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Pseudohyperkalemia of Leukemia Patients with Hyperleukocytosis Caused by Pneumatic Tube System
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摘要:
目的 探讨采用气动物流传输系统运输白细胞显著升高白血病患者的血液标本对血钾检测结果的影响。 方法 分析2013年7月至2015年7月北京协和医院检验科急诊生化实验室发现的4例白血病患者假性高钾血症相关临床指标，包括临床诊断、标本运输方式、白细胞数量、血浆钾离子浓度、血气钾离子浓度、部分血清钾离子浓度、化疗情况、心电图等临床信息。以同期10例感染性疾病合并类白血病反应患者和50例白细胞数量正常非血液系统疾病患者的以上临床指标作为对照组，比较气动运输和人工运输对白细胞不同功能状态、不同标本类型、不同容器标本血钾结果的影响。 结果 4例白细胞数量显著升高(206.8×109/L~652.1×109/L)白血病患者肝素锂抗凝静脉血标本通过气动传输导致血钾明显升高(5.9~14.8 mmol/L)；气动传输对血气标本、血清管标本的血钾无明显影响；而气泵运输方式对于对照组的肝素锂抗凝静脉血标本和血气标本的血钾水平无显著影响(P＞0.05)。 结论 对于白细胞显著升高的白血病患者，采用气动物流传输系统运输肝素锂抗凝的静脉血标本可导致血钾假性升高。 Abstract:Objective To invest the effects of pneumatic tube system(PTS) transportation on blood potassium measurement result in leukemia patients with hyperleukocytosis. Methods Clinical data of four leukemia patients with pseudohyperkalemia detected in emergency laboratory of Peking Union Medical College Hospital in the period from July 2013 to July 2015 were collected and reviewed to retrospectively analyze clinical diagnosis, sample transportation method, white blood cell count, plasma potassium level, arterial whole blood potassium level, partial serum potassium level, chemotherapy, and electrocardiogram.We also collected the above information of 10 cases of infectious disease with leukemoid reaction and 50 cases of non-blood system disease patients with normal white blood cell counts as control group from the same period. We compared the effect of different transportation methods (PTS vs. manual transportation) on blood potassium levels in different white blood cell functional status, sample types, and sample containers. Results In the 4 leukemia patients with high periph- eral blood white cell count(206.8×109/L-652.1×109/L), potassium concentration in lithium-heparin venous blood samples transported by PTS was strikingly elevated (5.9-14.8 mmol/L), while the level of potassium of arterial whole blood and serum samples transported simultaneously by PTS were not influenced. There was no significant effect of PTS on plasma potassium levels of venous and arterial whole blood samples transported by PTS in controls(P > 0.05). Conclusion The plasma potassium level in lithium-heparin venous blood samples of leukemia patients with high peripheral blood white cell count may be elevated if transported by PTS, which will lead to pseudohyperkalemia. -
Key words:
- pseudohyperkalemia /
- leukemia /
- white blood cell /
- pneumatic tube system
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表 1 4例白血病患者住院期间标本运输方式及血钾检测结果
患者 送检时间 运输方式 血K+(mmol/L) WBC计数(×109/L) 心电图表现 治疗策略 血浆 血气 血清 A 6-13 11:56 PTS 5.2 3.4 - 460.9 - - 6-16 17:42 PTS 5.9 3.9 - 482.1 - - 6-16 19:48 PTS - 3.1 - - - - 6-17 09:30 PTS - - 7.1 455.5 胸导广泛T波低平 降钾治疗 6-17 10:56 人工 2.7 2.5 - - 胸导T波低平 补钾治疗 6-17 17:54 人工 - 3.1 - 383.8 - - 6-17 18:23 人工 3.2 - - - - - B 2-09 05:49 人工 3.4 3.4 - 652.1 - - 2-11 18:30 人工 4.5 - - - - - 2-11 19:00 PTS 6.6 - - - 大致正常 降钾治疗 2-12 00:00 PTS 7.4 2.7 - 619.9 大致正常 降钾治疗 2-12 04:37 PTS 4.7 2.4 - 590.2 - - 2-12 09:21 人工 2.6 - 2.8 555.3 - 补钾治疗 C 9-17 08:51 人工 - - 2.6 327.8 - - 9-17 17:00 PTS - 1.9 - - - - 9-17 18:17 PTS 14.8 - - - 大致正常 - 9-17 18:30 PTS 7.3 - 2.4 - - - 9-17 18:30 人工 2.4 - 2.4 - - 补钾治疗 D 7-17 23:50 PTS 12.3 3.1 - 216.2 - 降钾治疗 7-18 01:27 PTS 14.6 3.4 - 206.8 - - 7-18 03:58 PTS 12.6 5.6 3.1 - - - 7-18 06:54 人工 3.5 3.1 - - - - PTS:气动物流传输系统; -:未检测; WBC:白细胞 
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表 2 文献报道PTS导致假性高钾血症病例汇总
文献报道 PTS运输K+(mmol/L) 人工运输K+(mmol/L) WBC计数(×109/L) PLT计数(×109/L) 心电图 血浆 血气 血清 血浆 血气 血清 Meng QH[4] 7.2 2.8 - - - - 374.0 158 低钾血症表现 10.9 4.3 4.7 - - - - - Dickinson H[5] 16.6 3.8 - - - - 396.0 - 无高钾血症表现 8.8 - - 4.3 - - - - 8.6 - - 4.8 - - - - Simran K[6] 7.5 - - - - - - - 无高钾血症表现 5.6 - - - 4.1 - - - - - - - 3.5 3.5 - - - George A[7] 7.5 3.4 - - - - 367.4 73 无高钾血症表现 10.7 3.6 - - - - 123.7 44 Garwicz D[8] 11.6 3.7 - - - - 391.0 86 无高钾血症表现 PTS、-、WBC:同表 1; PLT:血小板
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