The automatic blood cell analyzer is currently one of the most commonly used screening instruments for clinical tests at home and abroad. Compared with traditional methods, it has the advantages of high accuracy, fast speed, easy operation, and strong functions, especially the existing advanced blood cell analysis The instrument not only uses multiple detection principles to analyze and detect various blood cell detection parameters, but also can be effectively combined with blood smear preparation and staining equipment to provide more effective and accurate blood cell detection parameters for different levels of clinical needs, and diagnose diseases And treatment has important clinical significance. However, even the most advanced blood cell analyzer has its own deficiencies that cannot be remedied. Therefore, blood cell microscopy and other manual reexaminations are still necessary. Only the effective combination of automatic blood cell analyzer and blood cell microscopy can achieve a more perfect goal, and then make the detection results of the automatic blood cell analyzer more clinically practical.
1 Advantages of automatic blood cell analyzer in clinical application
The function of the automatic blood cell analyzer
In addition to the three general functions of modern blood cell analyzers (① complete blood count function; ② white blood cell classification and counting function; ③ expanded functions of blood cell count and classification function, including: nucleated red blood cell count; reticulocyte count and detection of related parameters; Immature granulocytes, immature granulocytes, hematopoietic stem cell count; immature platelet ratio; lymphocyte subtype count; blood cell immunophenotyping test, etc.), it can also know the parameters that cannot be detected by manual routine examination in the past, and then it is clinical Diagnosis and treatment provide more valuable experimental basis.
The advantages of automatic blood cell analyzer
Under normal physiological conditions, during routine blood examinations, the performance evaluations of modern blood cell analyzers are within the acceptable range, and its detection speed is high, high accuracy, and sufficient accuracy. Therefore, modern blood cell analyzers (instrumental methods) are current A recognized blood routine screening method at home and abroad.
At present, blood cell analyzers are divided into three groups and five groups. Not only the performance of the five groups of blood cell analyzers is good, but the performance of the three groups of blood cell analyzers is also very good. Relatively speaking, the three-section blood cell analyzer has a small amount of specimens, and is especially suitable for the detection and analysis of children's peripheral blood.
Expanded application of automatic blood cell analyzer
Modern advanced blood cell analyzer has naive cell detection channels, which can accurately count hematopoietic stem cells within a certain range (1~1 600)×106/L, and its detection results are not significantly different from flow cytometry detection. Therefore, the application of automatic whole blood cell analyzer to detect hematopoietic stem cells has good clinical application value in the rapid judgment of the best timing of peripheral blood hematopoietic stem cell collection, the prediction of successful stem cell collection and the observation of hematopoietic function recovery in leukemia patients.
2 Disadvantages of automatic blood cell analyzer in clinical application
Although the automatic blood cell analyzer has many advantages, in actual work, it also has fatal weaknesses.
Automatic blood cell analyzer's white blood cell classification
Because the three-section blood cell analyzer mainly uses the electrical impedance method to detect and analyze blood cell parameters, it has the disadvantage of inaccurate classification, especially when the detection and results of the intermediate cell population are abnormal. Studies have shown that when the white blood cell classification (intermediate cell group) detected by the blood cell analyzer (tripartite) is more than 10%, manual microscopic examination with Reiter staining should be done to prevent immature cells, atypical lymphocytes, and eosinophils. Pathological cells such as granulocytes were missed.
Reexamination experience of automatic blood cell analyzer
Even the most advanced five-group blood cell analyzer still has a certain false positive rate and false negative rate. Especially with the rise and development of medical testing, hematology and hematology testing have created a theory-test-disease combination. Closely connected new system, and in the process of practice continues to develop, improve and improve. Therefore, higher requirements are put forward for routine screening of clinical hematology.
Laboratory data show that formulating rules for re-examination of blood cell analyzers based on actual conditions can improve the accuracy of detection while ensuring that the workload is appropriate. To a certain extent, it can reduce the rate of missed diagnosis and misdiagnosis. Therefore, each blood routine laboratory formulates its own corresponding re-examination rules according to the actual situation, which can effectively reduce the rate of missed diagnosis and misdiagnosis.
The limitations of the automatic blood cell analyzer
There are certain limitations in either the three-part blood cell analyzer or the five-part blood cell analyzer (it cannot accurately detect changes in blood cell morphology). Therefore, in clinical work, ignoring the morphological analysis of blood cells has caused missed diagnosis and even misdiagnosis. Some scholars have used clinical examples to prove that the instrument classification method cannot express the characteristics of patients with abnormal peripheral blood morphology. Therefore, if the classification and counting results of the instrument are reported to the clinic, it is easy to miss important diagnostic information. For the cases with changes in the blood picture, there are cases where the blood cell analyzer prompts abnormalities. If the microscopic examination is not performed, the diagnosis and examination will be missed.
Changes in white blood cell morphology: immature granulocytes appear in peripheral blood, nuclei shifted to the left (increased proportion of neutral rod-shaped nuclei), nuclei shifted to the right (increased proportion of neutral lobulated nuclei) increased eosinophils or basophils, medium Neutrophil toxic lesions, atypical lymphocytes, etc.
Red blood cell morphology changes: nucleated red blood cells appear in the peripheral blood, mature red blood cells of different sizes (increased RDW), lightly stained center, stippling red blood cells, spherical red blood cells, teardrop-like red blood cells, red blood cells are arranged in a money-like arrangement.
Platelet morphology changes: EDTA-dependent pseudo-thrombocytopenia, unequal platelet size (increased PDW), platelet aggregation, accumulation and satellite phenomena make the automatic blood analyzer unable to confirm platelets and reduce the platelet count.
Other: tumor cells and parasites, etc.
In short, in clinical practice, the rate of microscopy should not be increased just to meet the standards. The determination of microscopy specimens must be based on the actual clinical situation and the prompts of blood cell analysis. The two should be considered in combination, and the prompts of blood cell analysis cannot be used as the microscopy. The screening conditions of the test specimens, some abnormal morphology, such as abnormal red blood cell morphology, changes in granulocyte poisoning, abnormal platelet morphology, etc., are not prompted by the instrument.
