Heireman Laura, Van Geel Pieter, Musger Lorenz, Heylen Evelien, Uyttenbroeck Wim, Mahieu Boris
Department of Laboratory Medicine, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium.
Department of Orthopedic Surgery, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium.
Clin Biochem. 2017 Dec;50(18):1317-1322. doi: 10.1016/j.clinbiochem.2017.09.013. Epub 2017 Sep 22.
Preanalytical hemolysis of blood samples is a common problem in medical practice, especially in emergency departments. Several potential influences on sample hemolysis have been investigated, including sampling techniques, centrifugation and sample transport. In particular, the use of intravenous catheters and the vacuum sampling technique have often been demonstrated to provoke hemolysis. Other factors playing a role include the use of inappropriate puncture sites, complicated blood sampling, prolonged tourniquet application, underfilling of tubes and excessive shaking of specimens. Training of phlebotomists can play a pivotal role in overcoming these issues. A sample may also undergo hemolysis at the point of centrifugation, more specifically when centrifugation lasts too long or is done repeatedly. Pneumatic tube system (PTS)-transported samples tend to be more strongly affected by hemolysis compared to hand-carried ones, though whether this difference is clinically relevant remains questionable. The velocity at which the sample moves, the distance it covers and the shock forces it sustains all determine to what extent hemolysis occurs during PTS transport. The use of cushion inserts in the carrier to stabilize the samples and the presence of a gel separator in the transported serum tubes may prevent PTS-induced hemolysis. Finally, there is considerable variation between patients in the extent to which samples are prone to hemolysis. Sample hemolysis leads to unreliable laboratory results, delayed diagnosis and patients suffering avoidable discomfort. Specifically, hemolysis may interfere with laboratory results due to release of intracellular components, dilution effects, proteolysis and interference with analytical techniques. There is ongoing debate about how laboratories should deal with results altered by hemolysis. Laboratory specialists should clearly communicate with the ordering clinicians in order to make an informed decision about how to interpret hemolysis-affected analytical results. This review looks into current evidence concerning the causes and consequences of in vitro hemolysis, and aims to explain how to deal with it.
血液样本的分析前溶血是医学实践中的常见问题，在急诊科尤为突出。人们已经研究了对样本溶血的几种潜在影响因素，包括采样技术、离心和样本运输。特别是，静脉导管的使用和真空采样技术常常被证明会引发溶血。其他起作用的因素包括使用不当的穿刺部位、复杂的采血过程、止血带使用时间过长、采血管未装满以及样本过度振荡。对采血人员的培训在克服这些问题方面可发挥关键作用。样本在离心时也可能发生溶血，更具体地说，当离心时间过长或反复进行离心时。与人工携带的样本相比，通过气动管道系统（PTS）运输的样本往往更容易受到溶血的影响，不过这种差异在临床上是否相关仍存在疑问。样本移动的速度、移动的距离以及承受的冲击力都决定了在PTS运输过程中溶血发生的程度。在运输载体中使用缓冲垫插入物来稳定样本以及在运输的血清管中使用凝胶分离器可能会防止PTS引起的溶血。最后，不同患者的样本发生溶血的程度存在很大差异。样本溶血会导致实验室结果不可靠、诊断延迟以及患者遭受不必要的不适。具体而言，溶血可能由于细胞内成分的释放、稀释效应、蛋白水解以及对分析技术的干扰而影响实验室结果。关于实验室应如何处理因溶血而改变的结果，目前仍存在争议。实验室专家应与开单的临床医生进行明确沟通，以便就是否以及如何解释受溶血影响的分析结果做出明智的决定。这篇综述探讨了关于体外溶血的原因和后果的现有证据，并旨在解释如何应对溶血问题。
