新生儿外周血检出胆红素结晶1例报道

Detection of bilirubin crystals in peripheral blood of neonates:a case report

胆红素结晶临床可见于阻塞性黄疸、急性肝坏死等疾病个体,出现在胸腹水、关节液中有报道,而外周血检出胆红素结晶罕见。本文报道1例出生4 d男性患儿,诊断为新生儿呼吸窘迫综合征、高胆红素血症。外周血涂片镜检于部分中性粒细胞、单核细胞内见金黄色、折光性强,呈针状、菱形、矩形、斜方体形或长方体形胆红素结晶。根据临床经验,显著高胆红素血症的新生儿外周血偶见胆红素结晶,可造成血清胆红素测定结果偏低。提示血常规结果的审核,需在审核各项检测数值的同时,务必注意观察散点图和报警信息,并结合血清胆红素水平及临床表现,镜检时仔细观察细胞形态,以便及时发现仅仅依靠检测数值发现不了的对临床诊疗有意义的形态学异常结果。

Bilirubin crystals can be seen clinically in patients with obstructive jaundice,acute liver necrosis,etc.Bilirubin crystals have been reported to appear in pleural and ascitic fluids,joint fluids,and other fluids,while those are rare in peripheral blood.This paper reports a male child diagnosed with neonatal respiratory distress syndrome and hyperbilirubinemia 4 d after birth.On peripheral blood smear microscopy,some neutrophils and monocytes were found to have a golden yellow color with strong refractive index,presenting as needle shaped,diamond shaped,rectangular,rhombic or rectangular bilirubin crystals.Based on clinical experience,occasional bilirubin crystals can be observed in the peripheral blood of newborns with significant hyperbilirubinemia,which can lead to low serum bilirubin measurement results.When reviewing blood routine results,it is necessary to pay attention to observing scatter plots and alarm information,combined with serum bilirubin concentration and clinical manifestations,and carefully observe cell morphology during microscopic examination,in order to timely discover morphological abnormalities that cannot be detected solely based on detection values and are meaningful for clinical diagnosis and treatment.