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[乙二胺四乙酸(EDTA)所致假性血小板减少症(病例报告)]

[Pseudothrombocytopenia caused by ethylenediaminetetraacetic acid (EDTA) (case report)].

作者信息

Putarek K, Vuk T, Soldo D, Sarlija D, Grgicevic D, Jaksić B

机构信息

Odjel hematologije Klinike za unutarnje bolesti KB Merkur, Zagreb.

出版信息

Lijec Vjesn. 1997 Jan;119(1):19-21.

PMID:9213726
Abstract

Pseudothrombocytopenia is a laboratory artefact that can introduce serious problems in diagnosis and treatment in patients with low platelet count. The most common reason for this artefact is in vitro platelet clumping in blood samples collected into ethilenediaminetetraacetic acid (EDTA) anticoagulant. The clumping activity is greater at temperatures less than 37 degrees C, and the EDTA concentrations required for clumping are 20 times below anticoagulant concentrations. In this article we described the case of a female patient with diagnosed EDTA induced pseudothrombocytopenia. The cause of incorrectly low platelet counts was proved by simultaneous analysis in blood samples collected into EDTA anticoagulant and into heparin as a control sample. Absences of incorrectly low platelet count in heparin sample and rapid decrease of platelet count in EDTA sample were noticed. Decrease in platelet count was accompanied by increase in the number of leukocytes, so called pseudoleukocytosis. Careful examination of blood film is necessary to establish correct diagnosis, promptly after the blood collection and approximately two hours later. It is important to verify formation of clumps two hours after the blood collection and also progressive reduction in the platelet count in EDTA sample. By blood assessment conducted in this concern it is possible to avoid severe misinterpretation in such patients.

摘要

假性血小板减少症是一种实验室假象,可给血小板计数低的患者的诊断和治疗带来严重问题。造成这种假象的最常见原因是采集到乙二胺四乙酸(EDTA)抗凝剂中的血液样本在体外发生血小板聚集。在低于37摄氏度的温度下,聚集活性更强,发生聚集所需的EDTA浓度比抗凝剂浓度低20倍。在本文中,我们描述了一例诊断为EDTA诱导的假性血小板减少症的女性患者。通过对采集到EDTA抗凝剂中的血液样本和作为对照样本的肝素抗凝血液样本同时进行分析,证实了血小板计数错误降低的原因。观察到肝素样本中不存在血小板计数错误降低的情况,而EDTA样本中的血小板计数迅速下降。血小板计数下降伴随着白细胞数量增加,即所谓的假性白细胞增多症。采血后及大约两小时后,必须仔细检查血涂片以做出正确诊断。重要的是要在采血两小时后确认是否形成凝块,以及EDTA样本中血小板计数是否逐渐降低。通过对此类情况进行血液评估,可避免对此类患者的严重误诊。

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