Klinik Kimya Laboratuvarında Acil Durum Testlerinde Plazma Tüpü Kullanımı

Yıl 2021, Sayı: 23, 243 - 247, 30.04.2021

Gülçin Şahingöz Erdal , Nilgün Işıksaçan , Pinar Kasapoğlu , Asuman Gedikbaşı Murat Koşer

https://doi.org/10.31590/ejosat.864325

Öz

Laboratuvarlarda gerçekleştirilen hızlı testler için ana hususlar hızlı ve doğru bir test sonucu elde etmektir. Hızlı testlerin serum yerine plazma kullanılarak gerçekleştirilmesini mümkün kılmak için artan sayıda cihaz ve yöntem geliştirilmiştir. Bu çalışmanın amacı, serum ve plazma örnek tüplerinin hızlı test sonuçlarını karşılaştırmaktır. 78 hastanın venöz kan örnekleri BD Vacutainer®SST ™ II Advance serum jeli ve Vacutainer®Barricor ™ plazma tüpüne toplandı. Randomizasyonun sağlanması için kan alma ve tüplerin aletlere yüklenmesi sırasında tüplerin örnekleme sıraları değiştirildi. Kan alma anından itibaren tüplerin ters çevrilmesi, tamamen doldurulması ve serum tüplerinin en az 30 dakika süreyle pıhtılaşması sağlandı. Klorür ve sodyum testlerinin iyi bir uyuma sahip olduğu ve kalan testlerin güçlü bir uyum düzeyine sahip olduğu belirlendi. Albümin, ALT, Amilaz, AST, Bilirubin, Direkt Bilirubin, BUN, Kalsiyum, Klorür, Kreatinin, Mg, Na, CK, CRP, Üre, BNP, troponin-T, D-dimer analizi her biri için benzerdi ve anlamlı bir fark yoktu .
Plazma elde etmek için pıhtılaşma süresinın gerekmemesi hızlı testin isüresinin kısalmasına yardımcı olurken, plazma tüpünde serum tüp örneklerinde görülebilen fibrin oluşumunun olmaması ise örnek kalitesini ve test sonuçlarının doğruluğunu destekler. Serum elde etmek için gerekli numune transferinin neden olduğu hemoliz olasılığı nedeniyle serum tüpleri yerine plazma tüpleri kullanılabilir.

Anahtar Kelimeler

Serum, Plazma tüpü, Hızlı test, Pıhtılaşma

Use of Plasma Tube for the Emergency Tests in Clinical Chemistry Laboratory

Öz

The major considerations for the STAT testing performed in laboratories are to obtain a fast and accurate test result. Increasing number of instruments and methods have been developed for making it possible to perform the STAT testing on plasma rather than serum. The aim of this study is to compare the STAT test results of the serum and plasma sample tubes. Venous blood samples of 78 patients were collected into BD Vacutainer®SST™II Advance serum gel and Vacutainer®Barricor™ plasma tube. The sampling orders of the tubes were switched during blood collection and loading the tubes into the instruments in order to ensure randomization. It was ensured the tubes were inverted, completely filled, and were allowed serum tubes to clot for a minimum of 30 minutes from the time of blood collection. It was determined that the chloride and sodium tests had a good concordance and the remaining tests had a strong level of concordance. Albumin, ALT, Amylase, AST, Bilirubin, Direct Bilirubin, BUN, Calcium, Chloride, Creatinine, Mg, Na, CK, CRP, Urea, BNP, troponin-T, D-dimer analysis was similar for both, with no significant difference.
While it helps to improve TAT since no clotting time is required to obtain plasma it also supports sample quality and accurate test results with the absence of fibrin formation at plasma tube which is possible at serum tube samples. Plasma tubes may be used instead of serum tubes due to the possibility of hemolysis caused by sample transfer required to obtain serum.

