Adam Elisabeth H, Zacharowski Kai, Hintereder Gudrun, Zierfuß Frank, Raimann Florian, Meybohm Patrick
Clin Lab. 2018 Jun 1;64(6):1083-1089. doi: 10.7754/Clin.Lab.2018.171008.
Blood loss due to phlebotomy leads to hospital-acquired anemia and more frequent blood transfusions that may be associated with increased risk of morbidity and mortality in critically ill patients. Multiple blood conservation strategies have been proposed in the context of patient blood management to minimize blood loss. Here, we evaluated a new small-volume sodium citrate collection tube for coagulation testing in critically ill patients.
In 46 critically adult ill patients admitted to an interdisciplinary intensive care unit, we prospectively compared small-volume (1.8 mL) sodium citrate tubes with the conventional (3 mL) sodium citrate tubes. The main inclusion criterium was a proven coagulopathy (Quick < 60% and/or aPTT > 40 second) due to anticoagulation therapy or perioperative coagulopathy.
In total, 92 coagulation analyses were obtained. Linear correlation analysis detected a positive relationship for 7 coagulation parameters (Prothrombin Time, r = 0.987; INR, r = 0.985; activated Partial Thromboplastin Time, r = 0.967; Thrombin Clotting Time, r = 0.969; Fibrinogen, r = 0.986; Antithrombin, r = 0.988; DDimer, r = 0.969). Bland-Altman analyses revealed an absolute mean of differences of almost zero. Ninety-five percent of data were within two standard deviations of the mean difference suggesting interchangeability.
As systematic deviations between measured parameters of the two tubes were very unlikely, test results of small-volume (1.8 mL) sodium citrate tubes were equal to conventional (3 mL) sodium citrate tubes and can be considered interchangeable. Small-volume sodium citrate tubes reduced unnecessary diagnostic-related blood loss by about 40% and, therefore, should be the new standard of care for routine coagulation analysis in critically ill patients.
静脉放血导致的失血会引发医院获得性贫血，并增加输血频率，而这可能与危重症患者发病率和死亡率的增加有关。在患者血液管理的背景下，已提出多种血液保护策略以尽量减少失血。在此，我们评估了一种用于危重症患者凝血检测的新型小容量枸橼酸钠采血管。
在收治于跨学科重症监护病房的46例成年危重症患者中，我们前瞻性地比较了小容量（1.8 mL）枸橼酸钠管与传统（3 mL）枸橼酸钠管。主要纳入标准为因抗凝治疗或围手术期凝血病导致的确诊凝血病（Quick<60%和/或活化部分凝血活酶时间>40秒）。
总共获得了92次凝血分析结果。线性相关分析检测到7项凝血参数呈正相关（凝血酶原时间，r = 0.987；国际标准化比值，r = 0.985；活化部分凝血活酶时间，r = 0.967；凝血酶凝结时间，r = 0.969；纤维蛋白原，r = 0.986；抗凝血酶，r = 0.988；D-二聚体，r = 0.969）。Bland-Altman分析显示平均差异绝对值几乎为零。95%的数据在平均差异的两个标准差范围内，表明具有互换性。
由于两根采血管测量参数之间极不可能存在系统偏差，小容量（1.8 mL）枸橼酸钠管的检测结果与传统（3 mL）枸橼酸钠管相等，可认为具有互换性。小容量枸橼酸钠管使不必要的诊断相关失血量减少了约40%，因此，应成为危重症患者常规凝血分析的新护理标准。
