硫酸阿米卡星对EDTA依赖性假性血小板减少症血小板聚集的解离作用

Dissociative effect of amikacin sulfate on platelet aggregation in EDTA-dependent pseudothrombocytopenia

目的:探讨硫酸阿米卡星对乙二胺四乙酸(EDTA)依赖性假性血小板减少症(EDTA-PTCP)患者血标本中血小板聚集的解离作用,为这类标本血小板的准确计数提供有效方法。方法:在1例少见的EDTA-PTCP患者EDTA-K2抗凝管中预先加入或不加硫酸阿米卡星后采集静脉血,分别于采血后不同时间用全自动血细胞分析仪检测血小板数和其他血细胞参数;留取EDTA-K2抗凝血后不同时间加入阿米卡星,观察其对血小板聚集的解离作用,并检查血涂片中血小板形态改变。结果:未加阿米卡星的EDTA-PTCP标本,随采血后标本放置时间(0.5～4.0h)的延长,血小板数从117×109L-1逐渐降至41×109L-1。在EDTA-K2抗凝管中预先加入阿米卡星的血标本,血小板计数在正常参考值范围内,且标本室温放置4.0h内血小板计数值相对稳定。采集的血标本放置30min以内加入阿米卡星,血小板计数(186×109L-1～191×109L-1)在正常参考值范围内,血涂片镜检可见聚集的血小板明显解离,而超过30min后加入硫酸阿米卡星,随标本放置时间(40min～4h)的延长,血小板计数从放置40min时的168×109L-1逐渐降至放置4h时的42×109L-1,镜检血涂片中血小板逐渐明显聚集。结论:留取血标本前或留取标本后30min内加入一定量硫酸阿米卡星,全自动血细胞分析仪检测EDTA-PTCP患者血小板计数是准确的,且其他血细胞参数的测定未受影响。

Objective To investigate the dissociative effect of amikacin sulfate on platelet aggregation in patients with EDTA-dependent pseudothrombocytopenia （EDTA-PTCP）, and develop an effective method for accurate platelet counting in this kind of samples. Methods Amikacin sulfate was added or not to the EDTA-K2 anticoagulated tube before collecting venous blood in an infrequent patient with EDTA-PTCP, and the platelet counts and other blood cell parameters at different time after blood withdrawal were examined by automatic eytoanalyzer. Amikacin was added at different time after collecting EDTA-K2 anticoagulated blood samples, and dissociative effect of amikaein on the platelet aggregation and the platelet morphological changes on the blood smear were observed. Results The platelet counts of EDTA-PTCP blood sample without amikacin were gradually reduced from 117×10^9 L^-1 to 41 ×10^9 L^-1 with extending time （0.5-4.0 h） after blood withdrawal. In the blood sample pre-supplemented with amikaein, the platelet counts were within range of the normal reference values, and the platelet eounts were relatively stable within 4 h at room temperature after blood drawn. When amikacin was added within 30 min after blood sampling, the platelet counts （186 × 10^9 L^-1 - 191 × 10^9 L^-1 ） were within the range ol the normal reference values, the obvious platelet dissociation on the blood smear were found. When amikacin was added over 30 min after blood drawn, the platelet counts were gradually reduced from 168 × 10^9 L^-1 at 40 min after standing to 42 × 10^9 L^-1 at 4 h after standing, and smear examination revealed significantly the platelet aggregation. Conclusion Amikacin sulfate is added either before blood withdrawal or within 30 min after blood sampling, the platelet counts of the patient with EDTA-PTCP examined by automatic cytoanalyzer are accurate and the determination of other blood cell parameters is not influenced.