Anahtar Kelimeler

Serum, Plasma tube, STAT testing, Clotting

Kaynakça

• Vermeulen, M.J., Guttmann, A., Stukel, T.A., et al. (2016). Are reductions in emergency department length of stay associated with improvements in quality of care? A difference-in-differences analysis. BMJ Qual Saf, (25), 489-98. DOI:10.1136/bmjqs-2015-004189
• Mullins, P.M., Pines, J.M. (2014). National ED crowding and hospital quality: results from the 2013 Hospital Compare data. Am J Emerg Med, (32), 634-39. DOI: 10.1016/j.ajem.2014.02.008
• White, B,A, Baron, J,M., Dighe, A.S., et al. (2015). Applying Lean methodologies reduces ED laboratory turnaround times. Am J Emerg Med, (33), 1572–76. DOI: 10.1016/j.ajem.2015.06.013
• Boelstler A.M., Rowland, R., Theoret, J., et al. (2015). Decreasing troponin turnaround time in the emergency department using the central laboratory: A process improvement study. Clin Biochem,( 48), 308–12. DOI: 10.1016/j.clinbiochem.2014.10.014
• Li, L., Georgiou, A., Vecellio, E., et al. (2015). The effect of laboratory testing on emergency department length of stay: a multihospital longitudinal study applying a cross-classified random-effect modeling approach. Acad Emerg Med, (22), .38– 46. DOI: 10.1111/acem.12565
• Hwang, U., Baumlin, K., Berman, J., et al. (2010). Emergency department patient volume and troponin laboratory turnaround time. Acad Emerg Med, (17), 501–507. DOI: 10.1111/j.1553-2712.2010.00738.x
• Young, D.S., Bermes, E.W. (2001). Specimen collection and other preanalytical variables. In Burtis CA, Edward RA. eds. Tietz textbook of clinicalchemistry Philadelphia: W.B sounders company, 30-53.
• Hawkins, R.C. (2007). Laboratory turnaround time. Clin Biochem Rev, (28), 179-94.
• Sharma, L.K., Dutta, D., Sharma, N., et al. (2018). Comparisons of metabolite profile from paired serum and ethylenediaminetetraacetic acid-plasma samples using dry chemistry technology: An emergency department perspective. J Lab Physicians, (10), 346-350. DOI: 10.4103/JLP.JLP_151_17. PubMed PMID: 30078974; PubMed Central PMCID: PMC6052806.
• Engstad, C.S., Guttenberg, T.J., Osterut, B. (1997). Modulation of blood cell activation by four commonly used anticoagulants. Thromb Hemost, (77), 690-6.
• Grafmeyer, D., Bondon, M., Manchon, M., et al. (1995). The influence of bilirubin, haemolysis and turbidity on 20 analytical tests performed on automatic analysers. Eur J Clin Chem Clin Biochem, (33), 31-52
• Organization, W.H. (2002). Use of anticoagulants in diagnostic laboratory investigations. World Health Organization.
• Harr, R., Bond, L., Trumbull, D. (1987). A comparison of results for serum versus heparinized plasma for 30 common analyses. Lab Med, (18), 449-55.
• Ciuti, R., Rinaldi, G. (1989). Serum and plasma compared for use in 19 common chemical tests performed in the Hitachi 737 analyzer. Clin Chem, (35), 1562-3. PubMed PMID: 2758626.
• Caliezi, C., Reber, G., Lämmle, B., et al. (2000) Agreement of D-dimer results measured by a rapid ELISA (VIDAS) before and after storage during 24 h or transportation of the original whole blood samples. Thromb Haemost, (83), 177-8.
• Hagemann, P. (1994). Qualität im Arztlabor. Optimierung der Präanalytik. Heidelberg: Springer.
• Ladenson, J.H., Tsai, L.M., Michael, J.M., et al. (1974). Serum versus heparinized plasma for eighteen common chemistry tests: Is serum the appropriate specimen?. Am J Clin Pathol, (62), 545-52.
• Miles, R.R., Roberts, R.F., Putnam, A.R., et al., 2004, "Comparison of serum and heparinized plasma samples for measurement of chemistry analytes, " Clin Chem., 50, p. 1704-6.
• Boyanton, B.L. Jr., Blick, K.E. (2002). Stability studies of 24 analytes in human serum and plasm. Clin Chem, (48), 2242-7
• Sonntag, O. (1986). Haemolysis as an interference factor in clinical chemistry. Clin Chem Clin Biochem, (24), 127-39.
• Goce, D., Johnston, J. (2018). Is the BD Barricor Tube the New Standard for Lithium Heparin Plasma?. Clin Med Pathol, (5), 1-5. DCMP: 000514.2018.
• Mandić, S., Mandić, D., Lukić, I., et al. (2020). Test results comparison and sample stability study: is the BD Barricor tube a suitable replacement for the BD RST tube?. Biochem Med, (30), 3:030704.
• Dupuy, A.M., Badiou, S., Daubin, D., et al. (2018). Comparison of Barricor™ vs. lithium heparin tubes for selected routine biochemical analytes and evaluation of post centrifugation stability. Biochem Med,(28), 2:020902.
• Moon, S.Y., Lee, H.S., Park, M.S., et al. (2021). Evaluation of the Barricor Tube in 28 Routine Chemical Tests and Its Impact on Turnaround Time in an Outpatient Clinic. Ann Lab Med, (41), 277-284.