LH780与XN-1000血液分析仪的网织红细胞参数结果比较

目的：分析Beckman‐Coulter LH780与Sysmex XN‐1000两台血液分析仪的网织红细胞（Ret）等参数的可比性和相关性。方法用上述两台仪器分别检测80份血常规标本,比较红细胞（RBC ）计数、Ret百分率（Ret％）、Ret绝对值（Ret＃）和未成熟网织红细胞指数（IRF）,并对Ret％、Ret＃和IRF进行相关性分析。将LH780的高散射光网织红细胞百分比（HLR％）和XN‐1000的中荧光强度网织红细胞百分比（MFR％）＋高荧光强度网织红细胞百分比（HFR％）做比较,观察采用两种仪器的计算方法时其相关程度并探讨 HLR％的应用价值。结果两仪器所测 RBC计数、Ret％和 Ret＃比较差异均无统计学意义（ P＞0．05）,而IRF比较差异有统计学意义（P＜0．05）。两仪器RBC计数的相对偏差符合率为97．5％,Ret％、Ret＃、IRF的相关系数r分别为0．912、0．895和0．666。采用XN‐1000和LH780计算方法时,HLR％和 MFR％＋ HFR％比较差异均有统计学意义（P＜0．05）,且均有相关性（r分别为0．666、0．767）。结论两仪器的 RBC计数符合比对要求,Ret％、Ret＃均呈高度相关,而IRF须建立各仪器的参考范围。     

不同检测系统中血小板相关参数参考区间的调查

目的调查血小板相关参数包括血小板平均体积(MPV)、血小板分布宽度(PDW)、血小板压积(PCT)的参考区间。方法使用Sysmex XN-9000流水线、PENTRA 120血细胞分析仪对绵阳市中心医院3 415例16~90岁体检人员的静脉血进行血细胞分析,经筛选对2 718例符合标准的健康人群的血小板相关参数结果进行统计分析。结果 XN流水线血小板相关参数95%参考区间(2.5%~97.5%):MPV 9.9~14.7fL,PDW 11.2%~24.3%,PCT 0.15%~0.30%;PENTRA 120血小板相关参数95%参考区间:MPV 8.4~12.7fL,PDW 13.8%~24.8%,PCT 0.12%~0.26%;仪器间比较:MPV、PDW、PCT结果比较差异有统计学意义(P0.05);XN流水线检测的男女间PCT结果比较差异有统计学意义(P0.05),PENTRA 120检测的MPV、PDW、PCT结果比较差异有统计学意义(P0.05);XN流水线男女性各年龄段间的PCT结果比较差异有统计学意义(P0.05),PENTRA 120的MPV、PDW、PCT结果男性各年龄段间比较差异有统计学意义(P0.05)、女性各年龄段间的PCT结果比较差异有统计学意义(P0.05)。结论各实验室应依据仪器不同建立与该实验室配套的血小板相关参数生物参考区间;实际应用中,可针对性别或年龄不同设置参考区间。     

同一品牌不同类型血细胞分析仪的校准及比对分析

目的对该科室的迈瑞全自动血细胞分析仪进行校准及比对分析,确保实验结果的溯源性及一致性。方法使用具有溯源性的迈瑞公司配套校准品对该科室的迈瑞BC5800全自动血细胞分析仪进行校准,校准后进行校准验证,校准验证通过后对新鲜血标本进行定值,以定值新鲜血标本对迈瑞BC5300及BC5180全自动血细胞分析仪进行校准,然后进行校准验证。校准验证通过后,以BC5800为基准仪器,BC5300及BC5180为比对仪器进行新鲜血比对试验。结果迈瑞BC5800、BC5300、BC5180全自动血细胞分析仪校准后均通过校准验证,新鲜血比对试验中BC5800与BC5300,BC5800与BC5180的白细胞(WBC)、红细胞(RBC)、血红蛋白(HB)、平均红细胞体积(MCV)、血小板(PLT)、血细胞比容(HCT)、平均红细胞血红蛋白含量(MCH)、平均红细胞血红蛋白浓度(MCHC)相对偏差符合率均超过80%,比对试验通过。结论血细胞分析仪校准后必须进行校准验证和比对试验并通过比对,确保实验结果的溯源性和检验结果间具有可比性,以满足临床的需要。     

Neurosurgery in a patient with severe hemophilia B: an experience using eftrenonacog alfa as perioperative management

Extended half‐life FIX (EHL‐FIX) concentrates have been developed with the purpose of reducing the frequency of infusions in patients with severe or moderate hemophilia B. We describe the case of a 63‐year‐old patient with severe hemophilia B (sHB) treated with FIX‐Fc fusion protein (rFIXFc) who underwent neurosurgery.     

Relapse of childhood acute lymphoblastic leukemia and outcomes at a reference center in Latin America: organomegaly at diagnosis is a significant clinical predictor

Objective: Relapse is the major cause of treatment failure in acute lymphoblastic leukemia (ALL) of childhood; it is more frequent among high-risk patients from low-middle income than from high-income countries. The frequency, sites and outcome of relapsed ALL in children of northeast Mexico over a decade was documented.

Methods: A retrospective analysis of 246 children belonging to a low-income group <16?years with de novo ALL during 2004–2015 was performed. Five-year overall survival (OS) and event-free survival was estimated by Kaplan–Meier analysis. Data on time, site, response to therapy and final outcome of relapse were analyzed. Hazard ratios (HRs) of relapse and death were estimated by the Cox regression model. Very early relapse was defined as that occurring in <18?months, early relapse between 18 and 36?months, and late relapse >36?months from diagnosis, respectively.

