红细胞体积分布宽度在地中海贫血和缺铁性贫血中的实验研究

Experimental study of the red blood cell volume distribution width in iron deficiency anemia and thalassemia

目的:探讨在血常规检测中红细胞体积分布宽度(RDW-CV)鉴别缺铁性贫血(IDA)和地中海贫血(Thal)的简易方法。方法:用全自动血细胞分析仪检测血常规,全自动快速电泳分析系统作血红蛋白(Hb)分析(部分标本作α、β-Thal基因分析),并用化学发光免疫分析仪检测血清铁蛋白。结果:共检测2890例(名),其中正常组800名;IDA组210例;Thal组共1880例,分为6个组:轻型α-Thal组520例,轻型β-Thal组550例,血红蛋白H病(HbH)组180例,重型β-Thal组(重B组)100例,不贫血的α-Thal组(A▲组)210例,不贫血β-Thal组(B▲组)320例。在血常规的RBC、Hb、MCV、RDW-CV等各项检测中,Thal组和IDA组都与正常组差异有非常显著性(P<0.01),其中RBC、Hb及RDW-CV的比较中,IDA组与Thal组差异有非常显著性(P<0.01)。结论:以血常规分析鉴别IDA和Thal有以下3点:①IDA组RBC总数在4.50×1012/L以下,Hb为50～95g/L;Thal组RBC总数常在4.30×1012/L以上,Hb在80～110g/L范围;②RDW-CV比较中,建议修订参考范围在<0.150;轻型Thal中A▲组和B▲组,A组和B组分别在0.152、0.157、0.171和0.167;IDA组在0.187;Hb H组和重B组在0.237、0.250,Thal组的RDW-CV值并非在正常范围内;③当血常规显示明显小细胞低色素性贫血时,RDW-CV为0.18～0.23时,必须做Hb电泳分析,以鉴别Hb H病、重型β-Thal还是IDA。以血常规RDW-CV鉴别IDA与Thal,对于暂时无条件开展血清铁蛋白和基因诊断检测的情况下,对小细胞低色素性贫血鉴别诊断有积极的临床意义。

Objective To investigate the red blood cell volume distribution width （RDW-CV） in the differential diagnosis of iron deficiency anemia（IDA） from thalassemia（Thal）. Methods The routine hematological examination was performed with full automatic hemocyte analyzer,the Hb analysis was done with full automatic rapid electrophoresis analysis system （parts of the samples were used for the α- and β-Thal genetic analysis） , and the serum iron protein was examined with chemiluminescence immunity analyzer. Results Two thousand eight hundred and ninety cases were examined and they were divided into normal group of 800 cases, IDA group of 210 cases and Thai group of 1 880 cases .The Thai group were divided into 6 subgroups （520 cases in the minor type α-Thal group, 550 cases in the minor β-Thal group, 180 cases in the Hb H group, 100 cases in the fatal type 13-Thai group,210 cases with normal Hb value in the α- Thai group A^▲, and 320 cases with normal Hb value in the β-Thal group B^▲）. The RBC,Hb,MCV and RDW-CV in the routine hematological examination in the Thai and the IDA groups showed significant difference （P〈0.01） compared with those in the normal group. There was significant difference in the RBC,Hb and RDW-CV between the IDA group and the Thai group （P〈0.01）. ConehlsiOns Several points are noted as follows about the routine hematological examination in the differential diagnosis of IDA from Thai： ① When the total number of RBC in the IDA group is below 4.50×10^12/L ,the Hb value is within the range of 50 g/L to 95 g/L; when the total number of RBC in the Thai group is above 4.30×10^12/L,the Hb value is within the range of 80 g/L to 110 g/L.② It is suggested to revise the normal value below 0.150 through the comparison of RDW-CV, which is 0.151-0.185 in the minor Thai group, 0.180-0.238 in the minor Thai group, 0.180- 0.238 in the IDA group, and 0.220-0.310 in the Hb H group and the fatal type β-Thal group. The RDW-CV value in the Thai group is not within the normal range. ③ When the routine hematological examination suggests the microcytic hypochromic anemia and the RDW-CV value is above 0.18-0.23,the Hb electrophoresis analysis should be performed to differentiate the Hb H or fatal type β-Thal from IDA. When the serum iron protein examination and the gene diagnosis are not available,the routine hematological examination is of positive clinical significance for the differentiation of IDA from Thai in the differential diagnosis of the microcytic hypochromic anemia.