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目的通过血涂片复检探讨血小板减少的真伪及纠正方法。方法对252例首次血小板计数<90×109/L的患者,同时进行血涂片镜检分析。结果 224例为真血小板减少,血涂片检测与血细胞分析仪检测结果相符;28例为假性血小板减少,血涂片检测与血细胞分析仪检测结果不符,血涂片检测明显高于血细胞分析仪检测,结果显示正常;对28例假性血小板减少患者,更换枸橼酸钠抗凝剂复检,结果有26例结果显示正常,与血涂片镜检相符,有2例与EDTA抗凝血结果相近,对这2例结果相近的,用手工法重新计数,结果显示正常,与血涂片镜检相符。结论假性血小板减少原因很多,绝大多数为EDTA依赖的假性血小板减少,对首次检测血细胞计数显示血小板减少的,或血小板减少明显但临床无任何出血倾向,或与临床诊断不符者,应高度怀疑为假性血小板减少,应严格按血涂片复检规则进行复检鉴别真伪,并及时更换枸橼酸钠抗凝剂复检,必要时进行手工计数复核,应避免误诊。
Objective To investigate the authenticity and correction of thrombocytopenia by blood smear retesting. Methods 252 patients with the first platelet count <90 × 109 / L were examined by blood smear microscopy. Results 224 cases of true thrombocytopenia, blood smear detection and hematology analyzer test results consistent; 28 cases of pseudo-thrombocytopenia, blood smears and hematology analyzer test results do not match, blood smears were significantly higher than the hematology analyzer Detection, the results showed normal; 28 cases of pseudo thrombocytopenia, replacement of sodium citrate anticoagulant re-examination, the results of 26 cases showed normal, consistent with blood smear microscopy, 2 cases with EDTA anticoagulant results Similar to these two cases of similar results, manually re-count, the results showed normal, consistent with blood smear microscopy. Conclusions There are many reasons for pseudo-thrombocytopenia, the vast majority of whom are EDTA-dependent pseudo-thrombocytopenia. They should be highly observant of the first detection of haemocytopenia showing thrombocytopenia or obvious thrombocytopenia but without clinical signs of any bleeding or incompatibility with clinical diagnosis Suspected false pseudo-thrombocytopenia should be strictly according to the blood smear recheck rule for re-examination to identify the authenticity and timely replacement of sodium citrate anticoagulant re-examination, if necessary, manual counting review should be avoided misdiagnosis.