妇儿专科医院血液分析复检规则的建立及验证

摘要

目的 建立适合妇女儿童专科医院的血常规复检规则.方法 以“XE-2100血细胞分析复检标准制定协作组”制定的XE-2100血液分析仪复检规则为评估基础,根据妇女儿童专科医院自己独特的病种特点及儿童白细胞(WBC)分类存在生理性交叉现象完善相应规则.Sysmex XE-2100全自动血液分析仪检测1 120例标本,以涂片镜检为金标准,进行临床复检工作并进行规则优化.结果 初始复检规则复检率65.98％,根据妇儿医院特点,通过调整WBC、血小板(PLT)计数、WBC分类百分比进行第1次优化后,假阳性率40.71％；将未成熟粒细胞(IG)与WBC≥10×109/L组合、幼稚细胞(Blast)与WBC≤4×109/L或≥10×109/L组合、变异淋巴细胞(Atypical/Variant)与淋巴细胞(Lymph)％＞50％组合进行第2次优化后,假阳性率为17.53％,假阴性率4.49％,造成假阴性的主要项目为Atypical/Variant Lymph(＜ 5％)、PLT ＞70×109/L,验证通过.最终制定出符合妇女儿童专科医院的专有复检规则.结论 血涂片复检规则在临床应用过程中,应注意收集、整理发现问题,及时根据自身医院特点对复检规则进行修改、完善,以提高血细胞分析质量和工作效率.%Objective To establish proper review criteria for blood cell analysis in women and children specialized hospital. Methods Based on the review criteria from the cooperation group of formulation for blood cell analysis by Sysmex XE-2100 hematology analyzer, as the women and children specialized hospital with the own unique disease characteristics and children white blood cell ( WBC ) physiological characteristics, the review criteria was optimized. The total 1120 samples were detected by Sysmex XE-2100 hematology analyzer, blood smear determination was as the golden standard, and the new review criteria was evaluated and optimized. Results The review rate of initial review criteria was 65.98%. According to the women and children specialized hospital characteristics, by adjusting the WBC, platelet (PLT) count and WBC differential percentage for the first time after optimization, the false positive rate was 40. 71%. By combining immature granulocyte (IG) and WBC≥ 10 × 109/L,combining blast cell (Blast) and WBC≤4 × 109/L or ≥ 10×l09/L,and combining atypical/variant lymphocyte (Lymph) (Atypical/Variant) and Lymph% > 50% for the second time after optimization, the false positive and false negative rates were 17. 53% and 4. 49% . The main items were Atypical/Variant Lymph ( <5% )and PLT >70 × 109/L,which were verified. The proper review criteria in women and children specialized hospital was established. Conclusions The review criteria for women and children specialized hospital should be established in clinical application, improve the review criteria timely, and improve the analysis quality and efficiency of blood cell analysis.