血红蛋白异常增高,竟是……

2019-01-27 朱名超,张红艳 检验医学网

在血常规检验中,血红蛋白异常(HGB)增高的病人时有出现,但“真高”or“假高”,有时候需要认真鉴别,否则很可能造成检验结果的误判,甚至造成纠纷。那么下面就跟大家分享几种“真假”HGB案例。

在血常规检验中,血红蛋白异常(HGB)增高的病人时有出现,但“真高”or“假高”,有时候需要认真鉴别,否则很可能造成检验结果的误判,甚至造成纠纷。那么下面就跟大家分享几种“真假”HGB案例。

案例一

患者,男,32岁,上腹痛入院,血常规检测结果如下图:

患者红细胞数量:5.83X1012/L,血红蛋白200g/L,MCHC427g/L,这三项指标升高明显,再看看仪器图形报警信息,如下图:

仪器报警为:Turbidity/HGB Interf?可以是脂血,或者乳糜血也可能是冷凝集哦,那么到底是哪一个呢?于是立即找到相应血标本,仔细观察试管底部,没有细沙状沉积物,如果是脂血,离心可以解决,于是立即将标本3000r/min离心10min,取出后上层“完美的”乳白色,似牛奶,如下图:

真凶找到了,原来是脂血造成的,那么该如何处理呢?

突然想到了文献上关于脂血的血常规解决方法——血浆置换。那今天就做个试验吧,将患者血样3000r/min离心10min,吸出上面的白色血浆层,以同等量的生理盐水加入血样中混匀再次检测,结果如下:

RBC5.95X1012/L,HGB184g/L,MCHC更是高达396g/L,仍然高于正常值,但血小板值却只有94X109/L,于是同法再次行血浆置换,再次检测结果如下:

这次检验结果基本趋于正常,RBC和HGB与上次相差不大,但MCHC相差较大,于是行第三次血浆置换,如下图:

RBC、HGB和MCHC结果与第二次相差不大,但仍然提示脂血,但血小板却一路直降,从正常的260降到42,说明血浆置换对血小板影响变化比较明显,主要是由于血液经过离心沉淀后,最上层为血浆层,紧接着是PLT层,然后是白细胞和红细胞层,在吸取血浆层的过程中很容易将血浆与血细胞层之间的血小板层吸走,最终导致血浆置换后PLT越来越低。

三次置换后的血浆

那么这个PLT值该怎么报告呢,我们也做了试验,涂片镜检加手工显微镜计数,镜检10个油镜视野共152个PLT,平均每油镜视野约15个PLT,初步评估:15X15=225个,手工计数结果为241X109/L。二者与仪器第一次计数结果均相符合,因此以仪器第一次计数的血小板结果报告,那其他指标呢?有文献报道,应该用置换后的HGB和置换前的RBC和HCT去计算MCH和MCHC。即

MCH=HGB(置换后)/RBC(置换前)

MCHC=HGB(置换后)/HCT(置换前)

但根据这次试验经验,发现直接血浆置换后的MCH和MCHC更为可靠。

案例二

患者,男,因“发热咳嗽4天”入院就诊,诊断:肺部感染伴肺旁积液、肺结核。患者血常规出现MCH、MCHC异常增高,仪器报警也为:Turbidity/HGB Interf?,如下图:

查看血样患者,样本底部可见细砂状颗粒,初步判断是冷凝集,文献报道冷凝集血常规结果中RBC与HGB明显比例失调,MCH与MCHC异常偏高,因此非常容易识别。处理方法:一般37℃温育30min,即可解除。于是立即温育30min,再次上机检测。

RBC与HGB比例恢复正常,MCH与MCHC也不再异常偏高。

两个案例给我们的启示:工作中当遇到MCH与MCHC异常增高,RBC与HGB明显比例不当时,要首先考虑到脂血和冷凝集的可能,如为严重脂血的标本,一定要及时进行血浆置换,并且置换后的血小板计数结果会明显降低,要按照仪器原始的结果报告或者以手工计数为准。如为冷凝集标本,首先要观察标本状态是否符合冷凝集特征,处理方法较多:温育,标本稀释,采用稀释模式检测,生理盐水血浆置换法等均可。

因此,血常规报告无小事,细心你就会发现很多“可怕”的安全隐患。综合分析,仔细审核每一个检测指标,才能防患于未然。

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    2019-03-16 jyzxjiangqin

    血红蛋白异常升高。

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    2019-03-06 jyzxjiangqin

    血红蛋白异常升高治疗。

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    2019-02-07 jyzxjiangqin

    血红蛋白异常升高。

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    2019-01-29 jyzxjiangqin

    血红蛋白异常增高。

    0

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    2019-01-28 liuxiaona
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    2019-01-28 liuxiaona

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