'Doctor, how long can I get the report?' 'About an hour or so. ' 'So long! XX hospital can be twenty minutes!'
'Doctor, why do I tie my fingers before him, his results are coming out, I haven't! The order is not divided, you are really messy!'
This is a dialogue that often appears in the laboratory of the laboratory. When we hear the patient's evaluation, we have a hard time saying in our hearts. Is it better to have a report for the shorter time? Today, I will talk to you about the test. thing.
Everyone's disease state, specimen status, and test items are different. In the simplest way, in our hospital, blood routine, high-sensitivity C-reactive protein (CRP) and serum amyloid A (SAA) are included. For different projects, the time required is different, so there will be cases where the patient who has a late finger is coming out first.
Even if it is the same blood routine, it is really as simple as the 'instrument sucking a little, it will be done in a few minutes'.
One weekend, our procuratorate sent a circle of friends. What did this '1.5 hours' have experienced?
The 11-month-old baby came to our clinic to take the finger. The first time the results were as shown above, because the white blood cells are obviously elevated, so we must manually push the film and stain the microscopic examination. Under the microscope, we see a lot of nucleated red blood cells.
'Basic concept to understand: mature red blood cells in the human body are cell-free, nucleated red blood cells are actually immature red blood cells, a small amount can be seen in the peripheral blood of newborns within 1 week of birth. In severe anemia, some leukemias When pathological conditions such as myelofibrosis or bone marrow metastases are present, nuclear red may also appear in peripheral blood.
At 11 months of age, nucleated red blood cells should not appear in the peripheral blood. What is the pathological condition? We checked the test results of the child and found that he was a child with severe β-thalassemia. Thalassemia It is due to genetic defects that cause anemia caused by the lack or lack of synthesis of one or more globin chains in hemoglobin. Guangdong is a high-incidence area.
The presence of nucleated red blood cells affects the counting and classification of white blood cells by the instrument. After correction, the white blood cell count of the child has dropped from 45.81 to 12.75*109/L, and the classification has been corrected accordingly.
Can the report be sent? No!!
As we all know, the blood routine report is mainly divided into three parts, the first is white blood cell count and classification, they reflect the body's infection, immune status, etc. The second part is red blood cell count, hemoglobin and a series of red parameters, the main reaction 3. The body's hematopoiesis is the main indicator for the diagnosis of anemia. The third part is platelets, which is one of the basic items of hemostasis.
Careful observation of this blood routine report, in addition to white blood cell count and classification, platelet count, hemoglobin and erythroid parameters were affected. Due to heavy thalassemia, the red blood cells in the peripheral blood of children are small cells with low pigmentation, appearing 4. Alien, target shape, fragmented red blood cells, small red blood cells and debris interfere with platelet counts, causing false elevations.
The more difficult problem is that hemoglobin is reduced in children with severe thalassemia, the MCV and MCH of red blood cell parameters are decreasing, and MCHC is rising. Isn't it strange?
'MCV: the average volume of red blood cells, representing the average volume of each red blood cell;
MCH: the average hemoglobin content of red blood cells, representing the average hemoglobin content in each red blood cell;
MCHC; erythrocyte mean hemoglobin concentration, representing the average hemoglobin concentration per liter of red blood cells.
Table 1 MCV, MCH, MCHC reference values
According to experience, we suspect that the child may have lipemia. After a few turns, I finally contacted the family of the child and asked the child to re-extract a blood routine. After centrifugation, the blood berry of the child was found to have a marked lipemia state. After the salt water was equally replaced by the plasma, the red line parameters were re-detected, and finally the real result was obtained. In the normal work, we encountered several cases of thalassemia children with severe blood lipids, which made the hemoglobin measurement value significantly higher. In practice, it masks the severity of anemia in children, so the result of a significant increase in MCHC alone, we need to be cautious.
After 1.5 hours, through a push film reading, contact the parents to draw blood, three saline washes to replace the lipemia plasma, five times on the machine retest, we corrected a rough result, the final result is as follows The figure shows.
Table 2 Blood routine results before and after correction
In twenty minutes, you can get the inaccurate result on the left, and the real result on the right may take about 2 hours or more. In today's fast food fast food era, everyone is in a hurry, but people I am willing to spend a few hours to make a beautiful haircut, spend a few hours playing games, but I don't want to be patient and wait for a test report. Today, we are talking about the simplest and most common inspection project, and Many project inspection processes are more complicated and have many influencing factors, and quality control is also a very important routine work in the laboratory.
We understand the patient's feelings waiting for results. In fact, we have to do hundreds of thousands of tests every day. We are more willing than the patients to send all the reports in the shortest time. When you are anxiously waiting, we may be doing Give you a reliable result and do a tedious re-examination. If you have any questions, you may wish to communicate with the staff in a timely manner.
About the author: Luo Yasha, MD, Guangdong Provincial Maternal and Child Health Hospital
