冷凝集对血常规的干扰分析及处理方法比较

Analysis of the interference of cold agglutination on the results of hemocytology and compare the processing methods

目的比较不同环境温度对冷凝集血常规标本的影响,以及不同处理方法的纠正效果,并总结冷凝集的提示性参数。方法收集2018年11-12月在本院住院患者的冷凝集标本22例,将冷凝集血常规标本经不同温度及方法处理后,采用Sysmex XN-2000上机检测。结果冷凝集标本试管壁均有细沙样或小块状凝集颗粒,血涂片可见红细胞聚集成团块状;室温下检测出RBC、HB比例明显降低,MCH、MCHC异常升高;37℃水浴30 min能纠正大部分标本的冷凝集干扰;血浆置换纠正冷凝集干扰效果较好,但会造成PLT丢失。结论当血常规RBC、HB比例明显异常,MCHC>400 g/L时要高度怀疑存在冷凝集干扰;针对冷凝集血常规标本,推荐首先采用37℃水浴30 min重新测定,对于水浴无法纠正的强凝集标本,则采用血浆置换处理,但PLT仍选取水浴处理的结果。

Objective To compare the impacts of temperature on the results of cold agglutinated blood specimens,and the corrective effects of different processing methods,and to summarize the reminder parameters of cold agglutination.Methods 22 cases of cold agglutination blood specimens were collected from the patients hospitalized in our hospital from November to December 2018.The blood samples were treated by different temperatures and methods and detected by Sysmex XN-2000.Results The cold agglutinated specimens had sand-like or small agglomerated particles on the test tube wall,red blood cells aggregated into blocks according to blood smear results.The ratio of RBC and HB was significantly reduced at room temperature.Meanwhile,MCH and MCHC abnormally elevated.After been incubated in the water of 37℃the cold agglutination interference of most specimens were corrected.The method of plasma exchange could effectively correct the cold agglutination interference,but it caused the lost of PLT.Conclusions When the ratio of RBC and HB is significantly abnormal,and concentration of MCHC over 400 g/L,the cold agglutination interference should extremely suspected.In the analysis of cold agglutinated blood specimens,it is recommended to re-measure after incubated in 37℃water for 30 min.In case of 37℃water incubation could not correct the results of strongly cold agglutinated specimens,plasma exchange method is recommended,but PLT results still adopted those results from incubation method.