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GI腸胃科
1. PEIT 經皮肝腫瘤酒精注射術
2. Liver abscess aspiration/drainage 肝膿瘍抽吸/引流術
EPHRO腎臟科
1. Kidney biopsy 腎臟切片_VS趙
2. Kidney biopsy腎臟切片_VS陳
CM胸腔科
1. Pleurodesis肋膜沾黏術_VS柯
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假性的血小板數目低下有部分是因為常規血球計數檢查中加入的EDTA導致血小板黏著在一起 (platelet clumping)而造成,機率約為1/1000,且與病患本身所患的疾病種類完全無關。診斷必須藉由週邊血液的抹片來加以確認。
UpToDate:
Pseudothrombocytopenia — The platelet count can be falsely low in a number of clinical situations:→許多臨床狀況都會造成血小板假性低下。
>If anticoagulation of the blood sample is inadequate, the resulting thrombin-induced platelet clumps can be counted as leukocytes by automated cell counters. In these circumstances, the WBC count is rarely increased by more than 10 percent and there is usually an associated spurious thrombocytopenia [10]. →血液在試管內沒有充分和抗凝血劑作用,可能會造成thrombin-induced platelet clumps,聚集的血小板團會被計數器當作是一顆白血球,因此白血球數量甚至有時候上升超過10%。
>Approximately 0.1 percent of normal subjects have EDTA- dependent agglutinins which can lead to platelet clumping and spurious thrombocytopenia and spurious leukocytosis. This is thought to result from a "naturally occurring" platelet autoantibody directed against a normally concealed epitope on the platelet membrane glycoprotein (GP) IIb/IIIa, which becomes exposed by EDTA-induced dissociation of GP IIb/IIIa [11-17]. Pseudothrombocytopenia then occurs because EDTA is the anticoagulant employed in the tubes used for routine complete blood counts. →正常人有1/1000會發現EDTA- dependent agglutinins引起的platelet clumping。
(機轉請讀UpToDate: Thrombocytopenia induced by glycoprotein IIb/IIIa inhibitors)
>Pseudothrombocytopenia can also occur after the administration of the murine monoclonal antibody abciximab, which is directed against the GP IIb/IIIa receptor [18]. EDTA-induced platelet clumping can be diagnosed by examination of the peripheral smear. This is an established routine for laboratory technologists, but sometimes the physician only receives the report of the falsely low platelet count number, without the note about clumping or a repeat count in a non-EDTA anticoagulant. → 給了abciximab (ReoPro®) 也可能造成假性血小板低下。ETDA引起的血小板團可藉由檢查周邊血液(PB smear)確診。對醫檢師來說應該是很常規的事情,但有時候臨床醫師只看報告就認定是血小板低下,卻忘了可能是platelet clumping或再做一次非EDTA抗凝劑的血球計數來確認。
>If platelet clumping is observed, the platelet count is repeated using heparin or sodium citrate as an anticoagulant. If citrate is used, one should remember to correct the platelet count for dilution caused by the amount of citrate solution used; no such correction is needed for heparin. Alternatively, one can use freshly-shed non-anticoagulated blood pipetted directly into platelet counting diluent fluid. →EDTA不行就換其他凝血劑,換heparin or sodium citrate試試看。藍頭PT/aPTT試管用Sodioum Citrate當抗抗凝血劑,不過因為Citrate的量會輕微稀釋血液(一管內約0.3-0.4ml),記得要矯正過。
下次看到血小板低下,不妨用藍頭管送個CBC吧~~~! !


01078038_20091216_CR_1_2
2009/11/11 04:09
文/李祥和
疲勞嗎?如果你經過休養,疲勞依舊,肝功能指數也沒有回復正常,要留意,這是肥胖導致的脂肪肝炎在作怪!
再怎麼休養 肝功能指數還是高
臨床上,經常有病人反應,自己沒有罹患B型肝炎、C型肝炎,沒有糖尿病病史,也不喝酒,卻出現疲倦、食慾不振、黃疸等狀況,加上有體重過重、脂肪肝與高三酸甘油脂等問題,經抽血驗肝功能指數(GOT與GPT)結果果真高出正常值許多。
肝臟是沉默的器官,雖然沒有不舒服的感覺,其實已有了狀況,因此要靠抽血檢驗、腹部超音波等方法來檢驗。譬如:我們會例行抽血檢驗肝功能指數(GOT與GPT),以了解肝臟細胞有沒有壞死、發炎的情形。
如果GOT與GPT指數偏高,表示肝臟正被破壞而發炎,釋出酵素GOT與GPT至血液中,而被偵測出來。日常生活中,僅能靠自我感覺身體不適症狀。雖然,肝功能指數不好的症狀往往是疲倦、食慾不振、黃疸等症狀,但7成往往無症狀。等到出現症狀時,病情已進展到不可收拾的程度。
常見肝功能不好的原因有:肥胖導致脂肪肝炎、高血脂、B型肝炎、C型肝炎、糖尿病、酗酒、藥物等。如果充分仔細檢查其中病因,將會發現脂肪肝炎已經悄悄站上肝功能不好的冠軍寶座,而肥胖往往就是背後主要原因。
◎如何減肥,防治脂肪肝炎呢?在日常生活就應該要努力控制:
●每天固定精確地量體重,以自我提醒。
●最好每天吃5到7小碟蔬菜。
●水果限兩顆,約兩個拳頭大。
●任何含糖飲料切記不可以喝。
●以恆心運動,使身體代謝。
●隔餐勿超過6小時,故三餐都要吃,以免引發飢餓或代謝停阻。
●不可過速脫水減重,卻不去減脂肪。
●細嚼慢嚥,每口食物嚼20下,要享受食物滋味,避免吃太快而多吃!
●學習辨識食物熱量,知道自己在吃什麼?
●要永遠控制體重在合宜範圍!
(作者為台北縣祥和診所主任醫師)
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