Pseudohyperkalemia with Myelofibrosis after Splenectomy

SEUDOHYPERKALEMIA refers the serum potassiumlevel is higher than plasma potassium due tovarious reasons in vitro monitoring, but actualpotassium level in vivo is at the normal range. Aseries of inappropriate clinical interventions due to initialfailure to recognize it may actually decrease potassiumlevel，which could cause life-threatening condition. Here wereport a patient with myelofibrosis who occurred spurioushyperkalemia after splenectomy, aiming at emphasizingthe importance of recognizing pseudodyperkalemia.

Pseudohyperkalemia caused by essential thrombocythemia in a patient with chronic renal failure: A case report

BACKGROUND Hyperkalemia is one of the most common complications of chronic renal failure.Pseudohyperkalemia is caused by elevated levels of serum potassium in vitro and is usually accompanied by thrombocythemia.Although an elevated level of potassium is typically correlated with impaired renal function,pseudohyperkalemia has been rarely reported in patients with chronic renal failure.Here,we conducted a review of the literature to study the case of pseudohyperkalemia caused by the essential thrombocythemia in a patient with chronic renal failure.CASE SUMMARY A 73-year-old woman was admitted to our hospital with complaints of palpitation,dyspnea,and acratia for 2 d and a history of essential thrombocythemia for 1 year.The routine blood test showed platelet count of 1460×10^9/L,and biochemistry tests showed that the patient suffered from hyperkalemia(potassium:7.50 mmol/L)and renal failure(estimated glomerular filtration rate:8.88 mL/min).Initial treatment included medicines to lower her potassium-levels and hemodialysis.However,the therapy did not affect her serum potassium levels.Plasma potassium concentration measurements and a history of essential thrombocythemia established the diagnosis of pseudohyperkalemia.The treatments of the platelet disorder gradually normalized serum potassium levels;however,the treatments had to be discontinued later due to the severe leukopenia,and enhanced levels of serum potassium concentrations were observable in the patient.Since plasma sampling was not permitted,doctors had to use a diuretic just in case.Finally,the patient collapsed into unconsciousness and died due to multiple organ dysfunction and electrolyte disturbance.CONCLUSION We reviewed the literature and suggest that serum and plasma potassium values should both be measured for patients whose platelet counts exceed 500×10^9/L to eliminate chances of pseudohyperkalemia,especially for those with chronic renal failure.An inappropriate treatment for pseudohyperkalemia can aggravate a patient's condition.

静脉采血时握拳时间过长导致假性高钾血症2例及文献复习

目的 通过分析两例血钾增高患者的临床表现和实验室结果特点,为识别采血过程中握拳导致的假性高钾血症及促进规范采血过程提供依据。方法 查阅患者病历并与患者、采血护士、医生进行沟通确认高钾与临床表现的符合性及采血过程中的影响因素;进行握拳试验、检测同时采集的多个样本分析血钾的连续变化特点;查阅文献并结合前述结果进行综合分析。结果 1例为糖尿病患者,肾功正常。在采血过程中全程紧握拳头。行握拳试验结果为:不握拳采样血钾为4.5mmol/L,握拳1min立即采样血钾为5.1mmol/L。另一患者因身材矮小就诊,无高钾血症相关病因及临床表现。该患者同一时间采集的6个血清管样本血钾结果由5.4mmol/L升高到6.2mmol/L。2例患者均排除样本溶血、输液、容器错误、高白细胞、高血小板、样本保存与处理不当等导致血钾增高的因素。结论 采血时握拳时间过长可导致假性高钾血症,在临床工作应注意鉴别,并通过规范采血过程避免此类问题。

气动物流传输系统致白血病患者假性高钾血症

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。

儿童反应性血小板增多症与假性高血清钾症的相关性实验研究

目的探讨反应性血小板增多症患儿血小板数（PLT）对血清钾测定的影响及临床意义。方法对26例中度反应性血小板增多症（PLT〉400×10^9／L）、36例轻度反应性血小板增多症（PLT300-400×10。／L）、82例血小板数正常（PLT100～300×10^9／L）和21例血小板数减低（PLT〈100×10。／L）患儿，分别用离子选择电极法测定血清和血浆钾，用SYSMEXXS-800i电阻抗全血细胞计数仪检测血小板。结果中度反应性血小板增高症组和轻度反应性血小板增高症组血清钾明显比血小板数正常组和血小板数减低组高（F=11．83，P〈0．01），血清钾分别为（5．05士0．93）mmol／L、（4．66±0．62）mmol／L、（4．26±0．54）mmol／L和（4．28±0．58）mmol／L；而血浆钾4组比较差异却无统计学意义（F=0．27，P〉0．05）。当PLT〉300×10。／L时，血小板数与血清钾呈正相关，血清钾Y（mmol／L）=0．0021x＋3．87（PLT×10^9／L），r=0．78。无论中度反应性血小板增高症组还是轻度反应性血小板增高症组，其血清钾均高于血浆钾（t=2．75～3．02，P〈0．01～O．005），而血小板数正常组及减低组血清钾与血浆钾检测比较，差异均无统计学意义（P〉0．05）。结论反应性血小板增多症患儿血小板数对血清钾测定有正干扰——可因人工分离血清而引起血清钾假性增高；在高血钾症的诊治过程中，应排除假性高血钾症的干扰。

