Beckman Coulter LH750血液分析仪复检规则的制定和评价

目的制定和评价本院Beckman Coulter LH750血液分析仪复检规则。方法上海瑞金医院门诊与病房标本共1000份乙二胺四乙酸二钾（EDTA-K2）抗凝的全血标本对复检规则草案进行评估，另选取2007年8月至2007年9月经血常规审核软件DM2审核的门诊、病房20695份标本结果对复检规则进行评价。结果通过检测1000份标本，其2．2％的假阴性低于国际血液学复检专家组制定5％的最大允许范围。其假阴性主要集中于有核红细胞、红细胞形态和血小板形态3个项目。经对20695份标本结果进行分析，本室复检规则自动确认占总标本的66．4％，需复检占33．6％，仪器报警分布以中晚幼粒细胞（IMM．NE2）报警为多，占44．4％，血小板聚集（PLT Clumps）其次，占16．9％，细胞计数超出审核范围共5943项，以血小板计数为多（28．4％），其中首次结果超出审核范围的以白细胞（29．9％）、血小板（31．6％）居多，与历次前后差异结果相比较（8-check）未通过审核的共1148例，以血小板计数居多。结论目前，复检规则的制定和执行越来越受到重视，可以提高血常规检验质量，减少差错，我院采用白细胞分类百分比作为衡量指标，相对“41条复检规则”中的白细胞分类规则，我院的分类采用的百分比作为衡量指标要求更为严格，减少了其假阴性的发生率。加大血小板复查量，可有效地发现假性血小板聚集，提高了我院的报告质量。关于历史结果我院因门诊患者一般1至2周复诊，故将历史结果比较定在2周。允许范围初步订在20％，但仍需对此进行进一步的探讨。

Evalution of the review criteria of Beckman Coulter LH750 automated hematology analyzer

Objective To formulate and evaluate the hematology review criteria of Beckman Coulter LH750 automated hematology analyzer. Methods The total 1 000 blood samples collected from our hospital with EDTA-K2 anticoagulation were under determination in order to assess the protocol of the hematology review criteria. While the review criteria was evaluated by checking the 20 695 specimen data with DM2 verification in a period of one month. Results According to the international consensus review rules proposed by international hematology expert group, the false negative mostly created by identification of nucleated red blood cell and the morphology of red blood cell and platelet was 2.2% , which was lower than the maximum reference value （5%）. When 20 695 specimen data with DM2 verification were considered as a whole, the ratio of automated passing was 66.4%. However, the other samples needed to review, among which, the ratio of myelocyte and metamyelocyte was 44.4%, while platelet clumps was 16.9%. Totally 5 943 specimens exceeded the verification range in blood cell count, and the problem in platelet count was 28.4% , even more, the count of leucocyte （29.9%）and platelet（31.6% ） was the major cause for the first time. With the comparison of the history record （8-cheek）, 1 148 specimens were failed in verifying, for which, platelet count was the most problem. Conclusions Comparing to International Consensus Review Rules, our measurement for leukocyte differential analysis demands much more. Accordingly, the false negative ratio was decreased . By using of review criteria, the quality of hematology results as well as our work efficiency could be better enhanced. The criteria should be improved in laboratory practice.