缺氧缺血性脑病患儿血常规结果分析及其临床意义

目的探讨27项血常规参数在新生儿缺氧缺血性脑病（HIE）中的变化及其意义。方法利用全自动血细胞分析仪对29例HIE患儿和30例健康新生儿进行白细胞、红细胞及血小板等参数检测,分析其结果和临床意义。结果H1E组与对照组比较,（1）白细胞参数：淋巴细胞比率、单核细胞比率、中性粒细胞比率差异有统计学意义（P〈0．05）,而白细胞计数、嗜酸性粒细胞比率、嗜碱性粒细胞比率差异无统计学意义（P〉0．05）;（2）红细胞参数：血细胞比容、红细胞平均体积、平均血红蛋白浓度（MCHC）、红细胞分布宽度CV、红细胞分布宽度SD、网织红细胞计数、网织红细胞百分比、未成熟网织红细胞、低荧光网织红细胞比率、高荧光网织红细胞比率、有核红细胞计数、有核红细胞百分比等12项红细胞参数差异有统计学意义（P〈0．05）,而红细胞计数、血红蛋白、平均血红蛋白含量、中荧光强度网织红细胞比率等参数差异无统计学意义（P〉0．05）;（3）血小板参数：血小板计数、血小’板：压积差异有统计学意义（P〈0．05）,而平均血小板体积、血小板分布宽度及大型血小板比率等参数差异无统计学意义（P〉0．05）。结论利用全自动血细胞分析仪对HIE患儿外周血进行常规筛查和动态监测,计数快速、准确,能很好地满足临床应用,协助临床诊断HIE。     

红细胞冷凝集对全自动血细胞分析仪检测血细胞参数的影响

目的探讨红细胞冷凝集对全自动血细胞分析仪检测血细胞计数结果的影响。方法采用SysmexXE-2100全自动血细胞分析仪,对13例冷凝集全血标本分别在室温及37°C孵育30 min后进行全血细胞计数,并对检验结果进行比较。结果室温下与37℃孵育30 min后的检测结果比较,白细胞计数、红细胞计数、红细胞压积、红细胞平均体积、平均血红蛋白含量、平均血红蛋白浓度差异均有统计学意义(P0.05);血红蛋白、白细胞分类及血小板参数比较差异均无统计学意义(P0.05)。结论红细胞冷凝集会影响全自动血细胞分析仪对多种血细胞的准确计数,临床检测血常规时应仔细检查血标本是否有冷凝集现象,如存在应在37℃孵育30 min后进行检测,以免影响结果的准确性。     

The effect of pneumatic tube system on complete blood count parameters and thrombocyte donation in healthy donors

This paper is the first report whether or not pneumatic tube system affects the selection of apheresis donors according to the results of complete blood count. According to the apheresis guidelines, hemoglobin level must be ≥12.5g/dL and platelet level ≥150/μL to be a donor. Paired blood samples of 26 healthy volunteers were transported by either hand delivered or a pneumatic tube system to the laboratory. No statistically significant differences were observed in order to mean values of routine complete blood cell count and white cell differential parameters that were send for selection of apheresis donor before the procedure. Therefore, all healthy volunteers decided as a donor according to the laboratory results independent from transport method.     

真性红细胞增多症和原发性血小板增多症患者中JAK2V617F突变负荷与临床特征相关性

为分析真性红细胞增多症（polycythemiavera,PV）和原发性血小板增多症（essentialthrombocythemia,ET）患者JAK2V617F突变负荷和患者临床特征的相关性,利用荧光实时定量PCR方法检测90例初诊骨髓增殖性疾病（myeloproliferativedisorder,MPD）患者（包括47例PV和43例ET）外周血标本中JAK2V617F突变基因负荷,统计分析JAK2V617F负荷和患者外周血中血红蛋白、红细胞压积、白细胞计数和血小板计数的相关性。结果表明：突变阳性的ET患者中JAK2V617F负荷（0．209±0．192）较PV患者中（0．441±0．270）低（P=0．028）。在PV和ET患者中JAK2V617F负荷和患者外周血中血红蛋白（PV：R=0．518,P〈0．001;ET：R：0．528,P=0．005）、红细胞压积（PV：R：0．510,P〈0．001;ET：R=0．524,P=0．005）和白细胞计数（PV：R=0．584,P=〈0．001;ET：R：0．471,P=0．013）都呈正相关。在PV患者中,JAK2V617F突变负荷和血小板计数呈负相关（R=-0．354,P=0．020）;但在ET患者中,JAK2V617F负荷和血小板计数无明显相关性（R=0．233,P=0．242）。结论：在PV患者和ET患者中,JAK2V617F突变负荷和患者外周血中血红蛋白、红细胞压积和白细胞计数都呈正相关。在PV患者中,JAK2V617F负荷和血小板计数呈负相关,而在ET患者中JAK2V617F负荷和血小板计数无明显相关性。     

