溶血对常规生化项目检测的干扰评估

Evaluation the influence of in vitro blood cell lysis on routine clinical chemistry testing

目的:评价溶血对常规生化项目检测的干扰。方法:肝素抗凝血冻融获取溶血样本,溶血样本与血清倍比稀释获9个不同溶血程度的测试样本(0-13.4 g/L血红蛋白),检测常规生化指标并与不溶血标本比较。结果:0.14 g/L以上血红蛋白影响了Na+、Cl-、LDH的检测结果,0.56 g/L以上血红蛋白影响了CK的检测结果,1.1 g/L以上血红蛋白影响了K+、AST、TP、Cr的检测结果,2.2 g/L以上血红蛋白影响了P3-、UA的检测结果,4.3 g/L以上血红蛋白影响了Glu、AMY的检测结果,7.4 g/L以上血红蛋白影响了Ca2+、TBIL的检测结果,ALB在13.4 g/L血红蛋白时受影响,而Mg2+、ALT、GGT、ALP、BUN在13.4 g/L血红蛋白时仍不受影响。结论:各实验室可以建立各自的溶血偏倚表,遇到紧急情况(如急性胰腺炎)可以报告临床检测值及校正参考区间以供参考并通知采血复查。

Objective：The aim of this study was to evaluate the influence of in vitro blood cell lysis on routine clinical chemistry testing. Methods： Lysis was achieved by subjecting heparin anticoagulated blood to an overnight freeze-thaw cycle. Nine aliquots were prepared by serial dilutions of lysis and contained a final concentration of serum hemoglobin ranging from 0 to 13.4 g/L. Afterwards, the biochemical parameters were measured.The parameters analysed were compared to the parameters of the native serum. Results： The bias of blood cell lysis samples exceeded the quality specification of china at 0.14 g/L serum hemoglobin or more for Na＋, Cl-, LDH and at 0.56 g/L serum hemoglobin or more for CK; at 1.1 g/L serum hemoglobin or more for K＋, AST, TP, Cr-at 2.2 g/L serum hemoglobin or more for P3-, UA; at 4.3 g/L serum hemoglobin or more for Glu, AMY; at 7.4 g/L serum hemoglobin or more for Ca2 ＋, TBIL; at 13.4 g/L serum hemoglobin or more for ALB each. Of the analyses evaluated, the bias values recorded for Mg2＋, ALT, GGT, ALP and BUN were the only ones that did not achieve a clinically significant variation, even at the highest concentration of serum hemoglobin（13.4 g/L）.Conclusion： If hemolysis and blood cell lysis result from an in vitro cause, we suggest that the most convenient corrective solution might be quantification of free hemoglobin, alerting the clinicians and sample recollection.