妊娠晚期EDTA依赖性假性血小板减少2例报告及文献复习

EDTA - PTCP in Late Trimester of Pregnancy： Report of 2 Cases and Literature Review

目的探讨妊娠晚期乙二胺四乙酸依赖性假性血小板减少（EDTA—PTCP）的发生机制及准确诊断与准确计数血小板方法，为临床提供参考。方法报告2例妊娠晚期EDTA—PTCP产妇分娩前后及新生儿血小板值，并追溯其第一次妊娠分娩前后血小板值。结果1例分娩前EDTA抗凝管查PLT8×10^9／L，可见血小板聚集，重新采血后不加抗凝剂行人工计数PLT189×10^9／L；新生儿第3天EDTA抗凝管查PLT291×10^9／L。另1例分娩前EDTA抗凝管查PLT7×10^9／L，可见血小板聚集，重新采血后不加抗凝剂行人工计数PLT137×10^9／L；新生儿第3天EDTA抗凝管查PLT248×10^9／L。结论利用血液学分析仪分析血小板和白细胞典型柱状图可准确诊断EDTA—PTCP。在EDTA血液样品试管中加入氨基糖苷类、镁盐或者柠檬酸盐、5-磷酸吡哆醛和3-磷酸吡哆醛，可以准确计数血小板；或在血液样品中加入氨基糖苷类，通过1．25倍稀释因子分析红细胞沉降率，也能获得准确的PLT计数。

Objective To investigate pathogenetic mechanism and accurate methods for diagnosing EDTA - PTCP and platelet counting in late trimester of pregnancy in order to provide a guidance for clinical diagnosis and treatment. Methods Platelet counts of two patients with EDTA - PTCP in late trimester of pregnancy before and after delivery as well as newborn were reported. Platelet counts were retrospected before and after delivery in the first preg- nancy. Results PLT in EDTA anticoagulant tube for one case before delivery was 8 ×10^9g/L and platelet aggregation was seen. PLT without anticoagulant was 189 ×10^9g/L. PLT in EDTA anticoagulant tube for newborn at the third day was 291 ×10^9g/L. PLT in EDTA anticoagulant tube for another case before delivery was 7 ×10^9g/L and platelet aggregation was seen. PLT without anticoagulant was 137 ×10^9g/L. PLT in EDTA anticoagulant tube for newborn at the third day was 248 ×10^9g/L. Conclusion EDTA - PTCP can be diagnosed accurately by analyzing platelet and white blood cell histogram using hematology analyzer. PLT can be counted accurately by adding aminoglycosides, mag- nesium salts or citrates ,5 -phosphate pyridoxal and 3 -phosphate pyridoxal to blood samples in EDTA tube. Analysis of erythrocyte sedimentation rates by 1.25 fold dilution factors by adding aminoglycosides to blood samples can also get accurate PLT counts.