Kim Yeowon A, Lewandrowski Kent B, Lucien Fils-Amie, Van Cott Elizabeth M
Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
Blood Coagul Fibrinolysis. 2018 Mar;29(2):184-188. doi: 10.1097/MBC.0000000000000700.
: Coagulation laboratories have largely stopped transporting whole blood specimens on ice, due to adverse effects on factor VIII, von Willebrand factor, and the prothrombin time. However, it is unknown whether ice should be required or avoided for other coagulation assays. Furthermore, the amount of time that specimens remain stable during transportation at room temperature (RT) is also largely unknown for many coagulation tests. Therefore, this study investigated specimen stability on ice and RT for a comprehensive panel of coagulation tests. One tube of whole blood from each volunteer (n = 22) was centrifuged immediately (time 0), one was stored for 4 h on ice, and one was stored for 4 h at RT before centrifugation. Among time 0, 4 h on ice, and 4 h at RT samples, no statistically significant differences were found for fibrinogen, activated protein C resistance, thrombin time, reptilase time, antithrombin activity, chromogenic protein C, factor XII, and antiplasmin activity. Prothrombin time, activated partial thromboplastin time, factors IX, XI, protein S activity, and plasminogen activity showed statistically, but not clinically, significant differences. On ice, the only analytes that showed clinically significant changes (≥6.0% from time 0) were factors VII, VIII, von Willebrand factor antigen, and ristocetin cofactor, which were 14.0% higher, and 19.2, 9.5, and 18.8% lower than time 0, respectively. At RT, all analytes were stable except factor VIII was 9.4% lower than time 0. Only factors II, V, X, and PTT-LA lupus anticoagulant showed a possible slight benefit from ice, but the statistically significant differences were not clinically significant. Ice did not substantially benefit any of the coagulation assays. All tests were stable at RT, except more study is needed regarding factor VIII.
由于对凝血因子 VIII、血管性血友病因子和凝血酶原时间有不良影响，凝血实验室已基本停止用冰运输全血标本。然而，对于其他凝血检测是否需要使用冰或避免使用冰尚不清楚。此外，对于许多凝血检测而言，标本在室温（RT）运输期间保持稳定的时间也大多未知。因此，本研究调查了一系列凝血检测在冰上和室温下的标本稳定性。从每位志愿者（n = 22）采集的一管全血立即进行离心（时间 0），一管在冰上储存 4 小时，另一管在离心前在室温下储存 4 小时。在时间 0、冰上 4 小时和室温 4 小时的样本中，纤维蛋白原、活化蛋白 C 抵抗、凝血酶时间、蛇静脉酶时间、抗凝血酶活性、发色蛋白 C、凝血因子 XII 和抗纤溶酶活性未发现统计学上的显著差异。凝血酶原时间、活化部分凝血活酶时间、凝血因子 IX、XI、蛋白 S 活性和纤溶酶原活性显示出统计学上但非临床上的显著差异。在冰上，唯一显示出临床显著变化（比时间 0 变化≥6.0%）的分析物是凝血因子 VII、VIII、血管性血友病因子抗原和瑞斯托霉素辅因子，它们分别比时间 0 高 14.0%，低 19.2%、9.5%和 18.8%。在室温下，除凝血因子 VIII 比时间 0 低 9.4%外，所有分析物均稳定。只有凝血因子 II、V、X 和 PTT-LA 狼疮抗凝物在冰上可能略有益处，但统计学上的显著差异在临床上并不显著。冰对任何凝血检测均无实质性益处。所有检测在室温下均稳定，不过对于凝血因子 VIII 还需要更多研究。
