凝血检测的标本误差来源定量分析及临床检验指导
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R446.11

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川北医学院附属医院科研项目(2023GC009);


Quantitative analysis of specimen errors in coagulation tests and its value in clinical laboratory guidance
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    摘要:

    目的:系统性分析导致凝血检测结果不准确的常见原因及其对各指标的影响程度,为实验室质量控制和临床标本采集提供依据。方法:回顾性分析209例凝血复查标本信息,根据首次检测结果标注为血液凝固、疑似肝素污染、标本采集量不足、红细胞压积过高等分为四组,收集复查前后PT、APTT、TT、FIB、FDP、ATIII和D-D等7项指标数据。比较各组上述指标首次与复查检测结果的差异。结果:血液凝固标本以FDP和D-D异常升高(中位数分别为28.7μg/mL和15.5μg/mL)和FIB降低(中位数为2.14 g/L)为主要特征,复查后均下降(FDP和D-D中位数分别为4.5μg/mL和2.2μg/mL)或上升(FIB中位数为3.31 g/L);疑似肝素污染对PT、APTT和TT的影响最为明显,复查后分别缩短9.2 s、46.4 s、19.6 s(中位数);标本采集量不足主要导致PT和APTT延长,复查后分别下降6.6 s和10.3 s(中位数);红细胞压积过高亦可导致PT和APTT延长,复查后分别平均下降49.9 s和27.6 s。结论:不同标本原因导致的凝血检测误差具有特征性的变化。血液凝固主要影响FDP、D-D和FIB,而疑似肝素污染、标本量采集不足和红细胞压积过高主要延长PT和APTT。因此,合格的标本质量对凝血检测准确性至关重要。同时,检验科建立基于原因分析的标准化复查与干预流程是提升凝血检测质量的关键。

    Abstract:

    Objective: To systematically analyze the common causes leading to inaccurate coagulation test results and their respective impact levels on various parameters, providing a basis for laboratory quality control and clinical specimen collection. Methods: A retrospective analysis was performed on the data of 209 re-tested coagulation specimens. All specimens were divided into four groups according to the initial test results: coagulated blood, suspected heparin contamination, insufficient specimen volume, and elevated hematocrit. Seven coagulation indicators including PT, APTT, TT, FIB, FDP, AT-III, and D-D were collected before and after re-examination. The differences in the above indicators between initial and re-test results in each group were compared between groups. Results: Clotted blood specimens were primarily characterized by abnormally elevated FDP and D-D (median: 28.7 μg/mL and 15.5 μg/mL, respectively) and decreased FIB (median: 2.14 g/L). After re-testing, these values decreased (FDP and D-D median was 4.5 μg/mL and 2.2 μg/mL, respectively) or increased (FIB median: 3.31 g/L). Suspected heparin contamination most significantly affected PT, APTT, and TT, which shortened by 9.2 s, 46.4 s, and 19.6 s (median), respectively, after re-testing. Insufficient sample volume primarily caused prolongation of PT and APTT, which decreased by 6.6 s and 10.3 s (median), respectively, after re-testing. Elevated hematocrit can also cause prolongation of PT and APTT. After re-examination, their mean values decreased by 49.9 s and 27.6 s, respectively. Conclusion: Errors in coagulation tests caused by different specimen issues present characteristic changes. Blood clotting mainly affects FDP, D-D, and FIB, while suspected heparin contamination, insufficient specimen volume, and elevated hematocrit predominantly prolong PT and APTT. Therefore, qualified specimen quality is essential for the accuracy of coagulation testing. Meanwhile, establishing a standardized review and intervention process based on cause analysis in the clinical laboratory is critical to improving the quality of coagulation assays.

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王洪友;胡帅;赵维皎;蒲劲;马强;.凝血检测的标本误差来源定量分析及临床检验指导[J].川北医学院学报,2026,41(10):1249-1254.

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  • 在线发布日期: 2026-10-26
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