强冷凝集对血细胞干扰1例处理方法探讨及文献复习

Discussion on a case of treatment of strong cold agglutination interfering with blood cells and literature review

探讨强冷凝集素补体C3对血细胞红系参数的影响及处理方法,以便获得可靠的处理结果。筛选1例骨髓移植术4个月后地贫患者,针对该患者补体C3强阳性样本,分别在室温(25℃)、37℃水浴30 min、37℃水浴60 min、41℃水浴1 min、41℃水浴30 min、45℃水浴1 min、45℃水浴30 min、45℃生理盐水洗涤红细胞3次等方法依次处理,然后采用迈瑞BC6800血细胞分析仪进行常规检测,同时进行手工涂片染色镜检。红细胞(RBC)、血红蛋白(HGB)、血细胞比容(HCT)、平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)、平均红细胞血红蛋白浓度(MCHC)均有不同程度改变。在日常实验操作中,如遇到强冷凝集素补体C3存在引起血细胞分析困难时,采用45℃水浴1 min或45℃生理盐水洗涤3次,然后进行血常规检测,均可获得符合临床的结果。实际操作中采用45℃生理盐水洗涤,操作比较繁琐,而且离心温度较难掌控,而45℃水浴1 min不仅操作简单,结果也较准确,保证了血常规检测结果的准确性。

To investigate the effect of strong cold agglutinin complement C3 on the erythroid parameters of blood cells and its treatment,so as to obtain reliable treatment results.A patient with thalassemia four monthsafter bone marrow transplantation was screened.For the complement C3 strong positive sample obtained from this patient,the sequential processing suchas room temperature(25℃)water bath,37℃water bath for 30 min,37℃water bath for 60 min,41℃water bath for 1 min,41℃water bath for 30 min,45℃water bath for 1 min,45℃water bath for 30 min,and erythrocyte washing with 45℃normal saline for three timeswas carried out.Then the routine detection was performed using a Mindray BC6800 hematology analyzer,and smear staining microscopic examination was performed manually.Red blood cell(RBC),hemoglobin(HGB),haematocrit(HCT),mean corpuscular volume(MCV),mean erythrocyte hemoglobin content(MCH)and mean erythrocyte hemoglobin concentration(MCHC)were all changed to different degrees.In the daily experimental operation,if it is difficult to analyze the blood cells due to the presence of strong cold agglutinin complement C3,the samples should be put into a 45℃water bath for 1 min or washed with 45℃normal saline for three times,and then subjected to routine blood test,all of which will yield clinically acceptable results.The actual operation of 45℃normal saline washing is tedious,with centrifugal temperature difficult to control.However,45℃water bath for 1 min is not only simple to operate,but also accurate in results,thus ensuring the accuracy of blood routine test results.