影响凝血四项检测结果异常原因的分析

Analysis on the abnormal causes of the four detection results of coagulation

目的分析凝血标本的采集量、离心时间、离心速度、储存时间和标本是否溶血等对PT、APTT、TT、Fib四项检测指标的影响,便于日常检测过程中控制。方法回顾性分析2016年1月至2016年12月在我院检验科检测859例不同因素的凝血标本对PT、APTT、TT和Fib四项指标影响的临床资料。结果采血量<2.0 ml标本和>2.0ml标本检测PT、APTT和TT结果均明显长于重新采血合格的标本(P<0.05),Fib检测结果短于重新采血合格的标本(P<0.05);标本经5、10、15min后不同离心时间检测PT、APTT、TT和Fib结果间比较(P>0.05);标本经4 000r/min离心5min和3 000r/min离心15min,其四项检测结果间无统计学差异(P>0.05);标本在室温(20℃-25℃)环境下储存1h后检测凝血四项结果与立即送检标本检测结果比较(P>0.05);标本储存4h后检测APTT长于储存2h标本,TT明显短于储存2h标本(P<0.05),PT和Fib检测结果与储存2h标本比较(P>0.05);标本在4℃环境下储存1h、2h、4h后检测凝血四项结果,不同时间之间比较(P>0.05),不同储存时间段与立即送检标本检测凝血四项结果比较(P>0.05),溶血标本检测PT和APTT结果明显短于未溶血标本检测的结果(P<0.05);溶血标本检测TT结果明显长于未溶血标本(P<0.05);溶血标本检测Fib结果与未溶血标本(P>0.05)。结论抗凝比例不合适、室温时间储存过长和标本溶血与否等都是导致检测结果准确性和可靠性异常原因,可用4 000r/min离心5min替代3 000r/min离心15min以更快速地向临床报告检测结果。

Objective Analysis of blood samples collection, centrifugal time, centrifugal speed, storage time and specimen whether hemolysis influence factors and detection of plasma prothrombin time （PT）,activated partial thromboplastin time （APTT）,thrombin time （TT） and fibrinogen （FIB） quantitative four results, which is convenient for daily inspection process control. Methods Retrospective analysis from January 2016 to December 2016 in our hospital laboratory test 859 cases of different factors of coagulation specimens for PT, APTT, TT and Fib four indicators of clinical data. Results PT,APTT and TT results were significantly longer than the qualified samples （P〈0.05） were test by blood sampling volume 〈2.0 ml 〉 and 〉2.0 ml specimens. Fib test results are shorter than the re sampling of qualified samples （P〈 0.05）. The results of APTT,TT and PT were test by 5,10,15min, and Fib results after different centrifugation time （P〉0.05）. There was no statistical differences between the samples centrifugated by 4 000 r/ min 5 min and 3 000 r/rain 15 rain （P〉0.05）. Specimens at room temperature （20 to 2℃） storage 1h test after coagulation four results and immediately specimens testing results （P〉0.05）,The specimens were stored in 4 h and the APTT was longer than that in 2 h specimens,TT was significantly shorter than that of 2 h specimens （P〈0.05） ; PT and Fib testing results were compared with stored 2 h specimens（P〉0. 05）. The samples were stored at 4℃ environment 1 H,2 h, 4 h after the testing of coagulation four results, the comparison between different time （P〉0.05） ,comparison of different storage time and immediately specimens of four items of blood coagulation detection results （P〉 0. 05）. Hemolysis tests of PT and APTT was significantly shorter in hemolysis test results （P〈 0. 05）; hemolysis specimens for the detection of TT results significantly longer than without hemolysis （P〈0.05） ; FIB results of hemolysis and not hemolysis （P〉0.05）. Conclusion The inappropriate proportion of anticoagulation,inappropriate storage in room temperature for long time,and hemolysis specimen or not, are the causes of the detection accuracy and reliability of the anomaly. We could use 4：000 r/min centrifugation 5min replacing 3 000 r/min centrifugation 15rain for reporting the detection results to clinicians quicker.