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    Home > Active Ingredient News > Blood System > True "potassium" is difficult to distinguish, false only in one mind between

    True "potassium" is difficult to distinguish, false only in one mind between

    • Last Update: 2020-06-24
    • Source: Internet
    • Author: User
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    01 ForewordWe all know many common causes of false hyperkale, and samples are refrigerated or frozen before separating serum? The specimen was not processed in time? Hard beat the blood collection area? The specimen is contaminated with potassium ions? Hemolysis? WBC high? RBC high? PLT high? Clinical potassium supplementation? Enter a lot of stock blood? Infusion sie-throed blood? Reduced potassium in the kidneys, acute renal failure? Potassium diuretics: acidosis? Intracellular potassium emigration? Yellow poisoning? Even PLT/RBC membrane structure abnormal? WBC, RBC, PLT all three are too high are likely to cause false hyperhemokaleh? Have you ever seen patients with high levels of all three but no typical symptoms of potassium?02 medical historypatients, male, 92 years old, December 12, 2019, repeated chest tightness, heart palpitations, after 6 years of asthma, and then 4 days, no obvious cause of chest tightness, blood, no whole body sweating, frequent death, fearless cold, fever and other discomfort, hospital admissionPrevious history of hypertension, irregular medication, "chronic bone marrow proliferation disease history", chronic heart failure history, coronary heart disease, atrial atrial fibrillation historyNT-proBNP: 9769pg/mlHeart: heartless front area bulge, heart-to-heart throb normal, located in the V rib, the left collarbone in the middle line 0.5cm, not shaking and lifting like beating, heart boundary diagnosis no expansion, heart rate 98 times / minute, heart rate is absolutely inconsistent, heart tone strength, A2 P2, no noise03 case afterDecember 13, 20198 o'clock test resultsspecimen status: normal, (no clots, jaundice, hemolytic blood)instrument status: goodreagent calibration curve status: normalindoor quality control: in the controlroom quality assessment: excellentThe results are high
    can be seen at 8:00 a.min the table, the patient's intravenous serum K-6.67mmol/L (3.5-5.5mmol/L), has reached the critical value set by my department;clinical reaction patients electrocardiogram no high blood potassium performance, symptoms and no high blood potassium performance, so communication with the testing department, in order to eliminate the time of placement of blood specimens and blood withdrawal order and other reasons, clinical immediately set out to draw blood, timely and sent specimens to the examination department for reviewthe results of theat about 11 a.mtestcan be seen at 11:00 the patient's intravenous blood K.47mmol/L (3.5-5.5mmol) is still criticalArterial blood K-4.8mmol/L (3.5-4.5mmol/L), the upper limit of the reference range, did not reach the critical valueIt doesn't make any difference with the last timeIt doesn't make any difference with the last timeso clinicians wondered and confused and questioned the results of the testWe see the patient WBC, RBC, PLT, all three are very high, up to 1434x10?9/LFigure:consider whether intravenous potassium may be related to WBC, RBC, PLTLater we looked up the relevant literature, so we wanted to try an exclusionary method, we used heparin tube re-pumping the final intravenous potassium dropped significantly, the result is 5.0mmol/L, close to the results of arterial blood gas, and will be higher than the arterial blood gas 0.2 or so, so we highly suspect that mainly PLT:1434x109/L caused by the high amount of pseudo-potassium pseudohyperkalemia ( Pseudohyperkalemia ) was first reported by Hartmann and Mel-linkoff in 1955 , referring to in vitro detection of higher serum potassium than normal and the concentration of plasma potassium in the body in the normal range , the difference between the two is greater than 0.4-0.5m/L , known as pseudo-hyperkaleemia It can be seen that the difference in this example is much greater than 0.4-0.5mmol/L 04 case study 1, what is the principle of false high potassium caused by this increase in PLT? the patient platelets up to 1434x10 x 6/L, centrifugal blood platelets released, serum potassium falseity increased, because of the use of anticoagulant, and not centrifugal, the impact is small, resulting in a large difference between serum and whole blood, the use of green tube blood retest, should be normal Potassium ions in platelets are much higher than those of platelets, and in the blood clotting process, platelets will gather to form blood clots, and a large number of platelets will destroy and release potassium ions Even if there is no damage to platelets, permeability changes, resulting in a large amount of potassium release in the platelets 2, red and white cells are also very high, why only consider the effects of high platelets here? the later stage of blood coagulation, only platelets involved, red and white cells do not participate, after centrifugal, platelet fragmentation or permeability changes, release potassium, red-white cell integrity, less affected potassium 3, the common cause of false hyperhemokaleulate potassium caused by red and white blood cells? (1) true erythrocytic disease Blood viscosity increases, potassium ions are released during blood coagulation, some researchers believe that the increase of red blood cells leads to accelerated glucose enzyme solution in the blood, decreases at ATP production, decreases the activity of the red cell membrane Na-K-ATP enzyme, and releases of potassium ions in the cell (2) a large increase in white blood cells caused by various leukemia and inflammatory reactions A large increase in white blood cells can lead to rapid consumption of blood sugar, reduced ATP production, reduced activity of Na-K-ATP enzyme on the red cell membrane, resulting in the release of intracellular K-plus cells, false hypoglycemia associated with pseudo-hyperkaleemia; (3) familial hyperkalemia Relatively rare, it is reported that it is an autosomal dominant genetic disorder, which may be due to increased penetration of the red blood cell membrane to potassium ions, resulting in false hyperpotassium 4, biochemical examination potassium ions exceed the critical value, heparin lithium anticoagulant check, potassium value in the normal range, the normal range is caused by heparin lithium and potassium replacement? How do specimens of the related disease be treated to reflect their true potassium values? The difference between potassium in plasma and potassium in serum? lithium heparin results can be reported But instead of replacement, platelets contain potassium ions, clotted blood platelets of potassium release caused by the increase of serum K ions Theoretically, the difference between anticoagulant and serum potassium ions in normal humans is 0.2-0.4 Anticoagulant testing must be used to detect serum for platelet hyperactivity 05 summary
