凝胶分离管储存后血液样本再离心导致的假性高钾血症。

Pseudohyperkalaemia caused by recentrifugation of blood samples after storage in gel separator tubes.

作者信息

Hira K, Ohtani Y, Rahman M, Noguchi Y, Shimbo T, Fukui T

机构信息

Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, Japan.

出版信息

Ann Clin Biochem. 2001 Jul;38(Pt 4):386-90. doi: 10.1258/0004563011900704.

DOI:10.1258/0004563011900704

PMID:11471881

Abstract

Because hyperkalaemia above a certain level is life-threatening, erroneous interpretation of serum potassium concentration may misguide and complicate diagnostic procedures. We investigated a number of cases with pseudohyperkalaemia, which was assumed to have been caused by the recentrifugation of blood samples after storage in gel separator tubes. The time trend of serum potassium concentration was explored before (January-March 1997) and after (May-July 1997) ceasing the practice of recentrifuging blood samples after overnight storage. Next, we conducted an experiment on a volunteer's serum. The sample was divided into two groups and centrifuged once (control group) or twice (recentrifugation group). For both groups, serum potassium concentrations were measured immediately, and at 24, 48 and 72 h. For the recentrifugation group, the second centrifugation was done just before the measurement. The time series study showed that the mean serum potassium concentrations measured after overnight storage were 4.68 (95% CI: 4.60-4.76) mmol/L before and 4.14 (4.07-4.20) mmol/L after ceasing the practice of recentrifugation. The experiment showed that the mean serum potassium concentrations in the control group versus the recentrifugation group were 3.95 (95% CI: 3.89-4.01) mmol/L versus 4.05 (3.92-4.17) immediately (P=0.0979), 3.95 (3.89-4.01) versus 5.95 (5.61-6.29) at 24 h (P=0.0001), 4.13 (4.05-4.22) versus 6.90 (6.46-7.34) at 48 h (P=0.0001), and 4.22 (3.85-4.58) versus 7.61 (6.94-8.30) at 72 h (P<0.0001). Recentrifugation of blood samples after storage causes a spurious rise in serum potassium concentration to the degree of clinical significance. Clinicians and biochemists should take appropriate measures to stop this practice.

摘要

由于超过一定水平的高钾血症会危及生命，血清钾浓度的错误解读可能会误导诊断程序并使其复杂化。我们调查了一些假性高钾血症病例，推测其是由凝胶分离管储存后的血样再次离心所致。我们探究了在停止过夜储存后血样再次离心的做法之前（1997年1月至3月）和之后（1997年5月至7月）血清钾浓度的时间趋势。接下来，我们对一名志愿者的血清进行了实验。样本被分为两组，一组离心一次（对照组），另一组离心两次（再次离心组）。两组均在即刻、24小时、48小时和72小时测量血清钾浓度。对于再次离心组，在测量前进行第二次离心。时间序列研究表明，停止再次离心做法之前，过夜储存后测量的血清钾浓度均值为4.68（95%CI：4.60 - 4.76）mmol/L，之后为4.14（4.07 - 4.20）mmol/L。实验表明，对照组与再次离心组的血清钾浓度均值在即刻时分别为3.95（95%CI：3.89 - 4.01）mmol/L和4.05（3.92 - 4.17）mmol/L（P = 0.0979），24小时时分别为3.95（3.89 - 4.01）mmol/L和5.95（5.61 - 6.29）mmol/L（P = 0.0001），48小时时分别为4.13（4.05 - 4.22）mmol/L和6.90（6.46 - 7.34）mmol/L（P = 0.0001），72小时时分别为4.22（3.85 - 4.58）mmol/L和7.61（6.94 - 8.30）mmol/L（P < 0.0001）。储存后的血样再次离心会导致血清钾浓度出现具有临床意义的假性升高。临床医生和生物化学家应采取适当措施停止这种做法。