临产孕妇全血细胞参数及凝血功能指标变化分析

目的探讨临产孕妇全血细胞参数、凝血功能指标的变化及其临床意义。方法采用日本SysmexK-4500血细胞分析仪、法国STA-R全自动凝血仪，对530例临产孕妇和140例健康妇女进行全血细胞参数、凝血功能指标的检测和分析。结果临产孕妇白细胞计数、粒细胞百分比、红细胞体积分布宽度、血小板计数、血小板平均体积、血小板体积分布宽度、大血小板比率、纤维蛋白原等指标高于健康对照组，两组差异有统计学意义（P〈0．05或P〈0．01）；淋巴细胞百分比、中间细胞百分比、红细胞数、血红蛋白浓度、红细胞压积、红细胞平均血红蛋白量、红细胞平均血红蛋白浓度、凝血酶原时间、凝血酶原时间国际标准比值、活化部分凝血活酶时间低于健康对照组，差异有统计学意义（P〈0．01）；红细胞平均体积、凝血酶时间与健康对照组比较差异无统计学意义（P〉0．05）。结论临产孕妇可出现不同程度的缺铁性贫血，且血液处于高凝状态，容易发生弥漫性血管内凝血。     

A 3-year analysis of plateletpheresis donor deferral pattern in a tertiary health care institute: assessing the current donor selection criteria in Indian scenario

Introduction: This study reports the frequency and nature of plateletpheresis deferrals and evaluates donors with low platelet count and hemoglobin levels so as to assess the possibility of reentry without hampering donor safety. Materials and methods: Three‐year retrospective data of plateletpheresis deferral was collected. Data from actual procedures was also reviewed to analyze the safety of performing plateletpheresis in donors with low hemoglobin and platelet values. Results: Four hundred sixteen donors were deferred for various reasons among 1,515 screened (27.5%), of which 69.7% deferrals were because of low platelet count (55.8%) and less hemoglobin levels. Among the low platelet count donor group, 20.3% had a count between 141 and 149 × 10⁹/L and 41.8% below 120 × 10⁹/L. Of the 14% donors deferred for low hemoglobin, 62.1% had values in the range of 11.5–12.4 g/dL with normal mean corpuscular volume and red cell distribution width in most (86.2%) of them. Expected blood loss in each procedure varied between 20 and 30 mL, whereas RBC contamination in the product varied from 0 to 1.6 mL in 538 procedures. There were 176 donations with predonation platelet count <180 × 10⁹/L (32.7%). None of the 14 procedures performed on donors with platelet count of 150 × 10⁹/L showed evidence of thrombocytopenia or donor reaction. Conclusion: Lowering the cut‐off value for plateletpheresis from 12.5 g/dL to 11.5 g/dL has no deleterious effect on donor safety as the blood loss is minimal. One‐fifth deferrals can be reconsidered if the criteria of plateletpheresis donor selection are relaxed for hemoglobin and platelet count. J. Clin. Apheresis, 2008. © 2008 Wiley‐Liss, Inc.     

