气动物流传输系统致白血病患者假性高钾血症

Pseudohyperkalemia of Leukemia Patients with Hyperleukocytosis Caused by Pneumatic Tube System

目的探讨采用气动物流传输系统运输白细胞显著升高白血病患者的血液标本对血钾检测结果的影响。方法分析2013年7月至2015年7月北京协和医院检验科急诊生化实验室发现的4例白血病患者假性高钾血症相关临床指标,包括临床诊断、标本运输方式、白细胞数量、血浆钾离子浓度、血气钾离子浓度、部分血清钾离子浓度、化疗情况、心电图等临床信息。以同期10例感染性疾病合并类白血病反应患者和50例白细胞数量正常非血液系统疾病患者的以上临床指标作为对照组,比较气动运输和人工运输对白细胞不同功能状态、不同标本类型、不同容器标本血钾结果的影响。结果 4例白细胞数量显著升高(206.8×10~9/L^652.1×10~9/L)白血病患者肝素锂抗凝静脉血标本通过气动传输导致血钾明显升高(5.9~14.8 mmol/L);气动传输对血气标本、血清管标本的血钾无明显影响;而气泵运输方式对于对照组的肝素锂抗凝静脉血标本和血气标本的血钾水平无显著影响(P>0.05)。结论对于白细胞显著升高的白血病患者,采用气动物流传输系统运输肝素锂抗凝的静脉血标本可导致血钾假性升高。

Objective To invest the effects of pneumatic tube system （ PTS） transportation on blood po-tassium measurement result in leukemia patients with hyperleukocytosis. Methods Clinical data of four leuke-mia patients with pseudohyperkalemia detected in emergency laboratory of Peking Union Medical College Hospital in the period from July 2013 to July 2015 were collected and reviewed to retrospectively analyze clinical diagno-sis ,sample transportation method, white blood cell count, plasma potassium level, arterial whole blood potassium level, partial serum potassium level, chemotherapy, and electrocardiogram. We also collected the above informa-tion of 10 cases of infectious disease with leukemoid reaction and 50 cases of non-blood system disease patients with normal white blood cell counts as control group from the same period. We compared the effect of different transportation methods （ PTS vs. manual transportation） on blood potassium levels in different white blood cell functional status, sample types, and sample containers. Results In the 4 leukemia patients with high periph-eral blood white cell count （206. 8 × 109/L -652. 1 ×109/L） , potassium concentration in lithium-heparin ve-nous blood samples transported by PTS was strikingly elevated （5. 9 - 14. 8 mmol/L） , while the level of potas-sium of arterial whole blood and serum samples transported simultaneously by PTS were not influenced. There was no significant effect of PTS on plasma potassium levels of venous and arterial whole blood samples transpor-ted by PTS in controls （ P 〉 0. 05 ）. Conclusion The plasma potassium level in lithium-heparin venous blood samples of leukemia patients with high peripheral blood white cell count may be elevated if transported by PTS, which will lead to pseudohyperkalemia.