嗜酸性粒细胞假性增高1例病例分析

A Case Analysis of Pseudo-Elevation of Eosinophils

摘要: 目的：探讨临床检验中嗜酸性粒细胞假性增高的成因、鉴别方法及解决策略，为临床检验提供参考。方法：对1例血常规检测中出现嗜酸性粒细胞显著假性增高的病例进行回顾性分析，结合全自动血细胞分析仪检测结果、血涂片瑞氏染色人工镜检结果、患者临床资料及重新采血复检结果，分析假性增高的原因，并总结相应的检验流程措施。结果：该患者首次血常规检测显示嗜酸性粒细胞百分比33.7%，显著高于正常参考值，且散点图显示嗜酸性粒细胞位置异常；人工镜检未见嗜酸性粒细胞，中性粒细胞占比显著升高；排除仪器、试剂因素后重新采血复检，嗜酸性粒细胞指标恢复正常(0%)，镜检结果与仪器检测结果一致。结合临床资料后查阅文献，推测首次检测结果异常为患者处于急性感染早期，大量内毒素入血改变了中性粒细胞的结构，被仪器误判为嗜酸性粒细胞。结论：全自动血细胞分析仪检测存在一定局限性，患者急性感染早期，可能出现嗜酸性粒细胞假性增高，检验人员需结合散点图、涂片镜检、患者临床信息综合判断，必要时重新采集血液复检，以保证检验结果的准确性，为临床诊断提供可靠依据。

Abstract: Objective: To investigate the causes, identification methods and countermeasures of pseudoeosi- nophilia in clinical laboratory testing, so as to provide references for clinical laboratory practice. Methods: A retrospective analysis was performed on one case with marked pseudoeosinophilia detected in routine blood examination. The cause of false elevation was analyzed based on test results from the automatic hematology analyzer, manual microscopic examination of Wright-Giemsa-stained blood smears, clinical data of the patient, and repeated blood sampling and retesting results. Corresponding improvements in laboratory procedures were summarized. Results: Initial routine blood test showed that the percentage of eosinophils was 33.7%, significantly higher than the normal reference range, with abnormal distribution in the eosinophil region on the scattergram. Manual microscopic examination revealed no eosinophils but a markedly increased proportion of neutrophils. After excluding instrumental and reagent errors, repeated blood testing showed a normal eosinophil percentage of 0%, consistent with microscopic findings. According to clinical data and literature review, the abnormal initial result was presumed to be due to the patient’s early stage of acute infection, in which a large amount of endotoxin entered the bloodstream and altered the structure of neutrophils, leading to misclassification as eosinophils by the analyzer. Conclusion: Automatic hematology analyzers have certain limitations in cell classification. Pseudoeosinophilia may occur in patients during the early stage of acute infection. Laboratory staff should make a comprehensive judgment combining analyzer scattergrams, blood smear microscopy and clinical information, and perform repeated blood sampling and retesting when necessary, to ensure the accuracy of test results and provide reliable evidence for clinical diagnosis.