血小板增多导致血清假性高钾的修正

目的研究血小板增多与假性高血钾之间的关系,建立修正公式对假性血钾水平进行修正。方法将52例血小板增多患者的血清钾与血浆钾差异值(K-difference,DK)、血小板数量(PLT)和血小板平均体积(MPV)作为重要变量进行回归分析。结果根据回归方程得到修正公式:血钾值=血清钾-血小板数量×0.001-0.009(r=0.914)。结论该修正公式简单实用,准确可靠,可估算血小板增多患者的真实血钾水平。

临床常见假性高血钾的原因分析及护理对策

目的对临床常见假性高血钾的原因从护士因素、患者因素、标本运送三方面进行分析,并提出护理对策。方法将我院神经内科两个病区的30名护士(每个病区15名)分为研究组和对照组,对研究组进行采血知识的培训、强化护患沟通,加强标本运送的效果,比较一年内两组操作后假性高血钾的发生率。结果研究组假性高血钾的发生率低于对照组(P<0.01)。结论提高护士的专业知识及操作水平,做好患者评估和护理,可明显降低假性高血钾发生。

血小板增多症导致假性血钾升高9例

目的研究血小板增多症患者的临床特点,以提高临床医生对血小板增多症引起假性血钾升高这一现象的认识,避免误诊高钾血症或漏诊低钾血症。方法测定9例血小板增多症患者的血浆钾浓度及采取血样后即刻血清钾浓度,进行对比分析,选取其中1例患者血液样本,测定其放置2 h的血清钾浓度。同时测定7例血小板计数正常患者的血清钾及血浆钾浓度作对照观察。结果 9例血小板增多症患者血清钾及血浆钾浓度检测结果显示,血清钾水平均高于血浆钾。9例患者血小板计数在（431~2448）×10~9/L,血清钾与血浆钾浓度差在0.47~2.53 mmol/L,平均浓度差为1.35 mmol/L。3例患者血清钾检测显示有高钾血症,但血浆钾浓度在正常范围内,无高钾病因及临床表现,诊断为假性高钾血症;2例患者血清钾检测在正常范围内,但血浆钾浓度显示有低钾血症。9例患者平均血清钾浓度（5.34±0.70）mmol/L与平均血浆钾浓度（3.99±0.55）mmol/L比较,差异具有统计学意义（P〈0.05）。1例患者测定了即刻血浆钾及放置2 h的血清钾浓度,发现血清钾水平随标本放置时间的延长而升高。7例血小板计数正常患者血清钾及血浆钾浓度差在-0.31~0.24 mmol/L,平均浓度差为0.104 mmol/L。7例血小板计数正常患者平均血清钾浓度（3.76±0.38）mmol/L与平均血浆钾浓度（3.65±0.38）mmol/L比较,差异无统计学意义（P〉0.05）。结论对于血小板增多症的患者,血浆钾浓度更能反映体内真实血钾水平;标本应在采样后尽快送检;血小板计数正常的患者其血清钾与血浆钾浓度差别较小,不影响临床判断。

A latent form of essential thrombocythemia presenting as portal cavernoma

Essential thrombocythemia is frequently associated with abdominal thrombotic complications including portal cavernoma as a consequence of chronic portal vein thrombosis.Essential thrombocythemia in a latent form is difficult to identify at onset due to the absence of an overt disease phenotype.In the presented case report,the diagnosis of essential thrombocythemia was initially missed because the typical disease phenotype was masked by bleeding and hypersplenism.The correct diagnosis was only reached when the patient experienced persistent thrombocytosis and pseudohyperkalemia after a shunt operation.

骨髓增殖性肿瘤中假性高钾血症现象的研究

目的研究骨髓增殖性肿瘤（MPN）中影响血清钾检测的主要因素。方法收集268例初诊MPN患者及60例健康体检者血常规及生化系列结果进行统计分析，并对其中20例血清钾升高患者进行血浆钾、血气分析检测。结果在MPN中，血小板计数与血清钾呈明显正相关（P=0．000、0．001、0．006）；红细胞压积与血清钾之间无明显相关（P=0．829、0．372、0．031）；白细胞计数只在慢性粒细胞白血病（CML）中与血清钾呈明显负相关（P=0．000）；在原发性血小板增多症（ET）中静脉血糖与血清钾存在明显负相关（P=0．000）。结论在MPN中，细胞成分中血小板计数升高是导致假性高钾血症的最主要原因；静脉血糖可以协同血小板计数来鉴别假性高钾现象；血气分析检测的全血钾浓度能较好地反映体内血钾水平。