McGlasson D L, More L, Best H A, Norris W L, Doe R H, Ray H
Wilford Hall Medical Center, Lackland AFB TX 8236-5319, USA. davemcglasson.hotmail.com
Clin Lab Sci. 1999 May-Jun;12(3):137-9.
Three recent studies discussed the possibility that the National Committee for Clinical Laboratory Standards (NCCLS) recommendations that the coagulation specimen should be the second or third tube collected are unnecessary. However, only one reagent/instrument was used in each study. Our protocol differed from the previous studies because we performed the assays on three different reagent/instrument systems on the same samples. Our study used photo-optic, mechanical, and nephelometric systems of clot detection. After obtaining informed consent, we obtained two blue-stoppered tubes of blood from 95 subjects: 15 normal patients and 80 patients currently on coumadin therapy. No discard tube was drawn for coagulation testing. A prothrombin time with an international normalized ratio and an activated partial thromboplastin time, were performed on each tube. Laboratory One used a MLA 1600C (Hemoliance) with Thromboplastin DS (Pacific-Hemostasis, ISI of 1.11) and APTT-LS (Pacific-Hemostasis). Laboratory Two used an STA (Diagnostica-Stago) with Neoplastine CI+ (Diagnostica-Stago, ISI of 1.14) and PTT-LT (Diagnostica-Stago). Laboratory Three used an ACL 300 with Plastinex (Biodata, ISI of 1.67) and Actin FSL (Dade Behring). No clinical or statistically significant differences were seen between the first or second tubes on any of the three reagent/instrument combinations in the PT in seconds, international normalized ratio reporting, or APTT results. Our results indicate that the NCCLS guidelines for obtaining a second tube when performing coagulation testing should be considered for elimination when new revisions are published.
最近的三项研究探讨了美国国家临床实验室标准委员会（NCCLS）关于凝血标本应作为采集的第二管或第三管的建议是否必要。然而，每项研究仅使用了一种试剂/仪器。我们的方案与之前的研究不同，因为我们在相同样本上对三种不同的试剂/仪器系统进行了检测。我们的研究使用了光学、机械和比浊法凝血检测系统。在获得知情同意后，我们从95名受试者（15名正常患者和80名正在接受香豆素治疗的患者）身上采集了两管蓝色帽真空管：用于凝血检测的样本未进行弃管。对每管样本进行了凝血酶原时间（国际标准化比值）和活化部分凝血活酶时间检测。实验室一使用配有凝血酶原复合物（太平洋止血公司，国际敏感度指数为1.11）和活化部分凝血活酶时间试剂（太平洋止血公司）的MLA 1600C（Hemoliance）。实验室二使用配有新凝酶CI+（Diagnostica-Stago公司，国际敏感度指数为1.14）和部分凝血活酶时间试剂（Diagnostica-Stago公司）的STA（Diagnostica-Stago公司）。实验室三使用配有Plastinex（Biodata公司，国际敏感度指数为1.67）和Actin FSL（达德拜耳公司）的ACL 300。在三项试剂/仪器组合中的任何一项上，第一管和第二管样本在凝血酶原时间（秒）、国际标准化比值报告或活化部分凝血活酶时间结果方面均未观察到临床或统计学上的显著差异。我们的结果表明，在发布新修订版时，应考虑取消NCCLS关于进行凝血检测时采集第二管样本的指南。
