危重患者血小板减少的诊治.pptxVIP

危重患者血小板减少的诊治;概述血小板减少的定义、机制、诊断思路、常用的检查方法

危重患者中血小板减少的诊断和治疗

总结

病例讨论

;;;;;;外周血涂片;裂红细胞（破碎红细胞）;球形红细胞;骨髓涂片/活检;;;抗人球蛋白试验;;;平均血小板容积（MPV，mean?platelet?volume）

Onehundredtwopatientswerecompletelyevaluated.

WhencomparedwiththeBMexamination,theMPVof7.9flcouldpredicthyperdestructive?

sensitivityof82.3%(95%CI:70.5-90.8),

specificityof92.5%(95%CI:79.6-98.4),

positivepredictivevalueof94.4%(95%CI:84.6-98.8),

negativepredictivevalueof77.1%(95%CI:62.7-88.0)

Aprospectiveevaluationofnormalmeanplateletvolumeindiscriminating

hyperdestructivethrombocytopeniafromhypoproductive0thrombocytopenia.Internationaljournaloflaboratoryhematology,2008Oct;30(5):408-14.;血小板指数?（plateletindices），包括MPV,血小板体积变异宽度（plateletsizedeviationwidth，PDW)和大血小板比率（platelet-to-large-cellratio，P-LCR)?

Thestudygroupwasdividedintotwocategories:hypoproliferativeanddestructivethrombocytopenia

Allthethree?platelet??indices?weresignificantlyhigherindestructivegroupascomparedtothehypoproliferativecategory;;血小板指数的局限性在于血小板严重下降的患者（10x10(9)/L）结果有较大的偏差，输血等治疗措施影响对结果的判断。

在ICU的应用价值需要再评估。

Roleofplateletvolumeindicesinthedifferentialdiagnosisofthrombocytopenia:asimpleandinexpensivemethod.Hematology(Amsterdam,Netherlands),2009Jun;14(3):182-6.

Increasedvaluesofmeanplateletvolumeandplateletsizedeviationwidthmayprovideasafepositivediagnosisofidiopathicthrombocytopenicpurpura.ActaHaematol.2008;119(3):173-7.;未成熟血小板比例和网织血小板比例

Group1.Central?thrombocytopenia

?IPF8.67%(6.49-10.46%)RP4.08%(2.86-5.30%)

Group2.Thrombocytopeniaasaresultofenhancedperipheral?platelet?destruction

6.80%(12.20-21.39%)，16.14%).?(P0.01).

Group3.Peripheralnon-immunethrombocytopeniabyabnormal?distribution

?9.04%(6.95-11.14%)，5.23%(3.41-7.05%).Correlationbetweenimmatureplateletfractionandreti