    1, blood in the coagulation process, a large number of platelet activation, aggregation, destruction, so that the concentration of platelets much higher than the potassium ions outside the platelets released into the serum, causing the falseity of serum potassium increased In addition, even if the platelets are not damaged, platelet membrane permeability will change, resulting in a large number of potassium ions in the plateletrelease release And plasma is the upper cleansing after the centrifugal precipitation of blood cells, containing rich fibrin and coagulation factors, etc., after centrifugal whole blood platelets have not been destroyed 2, serum potassium was 0.38mmol/L higher than plasma potassium concentration, and the difference range was 0.01-0.8mmol/L The cause of the difference in serum and plasma potassium concentration may be due to the blood in vitro coagulation process, cell and platelet rupture release of potassium serum potassium concentration increased, and the release of potassium is not only closely related to the number of cells and platelets and also related to the temperature of the blood sample placement and the length of separation serum reported that when platelet count is below 200x10,9/L, the incidence of pseudo-hyperhekaleulate is extremely low; This in itself is understandable that platelets in the plasma are not activated and therefore do not release potassium ions When the white blood cell count was higher than 50x109/L, the incidence of pseudo-hyperkaleemia was about 25% in both serum and plasma samples For every 100x109/L increase in platelets, serum potassium concentrations are approximately 0.15-0.18mmol/L higher than plasma In addition, the amount of potassium release is related to the amount of potassium in the body, blood clotting during high blood clotting, and less potassium in low blood potassium release due to the different conditions of different specimens, the impact on serum potassium is not consistent, and can not be predicted, so it is believed that serum potassium can not really reflect the level of blood potassium in the body, especially when the body potassium content is too low and platelet growth will cause a larger error, may affect clinical diagnosis and treatment plateletdamage is not like red blood cell damage When platelets are greater than 500x10?9/L, and for each increase of 100x10?9/L, serum potassium concentrationist is approximately 0.15-0.18mmol/L higher than plasma In addition, the amount of potassium release is related to the amount of potassium in the body, blood clotting during high blood clotting, and less potassium in low blood potassium release Due to the different conditions of different specimens, the impact on serum potassium is not consistent, and unpredictable, it is believed that serum potassium can not truly reflect the level of blood potassium in the body, especially when the body potassium content is too low and platelet growth will cause a larger error, may affect clinical diagnosis and treatment 3, platelet damage is not like red blood cell damage From the serum appearance is simply not found, with concealment, especially the normal results of blood potassium Therefore, the clinic should choose to determine plasma potassium, more conducive to clinical diagnosis and treatment of electrolyte balance disorders, especially in patients with hypokalemia and platelet hyperplasia And in clinical surgical observation and urgent investigation of the project, separation of serum, clotting process often takes a period of time, especially in the process of separation of blood samples, will cause red blood cells to shrink, deformation, resulting in error in the analysis results While heparin anticoagulant plasma samples are easy to separate, can be measured in a timely manner, the results are more stable, and avoid the blood coagulation process, so the use of plasma samples to detect biochemical projects, in the absence of interference, the results can better reflect the real situation in the patient but the current blood potassium reference value is based on serum So that clinicians often judge the concentration of blood potassium on the serum as the benchmark, in order to avoid the different types of test tubes of blood extraction, resulting in differences in potassium ions, to lead to clinical misdiagnosis and mistreatment, it is recommended to develop the reference range of plasma potassium, or plasma potassium measurement results corrected and then reported 4, this case the patient has a chronic history of bone marrow proliferation disease, may be primary platelet growth, so clinically encountered platelets greater than 500x109/L, atypical symptoms of hyperkalemia cases, this should be vigilant, the blood group to remind the biochemical group to stay snacks, look at the results of biochemical potassium To identify whether it is a symptom of pseudo-hyperhemokaleulate, testing plasma potassium through heparin anticoagulant tube control may be a quick and effective means of identification (especially in patients with increased platelets) At the same time, according to the patient's blood routine, current medical history, past history and family history and other information to further identify the diagnosis of the primary disease leading to pseudo-hyperkalemia, and combined with clinical prevention of misdiagnosis, mistreatment, blind potassium reduction caused by medically induced low blood potassium Chen Lihui Huang Ling Ling Ming Unit: Fujian Provincial Association and Peace Tan Branch Source:
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