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中华临床实验室管理电子杂志

中华临床实验室管理电子杂志 ›› 2024, Vol. 12 ›› Issue (01) : 22 -26. doi: 10.3877/cma.j.issn.2095-5820.2024.01.005

实验研究

枸橼酸钠抗凝比例及校正采血量分别对正常人和贫血患者血栓弹力图试验结果的影响
彭思远1, 贺王成2, 梁国华3, 罗冰4, 田英1, 李晓丹1, 肖晴1, 毛曼1, 区晓雯1, 耿文艳1,†()   
  1. 1. 510150　广东广州，广州医科大学附属第三医院检验科;510150　广东广州，广州医科大学附属第三医院输血科
    2. 510182　广东广州，广州医科大学金域检验学院
    3. 510150　广东广州，广州医科大学附属第三医院血液内科
    4. 510150　广东广州，广州医科大学附属第三医院输血科
  • 收稿日期:2023-07-16 出版日期:2024-02-28
  • 通信作者: 耿文艳

The effect of proportions of sodium citrate anticoagulation and corrected blood collection volume on thromboelastography test of normal people and anemic patients

Siyuan Peng1, Wangcheng He2, Guohua Liang3, Bing Luo4, Ying Tian1, Xiaodan Li1, Qing Xiao1, Man Mao1, Xiaowen Ou1, Wenyan Geng1,†()   

  1. 1. Department of Clinical Laboratory, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong 510150, China;Blood Transfusion Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong 510150, China
    2. KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou Guangdong 510182, China
    3. Department of Hematopathology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong 510150, China
    4. Blood Transfusion Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong 510150, China
  • Received:2023-07-16 Published:2024-02-28
  • Corresponding author: Wenyan Geng
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彭思远, 贺王成, 梁国华, 罗冰, 田英, 李晓丹, 肖晴, 毛曼, 区晓雯, 耿文艳. 枸橼酸钠抗凝比例及校正采血量分别对正常人和贫血患者血栓弹力图试验结果的影响[J]. 中华临床实验室管理电子杂志, 2024, 12(01): 22-26.

Siyuan Peng, Wangcheng He, Guohua Liang, Bing Luo, Ying Tian, Xiaodan Li, Qing Xiao, Man Mao, Xiaowen Ou, Wenyan Geng. The effect of proportions of sodium citrate anticoagulation and corrected blood collection volume on thromboelastography test of normal people and anemic patients[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2024, 12(01): 22-26.

目的

研究不同枸橼酸钠抗凝比例对正常人血栓弹力图（TEG）试验结果的影响以及校正采血量对贫血患者TEG试验结果的影响，为临床采血提供指导。

方法

选取2022年7月至2023年3月广州医科大学附属第三医院收诊的29名贫血患者作为观察组研究对象，另以20名正常人为正常组，采集全血进行TEG试验。贫血患者按照校正公式调整采血量，分为校正前和校正后2组，研究校正采血量前后TEG试验结果的差异。正常人按照抗凝剂与全血的比例分为4组，分别为A组（1∶4）、B组（1∶9）、C组（1∶12）、D组（1∶14），贫血患者根据是否参照校正公式校正采血量分别进行TEG试验检测，将各组的结果进行统计分析。

结果

A组凝血反应时间（R）与凝块形成时间（K）均高于B组，差异具有统计学意义（P<0.05）。A组角度（Angle）与凝块最大振幅（MA）均低于B组，差异具有统计学意义（P<0.05）。C、D组与B组的各指标结果相比差异无统计学意义（P>0.05）；贫血患者（HCT>0.2）校正后组Angle比校正前组有所升高（P<0.05），贫血患者（HCT≤0.2）校正后组R与MA比正常组有所升高（P<0.05）。

结论

正常人4组不同抗凝剂比例的实验结果提示，只有当抗凝比例增高达到1∶4时，TEG结果相较正常比例（1∶9）有较大差别，提示在临床采血时采血量一定要适当，才能保证实验结果的准确性。而贫血患者校正前后的TEG试验相关检测指标差异具有统计学意义。为了提高检测的准确性, 应校正抗凝剂的量或采血量后再进行采血检测。

关键词: 血栓弹力图, 贫血, 抗凝比例
Objective

To investigate the impact of different proportions of sodium citrate anticoagulation and corrected blood collection volume on the results of thromboelastography (TEG) test in normal people and anemia patients respectively, so as to provide guidance for clinical blood collection.

Methods

29 patients with anemia admitted to The Third Affiliated Hospital of Guangzhou Medical University from July 2022 to March 2023 were selected as the observation group, and 20 normal individuals were selected for TEG test as normal group. The anemia patients were divided into two groups according to the correction formula, which were the pre-correction group and the post-correction group. The difference of TEG results before and after adjustment of blood collection volume was analyzed. The normal subjects were divided into four groups according to the ratio of anticoagulant to whole blood: group A (1:4), group B (1:9), group C (1:12) and group D (1:14). The TEG test was performed and the results of each group were statistically analyzed.

Results

Reaction time (R) and coagulation time (K) in group A were significantly higher than those in group B (P<0.05). The angle and maximal amplitude (MA) in group A were lower than those in group B, and the differences were statistically significant (P<0.05). There was no significant difference between group C, D and group B (P<0.05); In patients with anemia (HCT>0.2), angle in the corrected group was higher than that in the pre-corrected group. In patients with anemia (HCT≤0.2), R and MA in the corrected group were higher than that in the pre-corrected group.

Conclusions

When the blood collection volume was insufficient, the results of TEG test were significantly different from the normal ratio (1:9), suggesting that the blood collection volume must be proper in clinical blood collection to ensure the accuracy of experimental results. There was a significant difference in TEG test before and after correction in anemia patients. In order to improve the accuracy of the test, the blood collection test should be conducted after correcting the amount of anticoagulant or blood collection.

Key words: thromboelastography, anemia, anticoagulation ratio
表1 正常人不同抗凝比例TEG试验结果（n=20）
项目 R/min K/min Angle/° MA/mm
A组 9.845 0±5.264 7a 3.505 0±1.647 5c 51.115 0±10.258 2c 55.075 0±6.409 0b
B组 7.210 0±1.564 7 1.730 0±0.692 1 65.820 0±6.442 8 61.030 0±3.446 0
C组 7.230 0±2.235 6 1.760 0±0.806 8 65.740 0±7.071 0 61.405 0±4.264 2
D组 7.270 0±2.282 9 1.795 0±0.666 1 64.825 0±6.874 4 60.985 0±4.407 2
表2 贫血患者（HCT>0.2）校正前组、校正后组的TEG试验结果
项目 例数 R/min K/min Angle/° MA/mm
校正前组 19 6.231 9±2.417 3 1.905 3±1.149 1 65.273 7±9.829 8 56.736 8±11.130 1
校正后组 19 6.052 6±1.989 8 1.752 6±1.035 7 68.484 2±8.262 7a 52.668 4±10.521 2
正常组 20 7.210 0±1.564 7 1.730 0±0.692 1 65.820 0±6.442 8 61.030 0±3.446 0
表3 贫血患者（HCT≤0.2）校正前组、校正后组的TEG试验结果
项目 例数 R/min K/min Angle/° MA/mm
校正前组 10 5.040 0±1.433 9 1.930 0±1.025 3 67.710 0±8.020 5 50.950 0±15.849 6
校正后组 10 6.550 0±2.376 9a 1.850 0±1.024 4 67.800 0±9.735 6 52.080 0±15.221 7b
正常组 20 7.210 0±1.564 7 1.730 0±0.692 1 65.820 0±6.442 8 61.030 0±3.446 0
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