Analysis and clinical significance of peripheral blood routine changes of platelet donors with ultra-high frequency donation

BackgroundIncreasing platelet donation frequency has become an important way to meet the growing clinical platelet need. Accordingly, the problem of whether the increase in platelet donation times will have an adverse effect on the health of donors has attracted more and more attention, and become an important factor affecting the donor enthusiasm and the safety of blood collection and supply.MethodsEleven ultra-high frequency platelet donors who donated more than or equal to 20 times in 2021 were selected, and the main peripheral blood routine indicators of hemoglobin, platelet and hematocrit were analyzed.ResultsThe above indicators of all donors fluctuated with the increase of donation times. Among them, older donors (≥50 years old) exhibited a significant downward trend in the above three indicators, and one young donor showed a downward trend in hemoglobin and hematocrit indicators. While the other donors showed the relatively stable performance of the above indicators.ConclusionThe effect of ultra-high frequency platelet donation on the main peripheral blood indexes of donors shows obvious age compliance, that is, the potential harm to ultra-high frequency donors older than 50 years is significantly greater than that of donors of other ages. Older platelet donors should be cautious about ultra-high frequency donations to avoid adverse health hazards. Meanwhile, the work will provide technical reference for the more scientific and efficient development of the platelet harvesting work and the establishment of the clinical blood supply system for related patients.     

Stability of blood cell counts, hematologic parameters and reticulocytes indexes on the Advia A120 hematologic analyzer

Delayed sample analysis is not a rare circumstance in clinical and laboratory practice, especially when blood samples are shipped to distant centralized laboratories, when the analysis can not be readily performed, or when retesting is appropriate. In this study we sought to evaluate the stability of conventional and new hematologic parameters in blood specimens stored for as long as 24 hours at 4 degrees C. Of the 21 hematologic parameters tested with the use of the Advia 120 hematologic analyzer (Bayer Diagnostics), means for paired samples of specimens differed significantly over the 24-hour storage period for hematocrit, main corpuscular volume, percentage of macrocytes, platelet count, main platelet volume, reticulocyte count and percentage, and reticulocyte hemoglobin content (all P < .01). We noted no significant changes in the other parameters tested or in the white blood cell differential. The overall distribution of the immature reticulocytes fractions remained substantially unchanged, though the high staining-intensity fraction showed a considerable shift from the baseline measure. Bland-Altman plots and limits-of-agreement analysis showed mean biases between -4.8% and 37.2% and relative coefficients of variations ranging from 0.4% to 32.7%. The 95% agreement interval in the set of differences was satisfactory and almost within the current analytic-quality specifications for desirable bias. The results of this investigation suggest that, within certain limitations for parameters derived or calculated from cellular volumes, blood specimens stored for as long as 24 hours at 4 degrees C may be suitable for hematologic testing.     

Evaluation of the automated haematology analyser Sysmex NE-8000

The automated haematology analyser Sysmex NE-8000 was compared with the Technicon H-1, the automated analyser routinely used in our laboratory, and with manual cell differentiation results. One hundred and seventy samples from the daily routine workload, comprising specimens from healthy adults and patients with various ailments, were analysed on the Sysmex NE-8000 and the Technicon H-1. A manual-400 leukocyte differential count was performed on each specimen. Comparison of the results from the two blood cell counters showed good correlation (r greater than 0.9) for the white blood cell count, haemoglobin, haematocrit and platelet count. For the red blood cell count and mean cellular volume, the correlation coefficients were greater than 0.8. In the leukocyte differential count, Sysmex NE-8000 and Technicon H-1 showed good correlations for the neutrophil (r = 0.953), lymphocyte (r = 0.763), and eosinophil counts (r = 0.904). Correlation coefficients were very low for monocyte (r = 0.130) and basophil counts (r = 0.006). Correlation between the manual-400 method and the electronic leukocyte differential count showed similar results. Two hundred and twenty six normal and abnormal samples were compared with respect to morphology flagging with the two analysers, using the manual differentiation as the reference method. The abnormal specimens were representative of the range of leukocyte abnormalities seen in our laboratory. Sensitivity for detecting blasts was equal for both analysers. Sysmex NE-8000 was much more sensitive for detecting immature granulocytes than Technicon H-1. Low ranges of atypical lymphocytes were missed by Sysmex NE-8000. Left shift was also frequently missed.(ABSTRACT TRUNCATED AT 250 WORDS)     

