诊断学理论与实践

诊断学理论与实践 ›› 2018, Vol. 17 ›› Issue (06): 707-710.doi: 10.16150/j.1671-2870.2018.06.015

• 论著 • 上一篇    下一篇

类肝素样抗凝物引起不同凝血仪间凝血筛查试验结果差异分析

许梦阳, 何斌, 华宝来, 吉薇, 沈连军, 施青青, 孙幸, 余菊, 谢晓艳, 孙梅, 顾健   

  1. 扬州大学临床医学院 江苏省苏北人民医院血液科,江苏 扬州 225001
  • 收稿日期:2018-05-24 出版日期:2018-12-25 发布日期:2018-12-25
  • 通讯作者: 何斌 E-mail: yzhebin2013@qq.com; 华宝来 E-mail: baolaihua@hotmail.com
  • 基金资助:
    北京市自然科学基金项目（7162151）; 中国诺和诺德血友病研究基金（NNHRF）

The discrepancy of thrombin time results between two kinds of thrombolyzer in a patient associated with heparin like anticoagulant

XU Mengyang, HE Bin, HUA Baolai, JI Wei, SHEN Lianjun, SHI Qingqing, SUN Xing, YU Ju, XIE Xiaoyan, SUN Mei, GU Jian   

  1. Yangzhou University College of Clinical Medicine, Northern Jiangsu's People's Hospital, Jiangsu Yangzhou 225001, China
  • Received:2018-05-24 Online:2018-12-25 Published:2018-12-25

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摘要： 目的：探讨2种不同检测原理的凝血仪,测得1例4岁“腺样体肥大”患儿的凝血酶时间（thrombin time,TT）结果间存在差异的原因。方法：动态监测患儿的凝血四项,用一期法检测凝血因子水平,行鱼精蛋白中和试验,纤维蛋白原基因测序分析。结果：2种凝血仪器测得的该患儿活化部分凝血活酶时间（activated partial thromboplastin time,APTT）、TT结果间存在明显差异,其中A凝血仪测得的APTT为52.4 s、TT为88.7 s;B凝血仪测得的APTT为36.6 s,TT为16.7 s。该患儿的爬虫酶时间、纤维蛋白原降解产物正常;纤维蛋白原基因测序未见异常;采用50 μg/mL（终浓度）的鱼精蛋白可纠正延长的TT,证明其体内存在有类肝素样抗凝物。结论：该患儿体内的类肝素样抗凝物导致2种凝血仪检测的TT结果间差异较大,十分罕见,提示临床上出现检测结果不一致时,不应盲目认定为检测错误,需进一步探究原因。

关键词: 类肝素样抗凝物, 凝血酶时间, 硫酸鱼精蛋白, 异常纤维蛋白原血症

Abstract: Objective: To explore the cause of discrepancy in results of thrombin time(TT) between two kinds of thrombolyzer in a 4-year-old male child with glandular hypertrophy. Methods: A series of plasma samples were obtained during 7 months follow-up periods, one stage clotting assay was used for coagulation factors tests, protamine sulfate neutralization test was performed, and three fibrinogen genes were sequenced. Results: The significant difference in TT results between thrombolyzer A (magenetic beads) and B (transmission turbidimetry) was further confirmed by two reference labs with a prolonged TT in A and normal TT in B. Activated partial thromboplastin time (APTT) were 52.4 s and 36.6 s, TT were 88.7 s and 16.7 s by A and B thrombolyzer, respectively. The prolonged TT was corrected by 50 μg/ml (final concentration) protamine sulfate, and the reptilase time was normal. No mutation was found in fibrinogen genes by gene analysis. Thus, the presence of endogenous heparin like anticoagulant in this boy was confirmed. Conclusions: Endogenous heparin like anticoagulant is rare and existed in this boy, causing the discrepancy of TT results between the two kinds of thrombokyzer. Therefore, if a discrepancy of TT results is found, other causes such as heparin like anticoagulant should be considered.

Key words: Heparin-like anticoagulant, Thrombin time, Protamine sulfate, Dysfibrinogenemia

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