Analysis of a rare clinical case of jelly-like serum

foreword

We all know that blood is an important component of human li.

case after

One day in the early hours of the night shift, an elderly female patient brought by an ambulance came to the emergency departme.

The left side of Figure 1 is the control, and the serum is in a light yellow liquid state; the right side is the patient's specimen, and the serum is in the form of a non-flowable jel.

According to past experience, it is possible that the time after blood collection is too short to cause the blood to start centrifugation without complete coagulation, or the speed of the centrifuge is too low, the force acting on the separation gel is relatively weak, and the separation gel does not return well, resulting in fibers The protein curds remain in the serum or in the colloid lay.

So what is the reason? After reviewing the information, I found that there are mainly the following three possibilities:

If the ambient temperature is too low, it will affect the precipitation of serum;

Plasma cell diseases such as multiple myeloma, macroglobulinemia in the abnormal proliferation of plasma cells produce large amounts of immunoglobulin ;

This patient may be a patient with myocardial infarction or renal dialysis, which is mainly related to the use of anticoagulants;

For the first possibility, the author gently pierced the jelly-like serum with a bamboo stick and placed the specimen in a 37°C water bath for 20 minut.

Figure 2 After incubating and centrifuging in a water bath, the serum is still jelly

Then, the author began to verify the second possibili.

FigureAfter centrifugation of the patient's sodium citrate anticoagulant tube specimen, light yellow liquid serum can be separated

Regarding the third possibility, the author went to the clinic to find a doctor for communication, and learned that the patient had a history of coronary atherosclerotic heart disease and atrial fibrillation for many years, and took dabigatran and aspirin for a long ti.

In this case, even if the blood coagulation time is prolonged, the liquid serum cannot be completely separat.

Figure 4 The patient's medical history

In this case, the author used heparin anticoagulation tube to collect blood again after communicating with the clinic to complete the biochemical test, and the test results also verified the correctness of this inferen.

Figure 5 The biochemical test results of the patient showed that the protein globulin in the body was within the normal reference range, excluding the possibility of plasma cell disease

Figure 6 The patient's PBN2 was significantly elevated, suggesting heart failure , consistent with the medical history

Summary

In modern medicine, the relationship between testing and clinical departments has become increasingly close, and the two complement each other and promote each oth.

references

[1] Xu Xiuj.

[6] Zhu Lei, Hu Liju.

A brief discussion on the relationship between testing and clinical from a clinical perspective [.

Chinese Journal of Laboratory Medicine, 2007, 30(02): 236-23