The Establishment Of A Grading Report Model Of Peripheral Blood Morphology And The Study Of Its Clinical Significance

Objective:According to a two tiered grading standard suggested in <ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological feature> published by the member of the international council for standardization in haematology(called “ICSH recommendations for nomenclature and grading” for short), we re-inspected the peripheral blood smear and re-reported through the method of grading to discuss the clinical significance of grading reports.The purpose is to standardize the peripheral blood cell morphological examination and report, building the mode of peripheral blood cell morphological grading reports for clinical disease diagnosis, differential diagnosis and curative effect observation.Methods:Randomly selected 473 pieces of peripheral blood smears of peripheral blood cell morphology test from January 2016 to February 2016 in clinical laboratory, the first hospital of jilin university, through a microscope to examine; According to ICSH classification standard for grading report, we found the morphology changes; Compare the positive rate of abnormal morphology of grading report with traditional report, and, by trace clinical cases,analyze the clinical significance of grading reports. Data analysis by SPSS 17.0 statistical software, use the chi-square test, alse named the Mc Nemar test, to evaluate the differences of positive rate of two kinds of reports, α=0.05, P value; use diagnostic test Kappa consistency check to evaluate The consistency of the two kinds of reports.Kappa> 0.75 consistency is better;0.75 > Kappa > 0.4 consistency in general; Kappa < 0.4 consistency is poorer; Kappa = 0 completely unrelated; Kappa = 1 completely the same.The correlation between the morphology classification of the hypochromic cells and haemoglobin is analysed using the Spearman’s rank correlation coefficient test.The statistical figure made by WPS Excel and SPSS 17.0 software.Results:(1) Red blood cells, review and grading reports: compared with the traditional report inred blood cells to check 1grading reports on red blood cell morphology of anomaly detection positive rate is higher than traditional reports, were 24.31% and 15.01%,respectively, the difference was statistically significant(P < 0.01), the consistency of the two methods of report generally(Kappa = 0.70, P < 0.01);2The positive rate of anisocytosis、microcytes and hypochromic cells were higher than the traditional report, the difference was statistically significant(P < 0.01, < 0.01, 0.03), but the consistency of the two methods of the report is better(Kappa were 0.77, 0.84, 0.93, P < 0.01); 3The sensitivity and specificity of grading report for the detection of hypochromic cells degrees were higher than traditional reports, the sensitivity and specificity of grading report for the detection of hypochromic cells degrees were 28.8% and 100%, the traditional report were 23.2% and 98.6%;3The higher the level of grading report when detected hypochromic cells, the smaller the mean value of the corresponding amount of hemoglobin; 5The positive rate of grading reports on schistocytes were highr than traditional reports, were 3.17% and 1.69%, and the difference was statistically significant, the consistency of the two methods of report is general(Kappa =0.69, P< 0.01); 6The positive rate of grading reports on oval erythrocytes were consistent with that of traditional report, but the consistency of the two methods of report were general(Kappa = 0.50, P < 0.01).(2) The white blood cells review and grading reports: compared with the traditional report on leukocyte check 1The positive rate of grading reports on white blood cells are higher than the traditional report, were 5.92% and 4.65%, and there was no statistically significant difference(P = 0.06).2The positive rate of grading reports on hypergranulation neutrophil are higher than the traditional report, were 5.07% and 3.8%, and there was no statistically significant difference(P = 0.15), the consistency of the two methods of report is general(Kappa = 0.70, P < 0.01).(3) Platelet review and grading reports: compared with traditional report on platelet examination, the positive rate of grading reports on the number of platelets are higher than the traditional report, were 3.81% and 2.75%, and there was no statistically significant difference(P = 0.06), the consistency of the two methods of report is better(Kappa = 0.81, P< 0.01).Conclusion:(1) The application of grading report detected abnormal rate of red blood cells form is superior to the traditional report, especially the positive rate of the red blood cells, can reduce disease associated with schistocytes, help provided some certain important clinical disease and determine the clinical diagnosis.(2) For the diagnosis of anemia, grading reports not only has higher sensitivity and specificty than traditional report, but also help clinical evaluate the severity of anemia. By means of the application of grading report, the higher the percenitage of hypergranulation neutrophil is, the more posible the infection is when the patient with low percentage of neutrophils.(3) Building the grading model of peripheral blood morphological can facilitate the clinical laboratory physician following the unified standard; New mode also facilitate diagnosis, differential diagnosis and curative effect observation of disease for the clinical physician.