骨髓涂片细胞形态学误诊分析及对策——2000～2005年骨髓细胞形态学室间质量评价分析

Analysis and countermeasures of misdiagnosis on cell morphology of bone marrow smear

目的分析误诊结果,提高骨髓细胞形态学室间质量评价的整体水平。方法用已确诊的骨髓涂片附临床资料及实验室其他检查结果,定期发放至参控单位进行细胞形态学室间质量评价。结果形态鉴别能力欠缺导致失误急性粒-单核细胞白血病,急性粒细胞白血病部分分化型;少、罕见病种导致失误多发性骨髓瘤伴慢性中性粒细胞白血病,红白血病(M6)的红血病期;综合分析不全面导致失误伴幼淋增高的慢性淋巴细胞白血病(CLL/PL),感染像;未及时了解学科新进展导致失误伴病态造血的急性髓细胞白血病;血液病诊断标准不完善导致失误CLL,CLL/PL,M6的红血病期及噬血细胞综合征。结论加强骨髓细胞形态学室间质量评价的广度和深度,并结合读片会等方式可以提高细胞形态的鉴别与全面综合分析能力,降低误诊率。

Objective To analyze the results of misdiagnosis to enhance the whole level of external quality assessment （EQA） for cell morphology of bone narrow smear. Methods The bone marrow smears of confirmed diagnosis with clinic information and other laboratory reports were periodically distributed to the participating EQA units to conduct EQA for cell morphology of bone marrow smear. Results Poor morphology distinguishing faculty conduced to the misdiaguosis of acute myelomonocytic leukemia（AMML） and acute granulocytic leukemia （AGL） with maturation; rare disease category conduced to the misdiaguosis of multiple myeloma（MM） with chronic neutrophilic leukemia（CNL） and erythremia period of erythroleukemia; not all-round of comprehensive analysis conduced to chronic lymphocytic leukemia with prolymphocytosis（ CLL/PL）, infectious myelogram; and the new proceeding of the subject being not timely understood conduced to the misdiasnosis of acute myeloid leukemia（AML） with displasia; the diagnostic standard of hematologic disease being not perfected conduced to the misdiaguosis of CLL, CLL/ PL, the erythremia period of AML M6 and hemophgocytic syndromes. Conclusion Strengthening the scope and depth of EQA for cell morphology of bone narrow smear and com- bining with reading-smear party may enhance distinguishing and comprehensive analyzing ability, and reduce misdiagnosis rate.