Ray M J, Carroll P A, Just S J, Hawson G A
Department of Pathology, Prince Charles Hospital, Chermside, Queensland, Australia.
Blood Coagul Fibrinolysis. 1993 Oct;4(5):805-7.
Differences in the activated partial thromboplastin time (aPTT) were shown when blood taken from patients receiving intravenous heparin therapy was collected into 5 ml and 1 ml citrate containers. Mean aPTTs were 27% shorter with the plasma from the 1 ml citrate containers (n = 23). These results were paralleled by a 37% reduction in the mean heparin concentration (n = 11) and a 77% increase in the mean platelet factor 4 (PF4) concentration (n = 7). This phenomenon is due to increased platelet activation and subsequent increased heparin neutralization in the 1 ml citrate container. In an attempt to overcome this, the citrate was removed from a 1 ml container and replaced with a buffered tri-sodium citrate solution containing theophylline, adenosine and dipyridamole anticoagulant (CTAD). Blood from heparinized patients taken into both 5 ml citrate and 1 ml CTAD showed a correction of the shortening artefact in the low volume container. The mean aPTT of plasmas from the 1 ml CTAD container showed an increase of 10% compared with the 5 ml citrate. There was no significant difference in the mean heparin or PF4 concentrations of blood taken into either container. The 1 ml CTAD tube described is a suitable collection container for monitoring heparin in neonates or patients who are difficult to venepuncture and overcomes the neutralization of heparin in part filled low volume containers.
当将接受静脉肝素治疗患者的血液采集到5毫升和1毫升枸橼酸盐容器中时，活化部分凝血活酶时间（aPTT）出现了差异。来自1毫升枸橼酸盐容器血浆的平均aPTT缩短了27%（n = 23）。这些结果伴随着平均肝素浓度降低37%（n = 11）以及平均血小板第4因子（PF4）浓度升高77%（n = 7）。这种现象是由于1毫升枸橼酸盐容器中血小板活化增加以及随后肝素中和增加所致。为了克服这一问题，从1毫升容器中去除了枸橼酸盐，并用含有茶碱、腺苷和双嘧达莫抗凝剂（CTAD）的缓冲枸橼酸钠溶液进行替代。采集到5毫升枸橼酸盐和1毫升CTAD中的肝素化患者血液显示，小容量容器中缩短假象得到了纠正。来自1毫升CTAD容器血浆的平均aPTT与5毫升枸橼酸盐相比增加了10%。采集到任一容器中血液的平均肝素或PF4浓度均无显著差异。所述的1毫升CTAD管是用于监测新生儿或难以静脉穿刺患者肝素的合适采集容器，并且克服了部分填充的小容量容器中肝素的中和问题。
