9 g／dl 生理盐水稀释解决EDTA 依赖性血小板假性减少的方法研究

Study on the Method of 0＆#183;9 g/dl Normal Saline Dilution to Solve EDTA Dependent Pseudothrombocytopenia

目的：探讨0.9 g／dl 生理盐水稀释仪器法解决乙二胺四乙酸二钾（EDTA-K2）抗凝剂依赖性血小板假性减少症（PTCP）的可行性，为临床实验室提供解决 PTCP 检测更为有效的方法。方法对2014年8～10月深圳市龙华新区人民医院检验科确诊为 PTCP 案例共3例，采集静脉血2 ml 二份分别于 EDTA-K2和枸椽酸钠抗凝管内混匀，于即刻，10，30，40及60 min 上机检测；同时分别采集末梢血于血细胞稀释液、0.9 g／dl 生理盐水内混匀，于即刻，10，30，40及60 min 上机检测，并与草酸铵手工法比较。结果EDTA 法、枸椽酸钠法、血细胞稀释液法及0.9 g／dl 生理盐水稀释仪器法即刻检测PTCP 血中血小板（PLT）结果与草酸铵法比较，差异均无统计学意义（t＝0.943～1.537，P ＞0.05），10～60 min 内 EDTA-K2抗凝血 PLT 结果明显降低，与草酸铵法比较差异有统计学意义（t＝12.413～49.162，P ＜0.01～0.001）；枸椽酸钠法于30 min 后 PLT 开始下降，与草酸铵法比较，结果差异有统计学意义（t＝4.915～20.164，P ＜0.05～0.01）；血细胞稀释液法于30～40 min PLT 检测结果开始出现下降，但不明显，与草酸铵法比较差异无统计学意义（t ＝1.315～1.715，P ＞0.05），40～60 min PLT 检测结果出现明显下降，与草酸铵法比较差异有统计学意义（t＝3.175～3.865，P ＜0.05）；0.9 g／dl 生理盐水法于0～60 min 内检测 PTCP 血中 PLT 结果与草酸铵法之间差异均无统计学意义（t＝0.694～1.062，P ＞0.05）。结论EDTA 法、枸椽酸钠法、血细胞稀释液法及0.9 g／dl 生理盐水稀释仪器法即刻检测 PTCP 患者 PLT 结果与草酸铵法相一致。30 min 内枸椽酸钠法和血细胞稀释液法对 PTCP 患者 PLT 检测可达到较理想的效果，但仍有少量 PLT 聚集而导致 PLT 小幅下降；0.9 g／dl 生理盐水稀释仪器法0～60 min 内与草酸铵法检测 PLT 结果之间无差异性。

Objective To investigate the effects of 0.9 g/dl NaCl diluting instrument method to solve the ethylenediamine tetraacetic acid dipotassium （EDTA）anticoagulant dependency pseudo reduce platelet syndrome （PTCP）feasibility,provides solutions to clinical laboratory PTCP more effective method.Methods From August to October of 2014 in their laboratory for PTCP cases in all 3 cases,2 ml venous blood in EDTA and citron acid sodium anticoagulation in-line blending,in the immediate,10,30,40 and 60 min computer detection.Collected of peripheral blood in blood thinners,respectively,0.9 g/dl NaCl solution blending,in the immediate,10,30,40 and 60 min computer detection,and compared with the manual method of ammonium oxalate.Results EDTA,citron acid sodium,blood thinners and 0.9 g/dl NaCl diluting instrument immediately detected PTCP blood PLT result compared with ammonium oxalate method,there were no statistically significant difference （t=0.943-1.537,P 〉0.05）,10 min-60 min anticoagulant blood PLT results significantly decreased,compared with ammonium oxalate method difference had statistical significance （t = 12.413 - 12.413,P 〈0.01 -0.001）.Citron acid sodium PLT began to decline after 30 min,compared with ammonium oxalate method,the difference was statistically significant （t=4.915-4.915,P 〈0.05-0.01）.Blood dilution method in 30-40 min PLT test results began to decline,but not obvious, there was no statistically significant difference with the method of ammonium oxalate （t=1.315-1.715,P 〉0.05）,40-60 min PLT test results appear significantly decreased,and the method of ammonium oxalate difference was statistically signifi-cant （t=3.175-3.175,P 〈0.05）;Within 0-60 min 0.9 g/dl NaCl method to detect the PLT differences between the results with the method of ammonium oxalate had no statistical significance （t=0.694- 1.062,P 〉0.05）.Conclusion EDTA,citron acid sodium,blood thinners and 0.9 g/dl saline diluting instrument immediately detected PLT PTCP patients were consistent with ammonium oxalate method.Citron acid sodium within 30 minutes and blood dilution method in patientswith PTCP PLT detection could achieve ideal effect,but there were still a small amount of PLT gathered and led to a slight drop in PLT.0.9 g/dl saline diluting instrument method with ammonium oxalate within 0-60 minutes method to detect the PLT result had no difference.