Departments of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States.
Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States.
Clin Chim Acta. 2023 Nov 1;551:117630. doi: 10.1016/j.cca.2023.117630. Epub 2023 Nov 4.
Hemolysis in the emergency department (ED) can significantly delay results and appropriate action. We evaluated the main sources of hemolysis during sample collection, and to evaluate the use of rapid serum tubes (RST) as a transport hemolysis-mitigating measure for high-sensitivity troponin T (hs-cTnT) testing.
We examined the effect of tube type, tube fill, types of sample draw and collection methods on hemolysis and hs-cTnT in samples (n = 158) from ED patients. We also compared hs-cTnT values in paired RST and plasma separate tube (PST) samples that were hemolysis-free.
The primary source of hemolysis in samples collected in the ED was underfilling tubes. In both tube types, PST and RST, filled tubes showed a median reduction in hemolysis of 69.1 % (p < 0.0001). Blood collected in RST also experienced less hemolysis compared to PST. In hemolysis-free samples, false positive results in PST were noted in patients with hs-cTnT values < 50 ng/l.
We suggest that proper tube filling during sample collection and use of RST tubes can significantly reduce the effects of hemolysis. In addition, laboratories should be aware that PST tubes have a non-trivial rate of false positives when hs-cTnT < 50 ng/l.
急诊科（ED）中的溶血会显著延迟结果和适当的处理。我们评估了样本采集过程中溶血的主要来源，并评估了使用快速血清管（RST）作为高敏肌钙蛋白 T（hs-cTnT）检测的运输溶血缓解措施的效果。
我们研究了管类型、管填充、样本采集方式和采集方法对 ED 患者样本溶血和 hs-cTnT 的影响。我们还比较了无溶血的配对 RST 和血浆分离管（PST）样本的 hs-cTnT 值。
ED 采集样本中溶血的主要来源是管填充不足。在 PST 和 RST 这两种管类型中，填充管的溶血中位数降低了 69.1%（p<0.0001）。与 PST 相比，RST 采集的血液溶血程度也较低。在无溶血的样本中，hs-cTnT 值<50ng/l 的患者在 PST 中出现了假阳性结果。
我们建议在样本采集过程中正确填充管并使用 RST 管可以显著降低溶血的影响。此外，实验室应注意到当 hs-cTnT<50ng/l 时，PST 管有相当高的假阳性率。
