1.Department of Laboratory Diagnosis, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Hebei Province，Cangzhou 061001, China;
2.Department of Hematology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Hebei Province，Cangzhou 061001, China
Abstract：Objective To investigate the abnormal blood separation in multiple myeloma (MM). Methods A total of 282 MM patients (152 cases of IgG type，92 cases of IgA type, 6 cases of IgD type and 32 cases of light chain type), 200 autoimmune diseases patients and 200 healthy physical examinees were selected from Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province from March 2008 to October 2019. Fasting venous blood was collected by vacuum blood collection with separation gel, and the results of blood separation were observed after centrifugation. The patients were divided into the control group and the abnormal group according to the blood separation results, and the differences of immunoglobulin (Ig), total protein (TP), hemoglobin (Hb), hematopoietic volume (Hct), platelet count (PLT), and fibrinogen (Fig) levels were compared between the two groups. Results The blood of patients with autoimmune disease, healthy physical examinees and partial MM patients were divided into three layers, followed by serum, separation glue and red blood cells from top to bottom, and the proportion of serum and red blood cells was appropriate. Patients with abnormal blood separation were MM patients, and the abnormal blood was separated into four layers, successively from top to bottom: serum, red blood cell, separation glue and red blood cell. There was a small amount of serum in the upper layer, a increase of red blood cells in the lower layer, and a small amount of red blood cell in the bottom layer. Abnormal blood separation was found in 46 cases of the 282 MM patients (16.31%). Abnormal separation was found only in IgG (28 cases) and IgA (18 cases), accounting for 60.87% and 29.13%, respectively. The levels of TP and Ig in the abnormal group were higher than those in the control group, while the levels of Hb and Hct in the abnormal group were lower than those in the control group (all P < 0.05). Conclusion Abnormal separation phenomenon occurred after centrifuged in patients with MM. In case of abnormal blood separation in daily work, timely communication with clinicians should be conducted and further confirmatory tests should be conducted.
[1] 赵娟，马乐，关键虹．多发性骨髓瘤继发性骨髓纤维化的骨髓病理学特征及与疾病预后的关系[J].中国实验血液学杂志，2017，25（4）：1080-1085.
[2] 年飞鸽，李锋，邵靓婧，等.66例IgG型多发性骨髓瘤患者初诊时IgG水平与疗效及预后的相关性分析[J].中国实验血液学杂志，2019，27（4）：1159-1165.
[3] 周靖泳，王娟，汤华.多发性骨髓瘤误诊资料分析[J].国际检验医学杂志，2016，37（10）：1396-1398.
[4] 张冬梅，吕菁君，魏捷.138例不同首发症状的多发性骨髓瘤临床回顾性分析[J].中华急诊医学杂志，2017，26（10）：1172-1179.
[5] Gerin F，Ramazan DC，Baykan O，et al. Abnormal gel flotation in a patient with apparent pneumonia diagnosis：a case report [J]. Biochem Med（Zagreb），2014，24（1）：180-182.
[6] 中国医师协会血液科医师分会，中华医学会血液学分会，中国医师协会多发性骨髓瘤专业委员会.中国多发性骨髓瘤诊治指南（2015年修订）[J].中华内科杂志，2015， 54（12）：1066-1070.
[7] 武大伟，魏殿军.天津某三甲医院30例多发性骨髓瘤首发表现及误诊原因分析[J].天津医科大学学报，2017，23（5）：458-459，468.
[8] 周靖泳，汤华，王娟.多发性骨髓瘤误诊荟萃分析[J].白血病·淋巴瘤，2013，22（8）：483-486.
[9] Maria F，Pablo F，Ricardo F. Anomalous flotation of separator gel：density or viscosity? [J]. Clin Chem，2008，54（4）：771-772.
[10] Bruns DE，Edwards M，Patterson W. What is wrong with this picture? [J]. Clin Chem，2011，57（11）：1620-1621.
[11] Srivastava R，Murphy MJ，Card J，et al. The case of the floating gel [J]. J Clin Pathol，2004，57（12）：1333-1334.
[12] Lima-Oliveira G，Lippi G，Salvagno GL，et al. Abnormal gel flotation caused by contrast media during adrenal vein sampling [J]. Biochem Med（Zagreb），2016，26（3）：444-450.
[13] 张靖宇，范洪，路炳通，等.免疫球蛋白等因素对分离胶采血管血液分离效果的影响[J].检验医学，2018，33（4）：275-278．
[14] van den Ouweland JM，Church S. High Total Protein Impairs Appropriate Gel Barrier Formation in BD Vacutainer Blood Collection Tubes [J]. Clin Chem，2007，53（2）：364-365.
[15] 汪薇，阎有功，张利方，等.IgD型多发性骨髓瘤实验室检查特征[J].临床血液学杂志，2015，28（1）：16-18.
[16] Chakraborty S，Chowdhury SR，Krishnan P，et al. Improper serum separation on gel tubes：a trivial laboratory problem or an indicator of monoclonal gammopathy? [J]. Clin Chem Lab Med，2014，52（12）：e275-e278.
[17] 杨林花.多发性骨髓瘤的凝血异常[J].临床血液学杂志，2012，25（7）：414-417．
[18] Faught RC，Marshall J，Bornhorst J. Solution densities and estimated total protein contents associated with inappropriate flotation of separator gel in different blood collection tubes [J]. Arch Pathol Lab Med，2011，135（9）：1081-1084.
[19] 宇尧，杜心如，陈文明，等.血栓弹力图检测多发性骨髓瘤骨病围术期凝血状态的临床研究[J].中国骨与关节杂志，2019，5（9）：700-705．
[20] Daves M，Lippi G，Cosio G，et al. An Unusual Case of a Primary Blood Collection Tube with Floating Separator Gel [J]. J Clin Lab Anal，2012，26（4）：246-247.
2020, Vol. 17 
京公网安备 11010502046598号