标本温度、存储时间对肝功能生化检验结果的影响

目的 探讨标本温度、存储时间对肝功能生化检验结果的影响,为提高检验质量提供重要依据。方法 选取2018年10月~2019年2月我院检验科接受肝功能生化检验的200例健康者作为研究对象,均采集晨起空腹外周静脉血3.0 ml/管,共6管,比较常温及4℃环境,即刻及存储12 h检验,溶血及无溶血标本中肝功能生化指标水平。结果 无溶血标本的DBIL、AST、ALT、ALB水平高于溶血标本,ALP、TP、TBIL水平低于溶血标本,差异有统计学意义（P＜0.05）。常温与4℃保存标本的DBIL、TBIL、AST、ALT、ALB、ALP、TP水平比较,差异无统计学意义（P＞0.05）。即刻与存储12 h标本的DBIL、TBIL、AST、ALT、ALB、ALP、TP水平比较,差异无统计学意义（P＞0.05）。结论 血样标本保存温度、存储时间对肝功能生化检验结果影响甚微,但是溶血会对检验指标产生一定影响,因而在采血后特别注意标本状态变化,规避溶血现象,以保证检验结果的准确性。     

Increased Plasma‐Free Hemoglobin Levels Identify Hemolysis in Patients With Cardiogenic Shock and a Trans valvular Micro‐Axial Flow Pump

Hemolysis is a potential limitation of percutaneously delivered left‐sided mechanical circulatory support pumps, including trans valvular micro‐axial flow pumps (TVP). Hemolytic biomarkers among durable left ventricular assist devices include lactate dehydrogenase (LDH) >2.5 times the upper limit of normal (ULN) and plasma‐free hemoglobin (pf‐Hb) >20 mg/dL. We examined the predictive value of these markers among patients with cardiogenic shock (CS) receiving a TVP. We retrospectively studied records of 116 consecutive patients receiving an Impella TVP at our institution between 2012 and 2017 for CS. Twenty‐three met inclusion/exclusion criteria, and had sufficient pf‐Hb data for analysis. Area under receiver‐operator characteristic (ROC) curve for diagnosing hemolysis were calculated. Mean age was 62 ± 14 years and ejection fraction was 15 ± 5%. Mean duration of support was 5.4 ± 3.5 days. Pre‐device LDH levels were >2.5x ULN in 71% (n = 5/7) of 5.0 and 29% of CP patients, while pre‐device pf‐Hb levels were >20 mg/dL in 14% (n = 1/7) of 5.0 and 25% (n = 4/16) of CP patients. Given elevated baseline LDH and pf‐Hb levels, we defined hemolysis as a pf‐Hb level >40 mg/dL within 72 h post‐implant plus clinical evidence of device‐related hemolysis. We identified that 30% (n = 7/23) had device‐related hemolysis. Using ROC curve‐derived cut‐points, an increase in delta pf‐Hb by >27mg/dL, not delta LDH, within 24 h after TVP implant (delta pf‐Hb: C‐statistic = 0.79, sensitivity: 57%, specificity: 93%, p <0.05) was highly predictive of hemolysis. In conclusion, we identified a change in pf‐Hb, not LDH, levels is highly sensitive and specific for hemolysis in patients treated with a TVP for CS.     

Effect of calcium on the hemolytic activity of Stichodactyla helianthus toxin sticholysin II on human erythrocytes

Sticholysin II (St II) is a toxin from the sea anemona Stichodactyla helianthus that produces erythrocytes lysis at low concentration and its activity depends on the presence of calcium. Calcium may act modifying toxin interaction with erythrocyte membranes or activating cellular processes which may result in a modified St II lytic action. In this study we are reporting that, in the presence of external K⁺, extracellular calcium decreased St II activity on erythrocytes. On the other hand an increase of intracellular calcium promotes Sty II lytic activity. The effect of intracellular calcium was specifically studied in relation to membrane lipid translocation elicited by scramblases and how this action influence St II lytic activity on erythrocytes. We used 0.5 mmol/L calcium and 10 mmol/L A23187, as calcium ionophore, for scramblases activation and found increased St II activity associated to increase of intracellular calcium. N-ethyl maleimide (activator) and 4,4′-diisothiocyanatostilbene-2,2′-disulfonate (inhibitor) were used as scramblases modulators in the assays which produced an increase and a decrease of the calcium effect, respectively. Results reported suggest an improved St II membrane pore-forming capacity promoted by intracellular calcium associated to membrane phospholipids translocation.     