不同的血压控制在早期失血性休克限制性液体复苏中的治疗效果

目的 探讨限制性液体复苏时维持不同的血压水平对创伤失血性休克早期的治疗效果.方法 回顾性分析维持两种不同的血压水平对患者的死亡率、存活患者并发症发生率、血乳酸、凝血酶原时间、血红蛋白、血小板计数及血细胞比容等指标在早期失血性休克限制性液体复苏中的影响.结果 p40组死亡率15.69%,存活患者并发症发生率16.28%;p60组死亡率28.57%,存活患者并发症发生率35.00%.两组死亡率及存活患者并发症发生率比较差异均有统计学意义(P<0.05).两组血乳酸、凝血酶原时间、血红蛋白、血小板计数、血细胞比容及血红蛋白比较差异均有统计学意义(P<0.05).结论 早期失血性休克患者限制性液体复苏过程中平均动脉压(MAP)维持在40～60 mm Hg之间,可以降低患者死亡率,提高存活率,降低存活患者并发症的发生率,改善预后.     

82例儿童噬血细胞综合征检验指标分析及成分输血治疗

目的探讨噬血细胞综合征患儿检验指标变化及成分输血在该病支持治疗中的作用。方法将符合噬血细胞综合征诊断条件的患儿分为输血组和未输血组,统计分析患儿病原体检测结果,分别比较其白细胞计数、血红蛋白、血小板计数、丙氨酸氨基转移酶、单纯天冬氨酸转移酶、乳酸脱氢酶、甘油三酯、纤维蛋白原、部分凝血活酶时间及C-反应蛋白等结果,统计输血组不同ABO血型患儿输注成分血的品种和数量。结果在78.05%(64/82)的患儿体内检出病原体,其中巨细胞病毒感染占大多数(73.44%,47/64)。2组患儿的多项检验指标均有异常,输血组患儿的血红蛋白水平、血小板计数、纤维蛋白原含量、部分凝血活酶时间等检验指标较未输血组的差异有统计学意义(P<0.05)。其他检验指标的差异无统计学意义(P>0.05)。输血组患儿输注最多的血液成分是新鲜冰冻血浆(人均700ml),其次是悬浮红细胞(人均4.44U)。结论巨细胞病毒感染是导致噬血细胞综合征患儿发病的主要诱因,该病患儿为多脏器受累,多种检验指标严重异常。成分输血,尤其是新鲜冰冻血浆的输注在重症噬血细胞综合征患儿支持治疗中发挥了重要作用。     

Use of a mildly restrictive administrative protocol to reduce orders for manual blood film examination from the emergency department

In order to conserve laboratory resources, we instituted a mildly restrictive administrative protocol requiring a telephone request by emergency physicians or their designees in order to obtain a manual blood film examination (BFE). This test includes a manual differential leukocyte count (DLC), examination of red cell morphology, and platelet estimate. The protocol resulted in a marked reduction of the number of BFE's performed on emergency department patients from the previous level of one for every complete blood count (CBC). Retrospective chart review of a sample of patients not receiving manual BFEs indicated no apparent adverse effect on patient care. We speculate that the availability of an electronic partial differential count, providing enumeration of lymphocytes and neutrophils along with the CBC, facilitated in part the reduced ordering of manual BFEs.     

维持性血液透析患者血常规、钙、磷、甲状旁腺激素检测指标的调查分析

目的调查分析维持性血液透析患者的血常规、血清钙、磷及甲状旁腺激素检测指标,为临床治疗提供依据。方法抽取患者透析前空腹静脉血,检测血常规、钙、磷和甲状旁腺激素。采用血细胞分析仪检测血常规各项指标;采用血生化自动分析仪检测血清钙和磷;采用化学发光仪检测甲状旁腺激素。结果 100例男性患者中,血红蛋白(Hb)<135g/L者84例,占84.00%。76例女性患者中,Hb<120g/L者68例,占89.47%。患者血清校正钙浓度平均为(2.26±0.29)mmol/L,达标142例,占80.68%。血清磷平均浓度为(1.69±0.48)mmol/L,达标30例,占17.05%。钙、磷代谢乘积平均为(3.88±1.36)mmol/L,达标37例,占21.02%。结论维持性血液透析患者普遍存在轻度贫血,粒系和血小板基本正常。患者血清钙磷检测结果表现为低钙高磷。贫血和血清钙呈负相关性,与血清磷及钙、磷乘积无相关性。血清钙、磷乘积和甲状旁腺激素具有一定的相关性,甲状旁腺激素异常者的钙磷乘积异常率明显高于甲状旁腺激素正常人群。     

