目的:本文报道一例罕见的重症原发免疫性血小板减少症(ITP)患者治疗过程中合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少的病例,分析与探讨其病因,为临床工作提供处理预案及经验指导。方法:通过静脉采血同时送EDTA-K2抗凝...目的:本文报道一例罕见的重症原发免疫性血小板减少症(ITP)患者治疗过程中合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少的病例,分析与探讨其病因,为临床工作提供处理预案及经验指导。方法:通过静脉采血同时送EDTA-K2抗凝管、肝素钠抗凝管和枸橼酸钠(1:9)抗凝管至血细胞分析仪进行PLT计数,手指末梢血采血立即手工稀释计数法作为对比。回顾性分析该例临床资料,结合文献复习探讨其发生可能的原因。结果:该例ITP患者使用EDTA-K2抗凝管、肝素钠抗凝管、枸橼酸钠(1:9)抗凝管的PLT计数分别为6.00 × 109/L、9.00 × 109/L、7.00 × 109/L,手指末梢血校正手工稀释计数为PLT 32.00 × 109/L。患者ITP出血评分5分,重症ITP合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少诊断明确,其原因可能与自身免疫性疾病及EDTA螯合、诱导血小板活化等机制相关,临床发生率极低,很容易误诊、漏诊,影响后续治疗,需要予以关注。结论:对于重症ITP患者治疗后血小板仍低的情况,除考虑治疗效果不理想外同时需要考虑合并EDTA、肝素钠、枸橼酸钠抗凝剂依赖性假性血小板减少的可能,需结合临床表现及时手工计数校正,可以减少临床误诊、漏诊。Objective: This article reports a rare case of severe primary immune thrombocytopenia (ITP) complicated with EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia during treatment, shares and discusses its etiology, and provides treatment plans and experience guidance for clinical work. Methods: Venous blood was collected and sent to the blood cell analyzer for PLT counting in EDTA-K2 anticoagulant tubes, sodium heparin anticoagulant tubes, and sodium citrate (1:9) anticoagulant tubes. Finger-end blood sampling and immediate manual dilution counting were used as a comparison. The clinical data of this case were retrospectively analyzed, and the possible causes of its occurrence were discussed in combination with literature review. Results: The PLT counts of the ITP patient using EDTA-K2 anticoagulant tube, heparin sodium anticoagulant tube, and sodium citrate (1:9) anticoagulant tube were 6 × 109/L, 9 × 109/L, and 7 × 109/L, respectively. The PLT count of fingertip blood corrected for manual dilution was 32 × 109/L. The ITP bleeding score of the patient was 5 points, and the diagnosis of severe ITP combined with EDTA, heparin sodium, and sodium citrate anticoagulant-dependent pseudothrombocytopenia was clear. The cause may be related to autoimmune diseases and EDTA chelation, induction of platelet activation and other mechanisms. The clinical incidence is extremely low, and it is easy to misdiagnose and miss, which affects subsequent treatment and needs attention. Conclusion: For patients with severe ITP whose platelet count remains low after treatment, in addition to considering the unsatisfactory treatment effect, the possibility of EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia should also be considered. Timely manual counting and correction should be performed based on clinical manifestations to reduce clinical misdiagnosis and missed diagnosis.展开更多
目的 探讨网织红细胞检测通道即荧光染色法(PL T-O法)检测乙二胺四乙酸(ED T A)依赖性假性血小板减少症(ED T A-P T C P)患者血小板的准确性.方法 选取2016年2月至2018年2月诊治的38例EDTA-PTCP患者作为试验组,并选取同期健康体检人员...目的 探讨网织红细胞检测通道即荧光染色法(PL T-O法)检测乙二胺四乙酸(ED T A)依赖性假性血小板减少症(ED T A-P T C P)患者血小板的准确性.方法 选取2016年2月至2018年2月诊治的38例EDTA-PTCP患者作为试验组,并选取同期健康体检人员共50例作为对照组.两组研究对象的血标本均经过ED T A-K2抗凝,应用电阻抗法(PL T-I法)及PL T-O法进行血小板计数;同时采集两组研究对象末梢血并用草酸铵进行抗凝,应用手工草酸铵法(PL T-M法)计数血小板.以PL T-M法为标准检测方法,并以涂片观察血小板形态为辅助方法,分析PL T-O和PL T-M两种方法检测血小板的一致性.结果 在试验组中,PL T-I、PL T-O、PLT-M法检测血小板计数结果分别为(25.34±9.54)×109/L、(190.74±56.12)×109/L、(199.08±54.32)×109/L,PLT-O与PLT-M法具有更高的相关性(r=0.996);对照组中,PLT-M、PLT-I、PLT-O法检测结果分别为(204.14±56.51)×109/L、(205.43±56.67)×109/L、(204.21±58.59)×109/L,3种方法检测结果差异无统计学意义(P>0.05).结论 PLT-O法在EDTA-PTCP患者血小板检测中有较高的准确性和较强的抗血小板聚集干扰的作用.展开更多
