實(shí)驗(yàn)診斷學(xué)血液一般檢驗(yàn)

第二章血液一般檢測(cè)（CompleteBloodCount)SchoolofMedicalLaboratoryScienceHuXin胡昕(BloodRoutineTest)ContentsandLearningObjectivesThemeasurementsinaCBCCriteriaforcollectionofproperspecimensReferencevalueforhumanandbloodclinicalsignificance-BeabletointerpretCBCinformationsheetsWhatdoesacompletebloodcountmeasure?Whatdoesacompletebloodcountmeasure?

RBCWBCPltRBC(erythrocyte)=RedbloodcellHb=HemoglobinHct=HematocritWBC(leukocyte)=WhitebloodcellDC=DifferentialcountPlt(thrombocyte)=Platelet***Howtocollectacompletebloodcountsample?Samplecollection-Site-Strictaseptictechnique-？BloodServiceClinicalLaboratorytheFirstAffiliatedHospitalEDTA-K2Howtointerpretcompletebloodcountresults?[Referencevalue]RBCHb成年男性(4.0~5.5)×1012/L120~160g/L

成年女性(3.5~5.0)×1012/L110~150g/L

新生兒(6.0~7.0)×1012/L170~200g/L

1.RBC&Hb貧血(anemia)Thalassemia1）Hematocrit，Hct(packedcellvolume，PCV）2.OtherRedcellindicesElevatedorloweredHctisaccordwiththechangeofRBC,sotheclinicalsignificanceofHCTcanrefertotheRBCandHb0.552)MeanRBCindicesusefulindiagnosingthetypeofanemiag/L＝＝①②3)RBCDistributionWidth，RDWThesecellsexhibitalargevariationinsize.TheRDWisanumericalindicationofthismorphologicabnormality.Thisvalueindicatesthedegreeofredcellsizevariationorhowmuchdifferenceexistsbetweenthelargestandsmallestredcells.2）TOTALLEUKOCYTECOUNT(TLC)法國(guó)ABX血球計(jì)數(shù)儀Micros60Leukocytosis

acuteinfectioncertainmedicationshaemolyticdiseasesPhysiologicalhighPregnancy(infant)IntheafternoonthaninthemorningInemotionalstress(anxiety)AfterstrenuousexerciseNormalvalues:

4~10×109/LLeukopeniacertaininfectionautoimmune

chemotherapy,radiation

therapyNeutrophil(Ne)Lymphocyte(Ly)Eosinophil(Eo)Basophil(Ba)Monocyte(Mo)DIFFERENTIALLEUKOCYTECOUNT[ClinicalSignificance]Ne：a增多：如急性感染或炎癥、急性溶血、失血、粒細(xì)胞白血病等。

b減少：感染性疾病如病毒感染及傷寒、血液系統(tǒng)疾病如再障、物理化學(xué)因素如接受射線、單核－巨噬細(xì)胞功能亢進(jìn)等。

Ly：a增多：感染性疾病如病毒感染、腫瘤性疾病、及移植排斥反應(yīng)等。

b減少：應(yīng)用腎上腺皮質(zhì)激素、免疫缺陷性疾病等。(50~70％)(20~

40％)M：a.增多：某些感染如感染性心內(nèi)膜炎等、

血液病如單核細(xì)胞白血病等。

b.減少：無(wú)重要臨床意義。Eo：a.增多：變態(tài)反應(yīng)性疾病、寄生蟲(chóng)病、皮膚病、某些惡性腫瘤及傳染病等。

b.減少：無(wú)重要臨床意義。Ba：a.增多：見(jiàn)于慢性粒細(xì)胞白血病、骨髓纖維化、變態(tài)反應(yīng)性疾病等。

b.減少：無(wú)臨床意義。(3~

8%)(0.5~

5%)(0~1%)4）PlateletCausesofthrombocytopenia:??Viralinfection??Idiopathicthrombocytopenicpurpura(ITP)??Medications??DIC??Liverdisease??Autoimmunedisease??Hypersplenism??Pregnancy??Bonemarrowcauses??Partiallyclottedsample??PlateletclumpinginthebloodcollectiontubeHigh

Platelet

Count(Thrombocytosis)MalignanttumorPolycythemiaveraSplenectomyHowtoperformacompletebloodcounttest?1.血細(xì)胞自動(dòng)化分析原理：1）三分類：電阻法原理（Coulter?Counter?.）WallaceHenryCoulter(1913-1998)2）五分類技術(shù)：為基于流式通道的三維分析技術(shù)COULTERPRINCIPLE-X軸：體積（fL）-Y軸：相對(duì)數(shù)量1）WBC/BASOhistogramGaussiandistributionMCV&RDWRedcellhistogram葉酸及維生素B12缺乏引起的巨幼細(xì)胞性貧血（D）：直方圖波峰右移，峰底增寬，顯示明顯的大細(xì)胞不均一性。給予葉酸或維生素B12后，正常紅細(xì)胞逐步釋放入血液，而病理細(xì)胞并未完全消亡，檢測(cè)時(shí)即再出現(xiàn)雙峰形，說(shuō)明治療有效。鐵粒幼細(xì)胞性貧血（B）：直方圖顯示紅細(xì)胞呈典型的“雙形”性改變（即同時(shí)存在著兩類型的紅細(xì)胞，一種是小細(xì)胞低色素性紅細(xì)胞，另一種是正常形態(tài)的紅細(xì)胞），故出現(xiàn)波峰左移、峰底增寬的雙峰。在缺鐵性貧血經(jīng)治療有效時(shí)，也可出現(xiàn)類似的圖形，但峰底要更寬些。輕型β-珠蛋白生成障礙性貧血（C）：直方圖圖形表現(xiàn)為小峰左移，峰底變窄，典型的小細(xì)胞均一性貧血。缺鐵性貧血（A）：典型呈小細(xì)胞性貧血，其特點(diǎn)為曲線波峰左移（MCV降低），峰底變寬（RDW增高），顯示小細(xì)胞不均一性。下面介紹幾種貧血時(shí)圖形變化：不同類型貧血紅細(xì)胞體積分布直方圖Vocabularyvenipuncturesyringeiodineperspirepicahydrationtherapyerythropoietinaplasticanemiahaemolysismegaloblasticanemiasideroblasticanemiarheumaticdiseasesteroidtyphoidmalariatuberculosisdengueinfectio