Reuter Tom, Müller Michael, Stelter Felix, Durner Jürgen, Kramer Jan
LADR Laboratory Group Dr. Kramer & Kollegen, Geesthacht, Germany.
Accredited Laboratories in Medicine (ALM) e.V., Quality Management Working Group, Berlin, Germany.
PLoS One. 2024 Dec 9;19(12):e0313572. doi: 10.1371/journal.pone.0313572. eCollection 2024.
In most countries the majority of patients are in outpatient care. In difference to hospitalized patients, their blood samples often take hours after collection to centrifugation. The study investigates the release of potassium and the development of pseudohyperkalemia in lithium heparin (Li-Hep) and serum blood collection tubes over time.
From 201 donors 4 serum and 4 Li-Hep blood collection tubes were taken each. After 0.5, 4, 6 and 8h whole blood was centrifuged, and potassium levels were determined. To simulate the preanalytic conditions, the samples with a storage time >0.5h were shaken on a standard shaker for 1h and stored at 4-8°C for the remaining time.
Over time, significant more potassium was released before centrifugation from the Li-Hep plasma than from serum (1.21 vs 0.94 mmol/L). After 6h, the two groups were no longer highly statistically significantly different (potassium mean: 5.01 mmol/L in serum group, 4.92 mmol/L in Li-Hep group). In the Li-Hep group 164 donors developed a pseudohyperkalemia after 8h, compared to 76 in the serum group.
The decision as to which material is best suited should not only be based on which value comes closest to the physiological situation immediately after blood collection. The subsequent preanalytic circumstances must also be considered. Serum tubes appear to be at least as suitable for potassium determination as Li-Hep tubes. In terms of patient blood management, serum provides the possibility of performing a wider range of analyses in the outpatient setting.
在大多数国家，大多数患者接受门诊治疗。与住院患者不同，他们的血样采集后往往要过数小时才进行离心。本研究调查了随着时间推移，锂肝素（Li-Hep）抗凝管和血清采血管中钾的释放情况以及假性高钾血症的发生情况。
从201名献血者中各采集4支血清采血管和4支Li-Hep抗凝管。在0.5、4、6和8小时后对全血进行离心，并测定钾水平。为模拟分析前的条件，储存时间>0.5小时的样本在标准振荡器上振荡1小时，其余时间在4-8°C下保存。
随着时间的推移，离心前Li-Hep血浆中释放的钾显著多于血清（1.21 vs 0.94 mmol/L）。6小时后，两组在统计学上不再有高度显著差异（血清组钾均值：5.01 mmol/L，Li-Hep组4.92 mmol/L）。Li-Hep组有164名献血者在8小时后出现假性高钾血症，而血清组为76名。
关于哪种材料最适合的决定，不应仅基于哪种值最接近采血后立即的生理情况。还必须考虑随后的分析前情况。血清管似乎至少与Li-Hep管一样适合测定钾。在患者血液管理方面，血清使得在门诊环境中进行更广泛的分析成为可能。