血清溶血程度对21项生化指标测定的影响

目的观察血清不同的溶血程度对21项生化指标测定的影响。方法用Bayer120全自动血常规分析仪测定血清血红蛋白（Hb）含量作为判定溶血的程度;采用全自动生化分析仪及电解质仪检测40例门诊随机病人,观察在不溶血和溶血程度在Hb=3．0g／L与Hb：6．0g／L时的21项血清生化指标的酶活力变化。结果在Hb=3．0g／L时的溶血程度下AST,LDH,CK,CK-MB,α-HBDH,TP,K值显著升高（P〈0．01,TP为P〈0．05）,并随着溶血程度加重（Hb=6．0g／L时）酶活力比Hb=3．0g／L时又明显升高（P〈0．01）。在Hb=3．0g／L的溶血程度下,GLU,Phos则显著降低（P〈0．01）,并随溶血加重（Hb=6．0g／L）时,检测值降低更明显（P〈0．01）;Cr在Hb=3．0g／L时差异无统计学意义（P〉0．05）,但当溶血程度加重（Hb=6．0g／L）时酶活力则显著下降（P〈0．05）。其余酶活力指标在不同溶血程度下则差异无统计学意义（P〉0．05）。结论不同程度的溶血主要对21项生化指标中心肌酶谱5项,TP,K,GLU,Phos,Cr的检测有明显影响,其余指标差异不显著。     

妊娠期溶血的管理

妊娠合并溶血可发生于原发性血液系统疾病,也可继发于妊娠期特发性疾病,需要产科医生尽早识别病因并全面评估母儿状况,给予合理的对症治疗、多学科管理以及发生严重并发症时的强化危重症管理。本文就妊娠期溶血的发病机制和临床表现,以及孕期常见溶血性疾病的监测及治疗进行讨论。     

免疫性溶血性输血反应100例分析

目的 近年来,临床样本的检测中,免疫性溶血性输血反应(IHTR)样本检出率不断增加.同时,毛细管离心技术、PEG增强技术、微柱凝集卡技术等逐渐普及应用,这些技术上的变化可能影响IHTR检出率.为了减少IHTR漏检,有必要对以往IHTR样本特点进行总结,分析造成临床漏检的可能原因,以及实验室及时发现IHTR的检测技术关键...     

镁合金的初步生物安全性评价

目的初步评价AZ31B镁合金的生物安全性。方法体外细胞毒性:L929细胞分别与实验组(M)镁合金培养基浸提液、空白对照组(N)DMEM培养基,阳性对照组(P)5%DMSO培养基培养,3 d后进行细胞毒性分级。体外溶血率:稀释兔血分别与实验组(M)镁合金生理盐水浸提液、空白对照组(N)生理盐水、阳性对照组(N)蒸馏水混合后置37℃水浴中孵育,60 min后离心,取上清液测定吸光度(OD),计算镁合金材料溶血率。体外浸提液分析:检测镁合金材料浸提液中镁离子和钠离子浓度,以及pH值。体内急性毒性:分别自小白鼠腹腔注射空白对照组(N)生理盐水和镁合金组(M)镁合金材料生理盐水浸提液,观察和记录动物的状态,72 h后计算动物体质量变化。结果 N组毒性反应分级为0级,M组为4级,P组为3级。M组溶血率为68.1%,具有溶血作用。浸提液镁离子浓度为1.33 mmol/L,钠离子浓度为134 mmol/L;浸提液pH值为10.10±0.29。所有动物注射后在各时间点无不良反应,一般情况好。M组和N组动物体质量的平均变化分别为1.97%和0.43%,小鼠体质量增加百分比差异无统计学意义(t=0.499,P=0.624)。结论体外实验显示高腐蚀率的镁合金有细胞毒性和溶血率,但体内实验并未见到急性毒性反应。     

基于问题的学习在预防血标本溶血中的实践与效果

目的分析问题式学习预防血标本溶血的效果。方法采用问题式学习模式,对22名护士进行避免血标本溶血相关措施的培训,比较培训前后血标本溶血的发生情况。结果培训后血标本溶血的发生率为4．36％,低于培训前（8．63％,P〈0．01）。结论问题式学习是一种有效降低血标本溶血的培训方法。     

Double Filtration Plasmapheresis in Different Diseases in Thailand

Double filtration plasmapheresis (DFPP) was applied to the treatment of two different categories from 100 cases that had been collected over a 5 year period (2007–2011). These categories were allocated into groups by size of toxic substances, which were classified as two different kinds of diseases. Group I comprised diseases that were caused by alloimmunity in transplantation, autoimmune diseases, complicated nephrotic syndrome, pure red cell aplasia, and toxemia of pregnancy. This group was treated with a plasma separator (plasmaflow‐05, Asahi Kasei) and plasma fractionators, EC‐20W. The second group, which included hyperviscosity syndrome, was treated by the same plasma separator, but with different plasma fractionators using EC‐40W. This group included diabetes nephropathy, hyperlipidemia, peripheral arterial diseases, and neurosensory hearing loss. Both groups used 1.5 plasma volumes in each treatment for three sessions in two consecutive weeks. The result of treatment in group I showed that plasma immunoglobulin G (IgG) was decreased substantially by 66% in either transplant or lupus nephritis patients after the third session. In the second group, IgM, fibrinogen, and lipid markedly responded to the treatment. Two diabetes nephropathy patients showed stable renal function for more than 12 months. Peripheral arterial disease was shown to benefit from significantly decreasing fibrinogen and IgM, which resulted in clinical tissue oxygenation. Neither bleeding diathesis nor membrane anaphylaxis were reported from the treatment. In summary, apheresis patients were shown to benefit in hypersensitized and hyperviscosity syndrome.