 doses (formula calculated) of IV iron (Venofer bolus over 10 min) at weekly intervals. The FBC is checked after an initial two doses and a third dose given only if the patient is still anaemic. The hospital transfusion practitioner (HTP) gives the 1st dose at the time of consent. The subsequent doses are given at weekly intervals by the HTP. Patients who have iron deficiency anaemia are also referred to the iron deficiency clinic for further investigations. Primary end points are number of patients receiving blood transfusion and number of units of blood transfused. Secondary end points are discharge times from hospital and postoperative infection rates. We present our full protocol and data collection form. We also hope to present the results from the first patients recruited.