儿童血细胞复检规则的建立及在临床诊断中的应用

Establishment of the review criteria of blood cell analysis in children and its application in clinical diagnosis

目的建立适用于儿童血细胞的复检规则,保证血细胞分析结果的准确,确保病理细胞不漏检。方法抽取2018年5至6月在山西省儿童医院就诊的门诊和住院患儿血细胞分析标本共计1420份,采用SYSMEX XN-350和XN-A1全自动血细胞分析仪检测,同时进行血涂片双盲法人工镜检。其中463份用于复检规则的建立,586份用于复检规则的验证,371份用于复检规则的应用效果研究。参照国际血液学复检专家组推荐的41条复检规则,结合儿童生理、病理、疾病特点及血液分析仪异常报警信息,建立适合儿童血细胞的复检规则。结果通过对国际41条复检规则的评估和优化,制定了23条儿童血细胞分析复检规则,复检率25.09%,假阳性率14.16%。定向选取血液病患者标本371份用于复检规则的应用效果研究,假阴性率2.96%,无病理细胞漏检。结论本研究建立的儿童血细胞复检规则经过验证和应用评估,既保证报告质量,又提高了工作效率,为儿童白血病、传染性单核细胞增多症及其他血液系统疾病的诊断和鉴别诊断提供了重要依据。

Objective To establish the review criteria for children′s blood cell analysis,ensure the accuracy of blood cell analysis results,and ensure that pathological cells are not missed.Methods A total of 1420 samples of blood cell analysis were collected from outpatients and inpatients in Shanxi Children′s Hospital from May to June 2018,which were detected by SYSMEXXN-350 and XN-A1 automated blood cell analyzer.Blood smears weredouble-blindly examinedunder microscope.Among them,463 were used for the establishment of review criteria,586 were used for the verification and evaluation of review criteria,and 371 were used for the application effect study of review criteria.According tothe 41 rules recommended by ISLH,combining the characteristics of children′s physiology,pathology,disease and abnormal alarming information of hematology analyzer,the review criteria suitable for children′s blood cells were established.Results Through the evaluation and optimization of 41 rules recommended by ISLH,23 rules for reexamination of children′s blood cell analysis were formulated,with a reexamination rate of 25.09%,and a false positive rate was 14.16%.A total of 371 samples of patients with hematological diseases were selected for the application of the review criteria.The false negative rate was 2.96%,and no pathological cells were missed.Conclusion The children′s blood cell review criteria established in this study has been verified and evaluated,which not only ensures the quality of the report,but also improves the work efficiency,and provides an important basis for the diagnosis and differential diagnosis of childhood leukemia,infectious mononucleosis and other hematological diseases.