文摘目的:本文报道一例罕见的重症原发免疫性血小板减少症(ITP)患者治疗过程中合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少的病例,分析与探讨其病因,为临床工作提供处理预案及经验指导。方法:通过静脉采血同时送EDTA-K2抗凝管、肝素钠抗凝管和枸橼酸钠(1:9)抗凝管至血细胞分析仪进行PLT计数,手指末梢血采血立即手工稀释计数法作为对比。回顾性分析该例临床资料,结合文献复习探讨其发生可能的原因。结果:该例ITP患者使用EDTA-K2抗凝管、肝素钠抗凝管、枸橼酸钠(1:9)抗凝管的PLT计数分别为6.00 × 109/L、9.00 × 109/L、7.00 × 109/L,手指末梢血校正手工稀释计数为PLT 32.00 × 109/L。患者ITP出血评分5分,重症ITP合并EDTA、肝素钠、枸橼酸钠抗凝剂同时依赖性假性血小板减少诊断明确,其原因可能与自身免疫性疾病及EDTA螯合、诱导血小板活化等机制相关,临床发生率极低,很容易误诊、漏诊,影响后续治疗,需要予以关注。结论:对于重症ITP患者治疗后血小板仍低的情况,除考虑治疗效果不理想外同时需要考虑合并EDTA、肝素钠、枸橼酸钠抗凝剂依赖性假性血小板减少的可能,需结合临床表现及时手工计数校正,可以减少临床误诊、漏诊。Objective: This article reports a rare case of severe primary immune thrombocytopenia (ITP) complicated with EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia during treatment, shares and discusses its etiology, and provides treatment plans and experience guidance for clinical work. Methods: Venous blood was collected and sent to the blood cell analyzer for PLT counting in EDTA-K2 anticoagulant tubes, sodium heparin anticoagulant tubes, and sodium citrate (1:9) anticoagulant tubes. Finger-end blood sampling and immediate manual dilution counting were used as a comparison. The clinical data of this case were retrospectively analyzed, and the possible causes of its occurrence were discussed in combination with literature review. Results: The PLT counts of the ITP patient using EDTA-K2 anticoagulant tube, heparin sodium anticoagulant tube, and sodium citrate (1:9) anticoagulant tube were 6 × 109/L, 9 × 109/L, and 7 × 109/L, respectively. The PLT count of fingertip blood corrected for manual dilution was 32 × 109/L. The ITP bleeding score of the patient was 5 points, and the diagnosis of severe ITP combined with EDTA, heparin sodium, and sodium citrate anticoagulant-dependent pseudothrombocytopenia was clear. The cause may be related to autoimmune diseases and EDTA chelation, induction of platelet activation and other mechanisms. The clinical incidence is extremely low, and it is easy to misdiagnose and miss, which affects subsequent treatment and needs attention. Conclusion: For patients with severe ITP whose platelet count remains low after treatment, in addition to considering the unsatisfactory treatment effect, the possibility of EDTA, sodium heparin, and sodium citrate anticoagulant-dependent pseudothrombocytopenia should also be considered. Timely manual counting and correction should be performed based on clinical manifestations to reduce clinical misdiagnosis and missed diagnosis.
文摘目的 探讨网织红细胞检测通道即荧光染色法(PL T-O法)检测乙二胺四乙酸(ED T A)依赖性假性血小板减少症(ED T A-P T C P)患者血小板的准确性.方法 选取2016年2月至2018年2月诊治的38例EDTA-PTCP患者作为试验组,并选取同期健康体检人员共50例作为对照组.两组研究对象的血标本均经过ED T A-K2抗凝,应用电阻抗法(PL T-I法)及PL T-O法进行血小板计数;同时采集两组研究对象末梢血并用草酸铵进行抗凝,应用手工草酸铵法(PL T-M法)计数血小板.以PL T-M法为标准检测方法,并以涂片观察血小板形态为辅助方法,分析PL T-O和PL T-M两种方法检测血小板的一致性.结果 在试验组中,PL T-I、PL T-O、PLT-M法检测血小板计数结果分别为(25.34±9.54)×109/L、(190.74±56.12)×109/L、(199.08±54.32)×109/L,PLT-O与PLT-M法具有更高的相关性(r=0.996);对照组中,PLT-M、PLT-I、PLT-O法检测结果分别为(204.14±56.51)×109/L、(205.43±56.67)×109/L、(204.21±58.59)×109/L,3种方法检测结果差异无统计学意义(P>0.05).结论 PLT-O法在EDTA-PTCP患者血小板检测中有较高的准确性和较强的抗血小板聚集干扰的作用.
