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What does "specimen hemolysis (X)" mean?
Sample hemolysis means that the red blood cells in the blood sample are destroyed and the contents of the red blood cells are released to the outside. In this case, many inspection items will be affected to varying degrees, and even the results will be seriously inaccurate. So it is often necessary to sample again at this time.

Hemolysis is a common phenomenon in clinical examination of medical blood samples. In order to understand the interference and influence of hemolysis on the test results, this paper compares 20 biochemical test results without hemolysis and hemolysis, and analyzes the influence of hemolysis on the biochemical test results and its countermeasures.

20 normal blood samples were taken, and no jaundice, lipid turbidity and hemolysis were found in the serum. Put them in two test tubes, 2.5 ml in each tube, and naturally separate 1 at room temperature. After 3 minutes, centrifuge with 1200 r/min to separate the serum, and take 1 ml serum as normal serum. In addition, the samples in 1 test tube were artificially hemolyzed, and then centrifuged under the same conditions to separate the hemolyzed serum for later use. The whole process was completed within 2 hours.

The results showed that the determination results of ALT, AST, LDH, k and CHO in hemolytic serum were significantly higher than those in normal serum (P < 0. 05), and the activity of ALP ALP decreased with hemolysis (P < 0. 05). Hemolysis has little effect on the determination results of BUN, Cr, TG, GLU and UA, and there is no statistical difference between normal serum and hemolytic serum.

This result shows that the hemolysis of samples will almost affect the accuracy of all biochemical test results. Therefore, both clinical nurses, doctors and laboratory workers should pay enough attention to the problem of sample hemolysis. The results of this experiment show that the change of enzyme concentration after hemolysis is extremely significant, and the requirements of enzyme on samples are higher than other biochemical tests, so it is not suitable to determine the enzyme after hemolysis in daily work. In addition, serum K is greatly influenced by hemolysis, followed by CHO, and the influence of hemolysis on protein, Na, Cl-, Ca2, TG, GLU, BUN, Cr and UA is very limited.

The influence mechanism of hemolysis on the results of different test items is different, which is mainly manifested in the following aspects: the interference of concentration difference inside and outside the cell, the high content of hemoglobin, enzymes, ions and organic substances in the cell, and the intracellular substances overflow along the concentration difference after hemolysis, which makes the measured value significantly higher than that of non-hemolytic samples; On the contrary, substances with extremely low concentration in red blood cells, such as lipoprotein, cholesterol ester, sodium, etc. , hemolyzed, intracellular fluid's dilution of serum made the determination results significantly decreased; Interference between intracellular and extracellular fluid components; The interference of colored substances on the absorption spectrum causes great errors in absorbance and astigmatism. When the color of the measured solution is close to the color of the colored substance, it will produce positive interference, and when it is far away from the color of the colored substance, it will produce negative interference. Iron ions in hemoglobin in hemolytic samples can be oxidized to yellow hemoglobin by oxidants (such as sodium nitrite) in reagents, which interferes with two-point colorimetry. When Hb is higher than 2 g/L, it will cause positive interference in CHODPAP endpoint method of serum total cholesterol. In the determination of phosphorus, phosphate ester in red blood cells in hemolytic samples was hydrolyzed, and inorganic phosphorus was increased.

In order to prevent hemolysis, it is necessary to master the correct blood sample collection method. Clinical blood collection mostly uses the middle elbow vein or the expensive vein, and infants mostly use the external jugular vein or femoral vein, so as to avoid choosing too thin veins and not to draw blood from the infusion tube. Strictly abide by the operating procedures. Keep the samples properly. After the samples are sent to the clinical laboratory, they should be kept at room temperature to prevent hemolysis. In the process of transporting blood samples, excessive oscillation of hemolysis can be prevented. Strictly control the quality of syringes and test tubes. Strictly grasp the purchase channels of disposable syringes and disposable test tubes, prevent unqualified products from flowing into the market and medical units, ensure the accuracy of test results, and reduce unnecessary economic burden and pain of patients. Understanding that hemolysis will cause false increase or decrease in the results of some biochemical items is of great significance for laboratory doctors to reduce mistakes and errors, improve the accuracy of laboratory results and better serve the clinic. Once obvious hemolysis is found in the work, corresponding measures should be taken immediately, such as re-collecting samples or correcting the results of samples with less hemolysis, especially with the popularization and use of automatic biochemical analyzer, checking whether the appearance of serum samples is hemolytic has become an important link in quality control during inspection.