建立台灣族群未成熟血小板生物參考區間

Establishment of Reference Range for Immature Platelet Fraction in Taiwanese Population

背景 : 目前自動化機台檢測項目中，可針對網狀血小板 (reticulated platelets) 殘存的核糖核酸 (RNA) 進行染色，藉此分析未成熟血小板 (immature platelet fraction, IPF%) 比例。而透過IPF%也可以了解骨髓中巨核細胞 (megakaryocyte) 的成熟情況，藉此應用於幹細胞移植、血液凝固疾病、用藥、感染、血小板低下與輸血等，將IPF%推廣到臨床檢驗中。然而目前國內大部分醫院並未將此項目納入常規檢驗中，且國內文獻與國際建立的生物參考區間有落差，因此希望建立屬於台灣族群的生物參考區間，以提供醫師做為診斷和治療依據，進一步探討IPF與各種疾病之間的關係。
方法 : 收集2080名成年人針對自動化機台XN-10 IPF%數據進行分析，已排除離群值 (outlier)、貧血、血小板異常、發炎、具有不成熟白血球或非典型淋巴細胞，建立生物參考區間。
結果 : 使用四台儀器間相關性與再現性俱佳之自動化機台XN-10，收集年齡22-88歲之969名女性與1111名男性，因數值並非常態分布，故以第2.5百分位與第97.5百分位之數值作為生物參考區間上下限，以此建立IPF百分比生物參考區間為1.1%-9.0%，IPF絕對值生物參考區間為2.9-18.7x103/μL。
結論 : 以年齡、性別與生化數值異常三種不同條件進行分析，其生物參考區間差異極小，表示IPF%不受此三種因子影響。未成年人與新生兒檢體較不易收集，日後我們會收集更多資料以建立屬於這兩族群的生物參考區間。透過本研究建立的台灣族群IPF生物參考區間，未來將應用於臨床相關疾病，提供醫師參考使用。

Background : Currently available automated blood cell analyzers stain the residual ribonucleic acid (RNA) of reticulated platelets to detect the proportion of immature platelet fraction (IPF, %) in the blood. IPF can be utilized to evaluate the maturation of megakaryocytes in the bone marrow, and applied to various aspects of patient care, such as stem cell transplantation, coagulation disorders, medication prescription, infectious diseases, thrombocytopenia and transfusion medicine. However, most hospitals in Taiwan have not included this testing into routine testing, and the biological reference range of IPF set up in foreign countries may not be the same for ethnic groups. Therefore, we hope to establish a biological reference range for Taiwanese, so that doctors can use this reference range to facilitate diagnosis and treatment, and correlate the relationship of IPF and various diseases in the future.
Method : To establish reference range of IPF, we collected IPF data from 2080 adults, analyzed by the XN-10 automated blood counter. We excluded the patients with outlier IPF values, anemia, platelet abnormalities, inflammation, immature leukocytes or atypical lymphocytes.
Result : 969 females and 1111 males aged 22-88 years were collected through the XN-10 automated blood counter exhibit correlation and reproducibility among four individual instruments. Based on the non-normal distribution of the values, the 2.5th percentile and the 97.5th percentile are used as the upper and lower bounds of the reference range of IPF, which is 1.1%-9.0% (absolute value: 2.9-18.7x103/μL).
Conclusion : The analysis was carried out under three different conditions, including age, gender and abnormal biochemical values. We found that the difference in the biological reference range was very small, indicating that IPF was not affected by these three factors. Since samples from minors and newborns are more difficult to obtain, so we plan to collect more data for these two groups to establish the IPF reference range in the future. On the other hand, we have established the Taiwanese biological reference range of IPF, it can be applied to various clinically relevant diseases and provided as a diagnostic or treatment surveillance factor for clinician.