Kurata Y, Hayashi S, Kiyoi T, Kosugi S, Kashiwagi H, Honda S, Tomiyama Y
Department of Blood Transfusion, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871 Japan.
Am J Clin Pathol. 2001 May;115(5):656-64. doi: 10.1309/RAW2-0LQW-8YTX-941V.
We measured reticulated platelets (RPs) and plasma glycocalicin (GC) and thrombopoietin (TPO) levels simultaneously in 107 thrombocytopenic patients to clarify the diagnostic value of these tests for discriminating hyperdestructive from hypoplastic thrombocytopenia. The percentage of RPs and GC index (plasma GC level normalized for the individual platelet count) were markedly elevated in patients with idiopathic thrombocytopenic purpura (ITP) but normal or slightly elevated in patients with aplastic anemia (AA) or chemotherapy-induced thrombocytopenia (ChemoT). For RP percentage for diagnosing hyperdestructive thrombocytopenia the sensitivity and specificity were excellent but were lower for the GC index. Absolute RP counts and plasma GC levels were markedly decreased and plasma TPO levels markedly elevated in patients with AA or ChemoT, but absolute RP counts and plasma GC levels were moderately decreased and plasma TPO levels only slightly elevated in patients with ITP. The sensitivity and specificity of plasma TPO levels for diagnosing hypoplastic thrombocytopenia were excellent. Using the RP percentage and plasma TPO levels in combination improved specificities. Simultaneous measurement of RP percentage and plasma TPO level may help discriminate thrombocytopenia of unknown cause in routine hematologic practice.
我们同时检测了107例血小板减少症患者的网织血小板（RP）、血浆糖萼蛋白（GC）和血小板生成素（TPO）水平，以明确这些检测对于鉴别血小板过度破坏型与血小板生成减少型血小板减少症的诊断价值。特发性血小板减少性紫癜（ITP）患者的RP百分比和GC指数（根据个体血小板计数进行标准化的血浆GC水平）显著升高，而再生障碍性贫血（AA）或化疗所致血小板减少症（ChemoT）患者的RP百分比和GC指数正常或略有升高。对于诊断血小板过度破坏型血小板减少症，RP百分比的敏感性和特异性极佳，但GC指数的敏感性和特异性较低。AA或ChemoT患者的绝对RP计数和血浆GC水平显著降低，血浆TPO水平显著升高，但ITP患者的绝对RP计数和血浆GC水平中度降低，血浆TPO水平仅略有升高。血浆TPO水平诊断血小板生成减少型血小板减少症的敏感性和特异性极佳。联合使用RP百分比和血浆TPO水平可提高特异性。在常规血液学实践中，同时检测RP百分比和血浆TPO水平可能有助于鉴别病因不明的血小板减少症。
