破碎红细胞检测研究进展

Research Progress in the Detection of Schistocytes

红细胞在血液循环中受到外在机械损伤而产生的破碎红细胞是诊断血栓性微血管病（thrombotic microangiopathy，TMA）的重要形态学线索。TMA代表性疾病有血栓性血小板减少性紫癜（Thrombocytopenic purpura，TTP）、溶血尿毒症综合征（hemolytic uremic syndrome，HUs）等，尤其是近年来，人们对移植相关血栓性微血管病的研究不断深入，外周血破碎红细胞检测越来越受到关注。但是关于破碎红细胞形态学诊断标准及破碎红细胞诊断TMA阈值等问题，由于工作人员个人经验、检测方法及疾病种类等差异，目前各实验室还没有一个完全统一的标准。并且随着近年来自动血细胞分析仪检测外周血破碎红细胞技术的发展，关于该技术检测方法的统一性、临床实用性及可靠性等问题也越来越受到人们的关注。该文将从手工检测方法及自动血细胞分析仪检测方法对目前临床上外周血破碎红细胞的检测进行总结。

Within the circulation, schistocytes are produced by extrinsic mechanical damage. Schistocyte is an important morphological clue to the diagnosis of thrombotic microangiopathy （TMA）. The presence of schistocyte in the blood indicates the possibility of a thrombotic microangiopathy,in particular, the two major syndromes of thrombocytopenic purpura （TTP） and hemolytic uremic syndrome （HUS）. In addition, with the increased study of hematopoietic stem cell transplantation as- sociated thrombotic microangiopathy, the detection of schistocytes has been paid more and more attention. Because of the differences of observers,methods and diseases, there are no full consensus criteria about the morphological of schistocytes and threshold value for the diagnosis of TMA. Recently, with the development of automated red blood cells （RBCs） fragment count, the reliability and clinical utility of automated schistocytes count has also been paid attention by more and more people. They will summary the detection of schistocytes from the two aspects of manual microscopy and automated RBCs fragment count.