标本部分凝集对凝血常规检测结果的影响

The influence of partially clotted sample on routine coagulation assay

目的评价标本部分凝集对凝血常规检测结果的影响,寻求处理部分凝集标本的实用方法。方法对比分析同一患者(累计55例)8 h内部分凝集与正常合格标本PT,FIB,APTT,TT检测结果的差异,将其差异百分比与生物学变异及检测不精密度比较以确定其临床意义。结果部分凝集标本较正常合格标本PT,FIB,APTT,TT明显降低(P<0.01),PT均值接近正常参考范围低限,FIB,APTT均值低于正常参考范围,TT尚正常;部分聚集标本与正常合格标本相比,约75%的患者PT差异百分比<10%;约67%患者FIB差异百分比<15%;约44%患者APTT差异百分比<10%;82%患者TT差异百分比<10%。结论 FIB,APTT同时降低提示标本内可能有小凝块存在,标本部分凝集造成的凝血常规检测结果的偏差可能不影响临床决策,在重抽复查困难且结果不超出临床决定水平的患者可不复查。

Objective To evaluate the influence of partially clotted sample on routine coagulation assay, and find a practical method to deal with these samples. Methods The prothrombin time （PT）, fibrinogen （Fbg）, activated partial thromboplastin time （ APTT）, thrombin time （TT） were compared between partially clotted samples in 8 hours and normal qualified samples in the same patient（ totally 55 cases） to analyze the difference, and the difference percentage was compared with biological variation and detection imprecision to identify the clinical significance of the partially clotted samples reexamination. Results Compared to normal qualified samples, the PT, FIB, APTT, Tr of partially clotted samples were obviously lower（P 〈 0.01 ）, and the mean PT value was close to the low limit of normal reference range, that of FIB and APTr was lower than normal reference value, while mean 3＂T was normal. Compared with normal qualified samples, about 75% of the partially clotted samples demon- strated percentage changes below 10% for PT, about 67% of those demonstrated percentage changes below 15% for FIB, about 44% demonstrated percentage changes below 10% for AprIT, and about 82% demonstrated percentage changes below 10% for Tr. Conclusion Both FIB and APTT decrease may indicate that there is clot in the test samples. The clinical decision making may not be influenced by the routine coagulation assay results deviation resulting from partially clotted samples, so those patients with difficulty in sampling and reexamination, whose test results are not beyond the clinical decision level, can avoid the reexamination.