自动血细胞分析仪全血细胞计数和白细胞分类复检规则的制定及评价

Evaluation on Review Criteria for Complete Blood Count and WBC Differential Analysis by Hematology Analyzer

目的 通过参考国际血液学复检专家组推荐的血细胞复检规则,结合实验数据制定适合四川省人民医院实验室使用的血细胞计数和白细胞分类复检规则.方法 采用日本希森美康公司生产的XE-2100全自动血细胞分析仪共检测1145份标本,同时每份标本制备2张血涂片进行手工白细胞分类,观察红细胞、白细胞及血小板形态.按照制定的分类复检初步规则和涂片镜检阳性标准进行评估,计算真阳性、假阳性、真阴性、假阴性及涂片复检率,结合该实验室的实际情况,对初步复检规则进行部分修改,制定出适合该实验室的全血细胞计数和白细胞分类复检规则.结果 通过分类复检初步规则和涂片镜检阳性标准进行评估,真阳性率为16.9%（194/1145）、假阳性率为28.8%（330/1145）、真阴性率为52.0%（595/1145）和假阴性率为2.3%（26/1145）,涂片复检率为45.8%（524/1145）.由于涂片复检率大大超过拟订的复检率,对初步复检规则的部分条款进行了修改,形成了该实验室的白细胞分类复检规则.应用新规则和涂片镜检阳性标准重新进行评估,真阳性率为13.3%（152/1145）和假阳性率为21.4%（245/1145）、真阴性率为62.3%（713/1145）、假阴性率为3.1%（35/1145）,涂片复检率为34.7%（397/1145）.验证实验结果表明有病理意义的白血病细胞无漏检.结论 通过制定适合该实验室的白细胞复检规则,提高了工作效率,保证了检验结果的质量,可以有效地避免出现病理标本的漏检及错误检验报告.

Objective To establish the review criteria for complete blood count and WBC differential analysis suitable for Sichuan Provincial People＇s Hospital of through consulting the international blood smear review criteria. Methods The 1 145 samples were detected by XE-2100 hematology analyzer,while 2 blood smears were performed with manual WBC differential and observation of three kinds cell morphology including RBC, WBC and Platelet. According to the temporary hematology review criteria suggested by clinical laboratory, the true positive ratio （TP）,the false positive ratio （FP）, the true negative ratio（TN）,the false negative ratio（FN） and the ratio of blood smear review were calculated. Based on the conditions of clinical laboratory,revised parts of the temporary hematology review criteria and set up the review criteria suitable for clinical laboratory. Results Aeording to the interantional blood smear review criteria and the temporary hema- tology review suggested by clinical laboratory,the TP,FP,TN, FN and the ratio of blood smear review were 16.9% （194/ 1 145）,28.8%（330/1 145）,52.0%（595/1 145）,2.3%（26/1 145） and 45.8%（524/1 145）,respeetively. Because the ratio of blood smear review exceeded the expectations ,revised parts of the temporary hematology review criteria and set up the review criteria suitable for clinical laboratory. On the basis of the revised blood smear review criteria,the TP,FP,TN ,FN and the ratio of blood smear review were 13.3%（152/1 145）,21.4%（245/1 145）,62.3%（713/1 145）,3.1%（35/1 145） and 34.7% （397/1 145）,respectively. The verification results showed that no blast cell and immature cell was missed. Conclusion Establishment the review criteria for complete blood count and WBC differential analysis suitable for clinical laboratory could enhance work efficiency and assure quality of examination procedures,while avoid missing of the samples of leukemia and mistake in reports.