摘要
目的应用全自动分析前标本质量核查系统筛查不合格标本,探讨提高止凝血检验标本质量的可能性。方法预选30例不合格标本交由13位检验技师核查,评价操作者目测判读的一致性。以首都医科大学附属北京朝阳医院检验科2018年4至5月期间2949例止凝血检验标本为对象,通过目测法和自动化标本质量核查系统在分析前评估标本质量,比较两种方法检出溶血、脂血、黄疸或凝集的能力。结果操作者目测判读存在较大差异,3组两两比较的Kappa系数分别为:0.32、0.26和0.38,表明人工目测判读的一致性较差。2949例标本中目测法检出2例溶血,1例脂血;而自动化核查系统通过检测吸光度改变的方法识别出不合格标本19例,各型占比为黄疸26.32%(5/19例)、凝集21.05%(4/19例)、溶血5.26%(1/19例)、脂血36.84%(7/19例)和溶血伴脂血10.53%(2/19例)。但是目测法拒收的1例溶血样本,TOP 750仪器的自动化核查系统未拒收。7例标本脂血未影响凝血酶原时间(prothrombin time,PT)和活化部分凝血活酶时间(activated partial thromboplastin time,APTT)检测,仅干扰D-二聚体;2例标本因溶血干扰PT、APTT和纤维蛋白原的检测,同时其脂血还干扰D-二聚体的检测,显示了项目特异的质量核查能力的优越性。结论全自动分析前标本质量核查系统提高了不合格标本的检出率,辅助了检验科的质量管理。
Objective To investigate the potential improvement of sample quality by automatic pre-analysis sample checking system,comparing to visual inspection for coagulation tests routinely.Methods Thirty samples with hemolysis,Icteric and lipemia in different levels were prepared and issued to 13 technicians for visual check,to evaluate the consistency individually.2949 blood samples with order for coagulation test were collected in Beijing Chaoyang Hospital in April and May 2018,the quality of all samples was evaluated by both visual check and automatic sample quality checking system before analysis,performance of two measurements detecting hemolysis,lipid,icteric or clot was compared.Results Significant differences were found in visual check among operators.The Kappa coefficients in three randomly selected groups were 0.32,0.26 and 0.38 respectively,indicating that the consistency of visual check was poor.Among all investigated samples,3 samples with unacceptable interference were detected visually,including 2 samples with hemolysis and another one with lipemia.On the other hand,19 unqualified samples were identified by automatic checking system.Five types of interference of unqualified samples were detected as icteric(26.32%,5/19),clot(21.05%,4/19)hemolysis(5.26%,1/19),lipemia(36.84%,7/19),and hemolysis with lipemia(10.53%,2/19)respectively by automatic checking system.But one case of hemolysis sample rejected by visual check was not rejected by automatic sample quality checking system.7 samples were merely affected on D-dimer by lipemia,which level did not influence the results of prothrombin time(PT)and activated partial thromboplastin time(APTT).Notably,other two samples were interfered with not only tests of PT,APTT and fibrinogen by hemolysis,but also D-dimer by the considerable level of lipemia,which showed the superiority of test-specific quality checking features.Conclusions The automatic pre-analysis sample quality checking system can improve the detection rate of unqualified samples and improve the efficiency of routine,helping realization of total quality management.
作者
高志琪
苑惠敏
周琪
王清涛
周睿
Gao Zhiqi;Yuan Huimin;Zhou Qi;Wang Qingtao;Zhou Rui(Department of Clinical Laboratory,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2019年第11期962-966,共5页
Chinese Journal of Laboratory Medicine
关键词
标本采集
凝血检验
全面质量管理
Sampling
Coagulation test
Total quality management
作者简介
通信作者:周睿,Email:zr-molly@163.com。