Donor platelet and leukocyte count as predictive factors of the quality of platelet concentrates obtained from whole blood by semiautomated fractionation

Platelet concentrates (PCs) obtained from whole blood are produced by fractionation of the buffy coat (BC) or the platelet-rich plasma. Despite the improvements in the technologies used for the hemocomponent fractionation, the proportion of PCs that do not accomplish the quality requirements is high. This study aimed to determine whether the basal platelet and leukocyte counts are predictive factors of the quality of the PCs obtained from BC by semiautomated fractionation. Quality control registers of 196 PCs were analyzed. Gender- and age-dependence of the blood cell count and the characteristics of PCs were evaluated. Platelet yield and residual leukocytes in the PCs were correlated with the platelet and leukocyte counts and the age of the donors. Predictive efficacy was assessed, and an optimal cut-off was established. The proportions of PCs accepted and rejected by using or not the optimal cut-off were compared. 50.0% of the PCs accomplished all the quality control requirements. Female donors had a higher basal platelet count than males. A correlation was observed between basal platelets and platelet yield, but not between basal leukocytes and residual leukocytes. The basal platelet count predicted the quality of the PCs. A cut-off of 231,000 platelets/mm³ was established, but it did not improve the proportion of accepted PCs. In conclusion, we found that the basal platelet count is correlated with the platelet yield. The basal leukocyte count is not correlated with the residual leukocytes. The established cut-off for the basal platelet count did not improve the proportion of accepted PCs.     

捐献机采血小板者血液初筛不合格原因分析及对策

目的分析捐献机采血小板者血液初筛不合格原因,以提出针对性的对策,提高再次献血率。方法统计2006—2008年捐献机采血小板者共26862例次血液初筛检测情况,将血液初筛检测不合格者按照转氨酶、血小板计数、红细胞计数、白细胞计数、红细胞压积和血红蛋白含量6项指标进行统计,并对初筛不合格原因进行分析。结果2006—2008年,捐献血小板者血液初筛不合格率分别为9.56%、9.41%、8.87%。不合格原因以转氨酶异常居首,分别为4.47%、3.73%、3.91%,主要集中在40～100U范围内;其次是血小板计数不合格,分别为2.02%、2.11%、1.73%,主要集中在〈150&#215;109/L范围;男性以转氨酶不合格为主,占男性初筛检测总例次的5.03%,而女性以血细胞压积不合格为主,占女性初筛检测总例次的3.32%。结论转氨酶和血小板计数不合格是捐献机采血小板者血液初筛不合格的主要原因,而红细胞压积不合格是导致女性捐献者暂缓捐血的主要原因,提示对捐献者进行有针对性的干预具有重要意义。     

Understanding the complete blood count with differential.

The complete blood count (CBC) with differential is one of the most common laboratory tests performed today. It gives information about the production of all blood cells and identifies the patient's oxygen-carrying capacity through the evaluation of red blood cell (RBC) indices, hemoglobin, and hematocrit. It also provides information about the immune system through the evaluation of the white blood cell (WBC) count with differential. These tests are helpful in diagnosing anemia, certain cancers, infection, acute hemorrhagic states, allergies, and immunodeficiencies as well as monitoring for side effects of certain drugs that cause blood dyscrasias. Nurses in the perianesthesia arena are frequently challenged to obtain and evaluate all or parts of the CBC as a part of the patient's preoperative, intraoperative, and postoperative assessments. An enhanced understanding of this laboratory test is essential to providing quality care.     

Total and partial blood exchange in the rat with hemoglobin prepared by crystallization

Hemoglobin, prepared by crystallization, has been used as a blood substitute in total (91 to 93%) and partial (70 to 76%) blood replacement studies. Exchange transfusions have been carried out in laboratory animals to a total blood replacement of 91 to 93 per cent with hemoglobin or with albumin solutions. When albumin was used, all animals died at approximately ten minutes after transfusion was completed, whereas all animals transfused with hemoglobin survived for five hours and displayed normal activity during this time. In these studies the plasma half-disappearance time of hemoglobin was 3.5 hours and body distribution of 51Cr-labeled hemoglobin, as a percentage of initial levels, has shown six per cent in the kidney, six per cent in the liver, 10.5 per cent in the marrow and 13 to 14 per cent in the urine at three hours after transfusion. Survival was obtained with all animals transfused with hemoglobin or albumin solutions to a partial blood replacement of 70 to 76 per cent. However, the oxygen capacity of the circulating fluid in the hemoglobin transfused animals was about three times greater than that found in the corresponding albumin-transfused controls. Values of hemoglobin, hematocrit, platelets, and P50 returned to normal pretransfusion levels within five to seven days.     

