高原反应诱发贫血患者红细胞破碎致血小板计数假性增多病例分析

A case study on false increase of platelet count caused by erythrocyte breakage in patients with anemia induced by high altitude reaction

广州市中医医院发现高原反应诱发贫血患者红细胞破碎致使血小板计数(PLT)假性增多1例。该患者因"头晕、疲倦乏力,反复心悸,手抖不适,畏热30余年加重1周"收入本院,既往有地中海贫血、蚕豆病及甲状腺功能亢进病史,曾在高原地区活动10余天。使用System XN-1000全自动血液分析仪检测患者血常规〔包括红细胞计数(RBC)、血红蛋白(Hb)、血细胞比容(HCT)、平均红细胞体积(MCV)、平均红细胞血红蛋白量(MCH)、平均红细胞血红蛋白浓度(MCHC)、血小板计数(PLT)〕。结合System XN-1000测得的科研参数〔小红细胞百分比(MicroR%)、大红细胞百分比(MacroR%)〕以及PLT-O通道和PLT-I通道,分析发现患者存在红细胞碎片情况下上述指标变化的情况。MCV与MicroR%成反比,MCV越小MicroR%越高;MCV与MacroR%成正比,随MCV增大MacroR%也升高。因此,同时使用PLT-I和PLT-O通道能减少小红细胞碎片对PLT的干扰,准确检测PLT,联合MCV、MacroR%和MicroR%可观察红细胞形态变化,快速判断标本是否存在小红细胞或红细胞碎片,增加结果的可靠性。

Guangzhou Hospital of Traditional Chinese Medicine found one case of erythrocyte breakage induced by high altitude reaction resulted in a false increase of platelet count(PLT).A female patient was admitted to the hospital because of"dizziness,fatigue and fatigue,repeated palpitations,hand tremors and discomfort,and fear of heat for more than 30 years and aggravating for 1 week".She had a history of thalassemia,favism and hyperthyroidism and had been active in the plateau area for more than 10 days.The routine blood test of the patient was detected using the System XN-1000 Full-automatic Blood Analyzer,including red blood cell count(RBC),hemoglobin(Hb),hematocrit(HCT),mean corpuscular volume(MCV),mean corpuscular hemoglobin(MCH),mean corpuscular hemoglobin concentration(MCHC),and platelet count(PLT).In combination with the scientific research parameters[percentage of small red blood cells(MicroR%)and percentage of large red blood cells(MacroR%)]measured by System XN-1000 and the PLT-I channel and PLT-O channel,the changes of above-mentioned indexes in the presence of red blood cell debris were observed.The MCV was inversely proportional to the MicroR%,the smaller the MCV,the higher the MicroR%,and the MCV was proportional to MacroR%,the MacroR%increased with the increase of MCV.Therefore,the simultaneous use of PLT-I and PLT-O channels can reduce the interference of small red blood cell fragments to PLT,so as to detect PLT accurately.Combined with MCV,MacroR%and MicroR%,the morphological changes of red blood cells can be observed,and the existence of small red blood cells or red blood cell fragments can be quickly judged,which can increase the reliability of the results.