27例乙二胺四乙酸依赖性假性血小板减少特点及临床分析

Analysis of characters and biochemical profiles of 27 cases with EDTA-Dependent Pseudothrombocytopenia

目的分析乙二胺四乙酸(EDTA)导致血小板聚集的特点,探讨与此现象有关的危险因素。方法用Sysmex XN-3000对2014年1月至2015年8月间的30 700例EDTA-K3抗凝标本测定,其中27例发生EDTA依赖性假性血小板减少(EDTA-PTCP)。再次采集27例患者的EDTA-K3和枸橼酸钠抗凝血标本进行测定并制作血涂片,显微镜检观察血小板分布,同时采集指血手工计数血小板。分析27例患者的生化指标,并与50例非EDTA-PTCP体检健康者结果对比。结果 EDTA抗凝血血小板数明显低于枸橼酸钠抗凝血,差异有统计学意义(P<0.05),而枸橼酸钠抗凝血与手工法结果相近(P>0.05)。EDTA-PTCP患者丙氨酸氨基转移酶(ALT)、血糖(Glu)、三酰甘油(TG)比健康者高,而高密度脂蛋白(HDL)要比健康者低,差异有统计学意义(P<0.05)。结论 EDTA引起假性血小板减少的程度取决于患者对EDTA的敏感度,该现象的存在可能与高血脂、高血糖有关。当发生EDTA-PTCP时,应更换抗凝剂或者手工计数血小板,从而避免漏诊。

Objective To analyze the characters about anticoagulation EDTA on the platelet aggregation,and discuss the risk factors about EDTA-PTCP by analyzing the biochemical parameters.Methods 30 700EDTA-K3 blood samples were collected from January 2014 to August 2015.WBC was performed using Sysmex XN-3000 and 27cases were identified of EDTA-PTCP.The blood samples of 27 subjects were recollected and WBC was repeated using EDTA-K3 and sodium citrate blood,respectively.Manual platelet counting and smear microscope examination on periphery blood were also performed.Biochemical parameters of 27 subjects with EDTA-PTCP were compared with 50 randomly selected non EDTA-PTCP controls.Results Platelet counts in citrated blood were significantly higher than EDTA blood,the difference was statistically significant（P〈0.05）,but similar to manual platelet counting（P〈0.05）.ALT,Glu and TG in patients with EDTA-PTCP were significantly higher than normal people,but HDL was significantly lower than control group,the difference was statistically significant（P〈0.05）.Conclusion EDTA-dependent pseudothrombocytopenia varies from people with different disease or using different medicine.It may be relative to hyperglycemia and hyperlipidemia.Another approach for rectifying,changing anticoagulant or manual platelet counting is a better way lead to correctly diagnose when EDTA-PTCP occurred.