Correlation between coagulopathy and outcome in severe head trauma in neurointensive care and trauma units

Background

Abnormal blood coagulation after traumatic brain injury is a common finding. Some studies have proposed these changes as useful predictors of outcome in patients with head trauma. This study aimed at evaluating the association of the routine tests of blood coagulation within the first hours after severe head trauma with prognosis of patients with severe head trauma.

Materials and Methods

A total of 52 patients with severe head trauma (Glasgow Coma Scale [GCS], ≤8) were admitted at Tabriz University Hospital for 1 year. Patients with major accompanying trauma were excluded. On admission, serum levels of hemoglobin and hematocrit as well as the platelet count, prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR) were documented. The relation between these parameters with final outcome and also with GCS at admission, 24 hours, 48 hours, and 1 week after admission and discharge time and Glasgow Outcome Scale (GOS) were studied.

Results

Thirty three patients were discharged, and 19 died. There were significant negative correlations between PT, PTT, and INR with all GCS and GOS scores. These correlations were significant and positive between the platelet count and all GCS and GOS scores. Median PT, PTT, and INR were significantly higher in nonsurvivors. Median serum platelets count was significantly lower in nonsurvivors.

Conclusion

On-admission PT, PTT, INR and platelet count may be used as predictors of outcome and prognosis of patients with severe head trauma.     

Sysmex系列4台不同型号全自动血液分析仪结果比对分析

目的：通过Sysmex系列4台不同型号全自动血液分析仪对同一全血标本进行检测,了解每台仪器检测结果的准确性和一致性。方法：选用参加室间质评而且成绩优秀的仪器XT-2000i为参比仪器,其他仪器为比对仪器,其结果以美国临床实验室修正法案（CLIA’88）规定的室间质量评价允许误差的1/2为标准进行比较分析,即白细胞计数（WBC）＆#177;7.50%、红细胞计数（RBC）＆#177;3.00%、血红蛋白测定（HGB）＆#177;3.50%、红细胞比容（HCT）＆#177;3.00%、血小板计数（PLT）＆#177;12.50%。结果：通过校准与比对,各台仪器准确性和一致性良好。结论：定期对我科4台全自动血液分析仪进行比对和校准,保证检测结果的准确性和一致性。     

桃红四物汤联合低分子肝素预防腰椎术后深静脉血栓的临床研究

目的:评价桃红四物汤预防腰椎手术术后深静脉血栓形成的临床疗效。方法:收集从2016年1月1日起入院准备行腰椎手术的病例,术前常规查双下肢深静脉B超,白介素-8、血小板计数、血D-二聚体、活化部分凝血活酶时间(APTT)及血浆凝血酶原时间(PT)等,随机分为两组,两组术后常规第二天予抗凝治疗,治疗组在抗凝的基础上加用桃红四物汤,对照组常规抗凝治疗。两周后复查双下肢深静脉B超、血红蛋白、白介素-8、血小板计数、血D-二聚体、活化部分凝血活酶时间(APTT)及血浆凝血酶原时间(PT)。对比两组术后深静脉血栓发生率;观察治疗后血红蛋白、白介素-8、血小板计数、血D-二聚体、活化部分凝血活酶时间(APTT)及血浆凝血酶原时间(PT)的变化情况。结果:治疗组术后深静脉血栓发生率低于对照组(P<0.05);治疗组术后血红蛋白计数、APTT及PT水平高于对照组;术后白介素-8、血小板计数、血D-二聚体水平低于对照组(P<0.05)。结论:桃红四物汤联合常规抗凝治疗可以有效的降低腰椎术后深静脉血栓形成的风险,并且改善术后患者的应激状态,减少失血及炎性反应。