实验性高钙血症对常规止血检测的影响。

Impact of experimental hypercalcemia on routine haemostasis testing.

作者信息

Lippi Giuseppe, Salvagno Gian Luca, Brocco Giorgio, Gelati Matteo, Danese Elisa, Favaloro Emmanuel J

机构信息

Section of Clinical Biochemistry, University of Verona, Verona, Italy.

Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia.

出版信息

PLoS One. 2017 Mar 31;12(3):e0175094. doi: 10.1371/journal.pone.0175094. eCollection 2017.

DOI:10.1371/journal.pone.0175094

PMID:28362859

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5376338/

Abstract

BACKGROUND

The blood to anticoagulant ratio is standardized according to the physiological calcium concentration in blood samples conventionally used for hemostasis testing. Specifically, one fixed volume of 0.109 mmol/L sodium citrate is added to 9 volumes of blood. Since little is known about the impact of hypercalcemia on the calcium-binding capacity of citrate, this study was planned to investigate the effect of experimental hypercalcemia on routine hemostasis testing.

METHODS

Fifteen pooled citrated plasmas with matching lithium-heparin pooled plasma from patients with different values of prothrombin time (PT) were divided in three aliquots of 0.6mL each. The first paired aliquots of both citrate and lithium-heparin plasma were supplemented with 60μL of saline, the second paired aliquots with 30μL of saline and 30μL of calcium chloride and the third paired aliquots with 60μL of calcium chloride. Total and ionized calcium was measured in all aliquots of citrate and lithium-heparin plasma, whereas PT, activated partial thromboplastin time (APTT) and fibrinogen were measured in citrate plasma aliquots.

RESULTS

Total calcium concentration gradually increased in both lithium-heparin and citrate plasma aliquots 2 and 3 compared to baseline aliquot 1. The concentration of ionized calcium also gradually increased in lithium-heparin plasma aliquots 2 and 3, whereas it remained immeasurable (i.e., <0.10 mmol/L) in all citrate plasma aliquots. No significant differences were observed for values of PT, APTT and fibrinogen in citrate plasma aliquots 2 and 3 compared to the baseline aliquot 1, with a mean bias was always comprised within the desirable quality specifications derived from biological variability data.

CONCLUSION

Hypercalcemia, up to severe hypercalcemia does not generate significant bias in results of first-line coagulations tests, so that hypothetical consideration of adjusting citrate-blood ratio is unjustified in hypercalcemic patients.

摘要

背景

传统上用于止血检测的血样中的抗凝剂与血液的比例是根据血液中的生理钙浓度来标准化的。具体而言，将1体积的0.109 mmol/L柠檬酸钠添加到9体积的血液中。由于关于高钙血症对柠檬酸盐钙结合能力的影响知之甚少，因此本研究旨在调查实验性高钙血症对常规止血检测的影响。

方法

将来自不同凝血酶原时间（PT）值患者的15份混合枸橼酸血浆与匹配的锂肝素混合血浆分成三份，每份0.6mL。第一对枸橼酸血浆和锂肝素血浆的等分试样分别补充60μL生理盐水，第二对分别补充30μL生理盐水和30μL氯化钙，第三对分别补充60μL氯化钙。对所有枸橼酸血浆和锂肝素血浆的等分试样测量总钙和离子钙，而对枸橼酸血浆等分试样测量PT、活化部分凝血活酶时间（APTT）和纤维蛋白原。

结果

与基线等分试样1相比，锂肝素血浆和枸橼酸血浆等分试样2和3中的总钙浓度逐渐升高。锂肝素血浆等分试样2和3中的离子钙浓度也逐渐升高，而在所有枸橼酸血浆等分试样中离子钙浓度仍无法测量（即<0.10 mmol/L）。与基线等分试样1相比，枸橼酸血浆等分试样2和3中的PT、APTT和纤维蛋白原值未观察到显著差异，平均偏差始终在源自生物学变异数据的理想质量规范范围内。