Clinical Chemistry Laboratory, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale di Monza ASST-Monza, St Gerardo Hospital, Monza, Italy.
Scand J Clin Lab Invest. 2022 Apr;82(2):138-142. doi: 10.1080/00365513.2022.2034037. Epub 2022 Feb 13.
Modern blood gas analyzers are not able to identify hemolysis, lipemia and icterus; therefore, the aim of this study was to assess the influence of hemolysis on blood gas samples. Blood gas analysis represents an essential part in the diagnosis and treatment of critically ill patients, including those affected by the pandemic coronavirus disease 2019 (COVID-19). Hemolysis, lipemia, and icterus, are causes of clinical misinterpretation of laboratory tests. A total of 1244 blood gas specimens were collected over a one-week period from different clinical wards, including the Emergency Department, and were assessed for serum indices on Cobas C6000 CE (Roche Diagnostics, Mannheim, Germany). The prevalence of hemolysis, lipemia, and icterus were 5%, 12%, and 14%, respectively. Sample storage at room temperature, delivery to central laboratory using pneumatic tube system, as well as small sample size, strongly affected blood gas parameters ( < .01). Hemolysis led to an increase in analytical bias for pH, pO, and potassium, and a significant decrease for pCO, HCO, sodium, and Ca ( <.01). Currently, hemolysis detection systems are not yet widespread, and a rapid centrifugation of samples after blood gas analysis along with the assessment of serum indices represent the only prompt approach to identify unsuitable results, avoiding pitfalls in clinical decision-making, although it cannot be applied to the Emergency Department routine. Blood gas analyzers manufacturers and suppliers should implement automated built-in serum indices detection systems.
现代血气分析仪无法识别溶血、脂血和黄疸；因此，本研究旨在评估溶血对血气样本的影响。血气分析是诊断和治疗危重病患者的重要组成部分，包括受 2019 年冠状病毒病（COVID-19）影响的患者。溶血、脂血和黄疸是导致实验室检测临床误读的原因。在一周内，从不同的临床病房（包括急诊科）共采集了 1244 份血气标本，并在 Cobas C6000 CE（罗氏诊断，曼海姆，德国）上评估血清指标。溶血、脂血和黄疸的发生率分别为 5%、12%和 14%。室温储存样本、使用气动输送系统将样本送到中心实验室以及样本量小，强烈影响血气参数（<0.01）。溶血导致 pH、pO 和钾的分析偏差增加，而 pCO、HCO、钠和 Ca 的显著降低（<0.01）。目前，溶血检测系统尚未广泛普及，在血气分析后快速离心样本并评估血清指标是唯一一种能够快速识别不合格结果的方法，可以避免临床决策中的陷阱，尽管它不能应用于急诊科常规。血气分析仪制造商和供应商应实施自动内置血清指标检测系统。
