Аннотация
Специфическое воздействие ЭДТА в ряде случаев может приводить к лабораторному феномену – ЭДТА-ассоциированной псевдотромбоцитопении (ПТП), при которой происходит образование in vitro агрегатов тромбоцитов. Гематологический анализатор определяет при автоматическом подсчете ложное снижение тромбоцитов, что может быть интерпретировано как истинная тромбоцитопения и приводить к принятию ошибочных клинических решений. Использование сульфата магния (MgSO4) в качестве добавки к ЭДТА исключает появление этого in vitro феномена.
Цель работы: провести сравнение информативности диагностики ПТП в зависимости от метода взятия пробы (вакуумный или аспирационный)
Материал и методы. Обследованы 50 пациентов с тромбоцитопенией неясного генеза, обратившихся за консультацией гематолога. Проведено параллельное исследование цельной венозной крови в пробах с ЭДТА и ЭДТА+ MgSO4 двух вакуумных систем (2- и 3-компонентных), полученных вакуумным и аспирационным методом. Количество тромбоцитов (PLT) определяли на автоматическом анализаторе Sysmex XN1000 флуоресцентно-оптическим методом. Морфологическая оценка тромбоцитов и наличия их агрегатов проводилась в препаратах, окрашенных по методу Паппенгейма (фиксация по Май-Грюнвальду, окраска по Романовскому-Гимзе).
Результаты. У 41 из 50 пациентов (82 %) наблюдалось истинное снижение содержания тромбоцитов. У остальных 9 пациентов (18 %) наблюдался феномен ЭДТА-ПТП. Использование MgSO4 позволило скорректировать уровень тромбоцитов до референсного диапазона в обеих группах. Определялось статистически значимое (р>0,05) увеличение MPV под воздействием ЭДТА, однако все значения находились внутри референсного интервала. По количеству лейкоцитов статистически достоверных различий между группами не обнаружено. Полученные результаты продемонстрировали высокую информативность применения обеих систем для выявления ЭДТА-ПТП.
Заключение. Добавление сульфата магния к ЭДТА при проведении гематологических исследований является перспективным направлением в диагностике ЭДТА-ПТП, позволяя выявить этот феномен вне зависимости от варианта взятия венозной крови на этапе первичного обследования пациента.
Annotation
EDTA’s specific effects can lead to a laboratory phenomenon – EDTA dependent platelet pseudothrombocytopenia (EDTA-dependent PTCP) – characterized by the in vitro formation of platelet aggregates. Hematological analyzers, during automated counting, falsely register a decrease in platelet count, potentially misinterpreted as true thrombocytopenia, leading to erroneous clinical decisions. The addition of magnesium sulfate (MgSO4) to EDTA eliminates this in vitro phenomenon
The aim — to compare the informative value of the diagnosis of PTP depending on the method of sampling (vacuum or aspiration).
Material and methods. 50 patients with thrombocytopenia of unclear origin, referred to a hematologist, were studied. Parallel analysis of whole venous blood was performed using samples with EDTA and EDTA+MgSO4 from two vacuum systems (2- and 3-component), obtained via vacuum and aspiration methods. Platelet counts (PLT) were determined using a Sysmex XN1000 automated analyzer employing a fluorescence-optical method. Morphological platelet assessment and aggregate detection were performed on smears stained using the Pappenheim method (May-Grünwald fixation, Romanowsky-Giemsa staining).
Results. True thrombocytopenia was observed in 41 of 50 patients (82 %). In the remaining 9 patients (18 %), EDTA-dependent PTCP was observed. MgSO4 addition corrected platelet levels to the reference range in both groups. A statistically significant (p>0.05) increase in MPV was observed under the influence of EDTA, although all values remained within the reference interval. No statistically significant differences in leukocyte counts were found between groups. The results demonstrated the high diagnostic value of both systems in detecting EDTA- dependent PTCP.
Conclusion. Adding magnesium sulfate to EDTA during hematological studies is a promising approach in diagnosing EDTA-dependent PTCP, allowing detection of this phenomenon regardless of the venous blood collection method during initial patient examination.
Key words: thrombocytopenia; ptcp; platelets; magnesium sulfate
Список литературы
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