Results: Eighty-seven (35.4%) children relapsed. Five-year OS was 82.6% in children without relapse vs. 42% for relapsed patients. Bone marrow (BM) was the most frequent site of relapse (51.72%). Isolated central nervous system (CNS) relapses occurred in 29.9%. Five-year OS was 11.2% for BM and 15.5% for early relapse. HR of relapse for organomegaly was 3.683, 2.247 for an initial white blood cell count >50?000?×?10⁹/l and 1.169 for positive minimal residual disease status.

Conclusion: A high rate of very early, CNS, and BM relapse with a considerably low 5-year OS requiring reassessment of therapy was documented. Organomegaly at diagnosis was a highly significant clinical predictor for relapse.     

血细胞分析仪血涂片复检标准的制定及评价

目的制定血细胞分析仪血涂片复检标准,保证血细胞分析仪结果准确性,以利临床诊断和治疗。方法根据医院及HYCELCELLY血细胞分析仪特点制定血涂片复检的标准,通过对1269例标本结果的数据分析,评价标准的可行性和可靠性。结果所制定的标准经临床验证有重要临床价值和意义。仪器检测的标本中有29.4%的血细胞分析(CBC)标本需要复检,其中32.4%存在杆状细胞增多、异形淋巴细胞增多或其他类型的异常。结论制定血细胞血涂片复检标准非常重要,可以加强血细胞检查准确性,为临床提供更有价值的信息,以免造成漏诊和误诊。     

中国北方汉族男性铁调素基因rs7251432多态性与HiHiLo训练前后血象指标变化的关联性研究

目的:探讨铁调素(HEPC)基因rs7251432多态性与HiHiLo训练前后血象指标变化的关联性。方法:65名中国北方汉族男性健康受试者在模拟海拔约为2500m～2800m高度(氧浓度14.8%～14.3%)进行30天HiHiLo训练(低氧暴露10h/d,低氧训练3次/周)。分别测定训练前,训练第4、7、16、23和30天的RBC、Hct和Hb。采用RCP-RFLP方法解析基因多态性,探讨HEPC基因rs7251432多态性与30天HiHiLo训练前后血象指标变化率的关联性。结果:3种基因型的分布频率分别为AA(0.11)、AG(0.29)和GG(0.60),符合Hardy-Weinberg遗传平衡定律,具有群体代表性。基因多态性与各项指标初始值不关联,且所有指标未见基因型与HiHiLo效果的交互作用。在HiHiLo过程中,RBC、Hct和Hb均出现不同程度变化趋势,AA基因型受试者RBC、Hct和Hb提高幅度明显高于AG和GG基因型(P<0.05)。结论:rs7251432多态性与HiHiLo训练前后血象指标的变化关联,AA基因型可以作为预测血象指标HiHiLo低氧训练效果的分子遗传学标记。     

Early blood transfusions protect against microalbuminuria in children with sickle cell disease

BACKGROUND: Microalbuminuria (MA) is an early indicator for glomerulopathy in sickle cell disease (SCD). PROCEDURE: We reviewed the medical records of asymptomatic patients ages 4-20 with sickle hemoglobinopathies, who were screened for MA in order to find out its prevalence and risk factors. RESULTS: Nineteen of 120 (15.8%) screened patients had MA detected by spot urine (mean albumin absolute value 6.95 +/- 0.56 mg/dl) and abnormal albumin to creatinine ratios (79.8 +/- 0.62 mg/g creatinine). Twenty four-hour urine collections confirmed 57% of MA cases by spot urine. There was no difference in hyperfiltration between positive and negative patients. From the MA-positive patients, 15 had SS (16.8% of SS group) and 4 had SC (18% of SC group). Nineteen percent of children 10 years of age or older had MA, as compared to 8% of the younger children (P = 0.018), demonstrating that increasing age is a risk factor for MA. There was a positive correlation between MA and acute chest syndrome. Young age at start of chronic transfusions was inversely related to MA and therefore renoprotective (P = 0.03). We did not see a protective effect in the group of patients taking hydroxyurea for a relatively short time, mean age at start of treatment 12 +/- 5 years; however the sample was small. CONCLUSIONS: We conclude that: (1) children with sickle cell hemoglobinopathies 10 years or older should be screened for MA and (2) chronic transfusions starting at an early age may be renoprotective.     

Sysmex XE-2100全自动血液分析仪分析有核红细胞的临床应用评价

目的探讨 Sysmex XE-2100全自动血液分析仪有核红细胞计数的准确性并作评价.方法准确性测定分别用仪器法和显微镜目测法计数 38例抗凝静脉血的有核红细胞数( NRBC%),并将两者的结果进行比较.精密度测定选择 3份有核红细胞数值不同的抗凝静脉血分别用仪器法和目测法测定,每份标本重复计数 10次,各自计算出 CV值进行比较.结果 38份抗凝静脉血仪器法计数的有核红细胞结果与显微镜目测法计数结果之间无显著性差异,经 t检验, P >0.05,相关系数 r为 0.9893, P< 0.01.仪器法和显微镜目测法对 3份有核红细胞数值不同的标本重复计数的平均 CV值分别为 7.9%和 15.1%,显示出仪器法的精密度明显高于目测法.结论 Sysmex XE-2100全自动血液分析仪计数有核红细胞是一种较准确、快速、精密的方法,可满足临床诊断、治疗及疗效观察的需要.