一例嗜碱性粒细胞假性增高患者的诊断分析

Diagnostic analysis of a patient with pseudo-elevated basophil

目的通过对慢性淋巴细胞白血病患者异常淋巴细胞造成血细胞分析仪白细胞(WBC)分类嗜碱性粒细胞(BASO)百分比假性增高的分析,探讨其可能发生的机制,为临床诊疗提供依据。方法采用SYSMEX-XE5000全自动血细胞分析仪对患者血常规标本进行计数,根据报警信息,进行涂片和瑞氏染色及显微镜复检,以核实报警提示信息是否正确。结果该患者初诊时血细胞分析仪出现异常淋巴细胞及BASO增加的报警提示,BASO比例高达29.1%,而显微镜镜检人工分类发现BASO仅为1%,WBC分类以淋巴细胞为主,部分淋巴细胞形态异常,染色质稍疏松,呈龟背样,可见核切迹,为异常淋巴细胞(疑似肿瘤性),比例高达23%。WBC/BAS0散点图显示BASO区域明显增大并向左偏移且与WBC群分界不清,DIFF散点图显示单核细胞区与淋巴细胞区的延伸处相连,不能分割。结论实验室可通过仪器的散点图及报警信息初步辨别白细胞分类的准确性,对散点图报警异常者,应加强显微镜复检,以降低血液病的漏诊和误诊概率。

Objective To investigate the possible mechanism of pseudo-elevation of basophils(BASO)in WBC classification of hematology analyzer caused by abnormal lymphocytes in patients with chronic lymphoblastic leukemia(CLL),so as to provide basis for clinical diagnosis and treatment.Methods SYSMEX-XE5000 automatic blood cell analyzer was used to count the routine blood samples.According to the alarm information,smears,Rayleigh staining and microscopic re-examination were carried out to verify whether the alarm information was correct.Results The alarm of abnormal lymphocytes cells and the increase of BASO showed that BASO percentage was increased up to 29.1%,but only 1%was found by microscopic classification.Under microscope,lymphocyte is the major cell in the WBC classification.Some lymphocytes were abnormal in morphology,with slightly loose chromatin like turtle back,and visible nuclear notch,Those lymphocytes were abnormal lymphocytes.The proportion of abnormal lymphocytes(suspected tumor)was as high as 23%.WBC/BASO scatter plot showed that BASO area was significantly increased and shifted to the left and its demarcation with WBC group was not clear.DIFF scatter plot showed that monocyte area was connected with the extension of lymphocyte area and could not be divided.Conclusion The accuracy of leukocyte classification can be preliminarily distinguished by the scatter plot and alarm information of the instrument.Microscopic re-examination should be strengthened for those with abnormal alarm of scatter plot to reduce the probability of missed diagnosis and misdiagnosis of hematological diseases.