Tăng kali giả do vận chuyển mẫu xét nghiệm bằng hệ thống khí nén tự động trên bệnh nhân bạch cầu mạn dòng tủy Ph(+) có tình trạng tăng bạch cầu cấp cứu: Báo cáo ca lâm sàng=A case report: Pseudohyperkalemia due to pneumatic tube transport in a hyper leukocytosis chronic myeloid leukaemia Ph(+) patient

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Tác giả: Nguyên Khanh Hoàng, Đắc Quỳnh Anh Nguyễn, Nguyễn Thùy Trang Phạm

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.335-341

Bộ sưu tập: Báo, Tạp chí

ID: 478272

Thêm vào giỏ

Báo cáo một trường hợp tăng kali máu giả do hệ thống vận chuyển ống khí nén. Ca lâm sàng: Bệnh nhân nam, 41 tuổi được chẩn đoán bạch cầu mạn dòng tủy Ph(+) từ năm 2019, nhập khoa cấp cứu vì đau ngực và mệt mỏi hai ngày trước đó. Các xét nghiệm cho thấy nồng độ kali trong huyết tương là 6,75 mmol/L và số lượng bạch cầu tổng là 394 x 109/L, các thông số điện giải khác và chức năng thận bình thường. Điện tâm đồ không cho thấy những thay đổi tương ứng với tình trạng tăng kali máu. Xử trí cấp cứu cho tình trạng tăng kali máu đã được tiến hành. Theo dõi giá trị kali huyết tương sau khi điều trị cho thấy giá trị kali huyết tương vẫn tăng đáng kể không phù hợp với biểu hiện lâm sàng và thay đổi trên ECG, điều này dẫn tới nghi ngờ tình trạng tăng kali máu giả và các mẫu tiếp theo được vận chuyển đến phòng xét nghiệm bằng đi bộ cho thấy nồng độ kali huyết tương bình thường. Do đó đã chứng minh rằng tăng kali máu giả là do sự li giải các tế bào bạch cầu trong quá trình vận chuyển mẫu máu từ khoa cấp cứu đến khoa xét nghiệm trong hệ thống ống khí nén vận chuyển mẫu tự động. Bàn luận: Tăng kali máu là một rối loạn điện giải có khả năng gây tử vong cần được phân biệt với tăng kali máu giả. Tăng kali máu giả được định nghĩa là sự tăng giả nồng độ kali, thường do chấn thương cơ học trong quá trình tiêm tĩnh mạch lấy mẫu xét nghiệm dẫn đến tan máu và giải phóng kali từ các thành phần tế bào của máu. Ngoài ra, hệ thống vận chuyển bằng ống khí nén nên được liệt kê trong y văn như một nguyên nhân tiềm ẩn khác gây tăng kali máu giả, đặc biệt ở những bệnh nhân có số lượng bạch cầu cao. Kết luận: Các bác sĩ lâm sàng nên nhận biết hệ thống vận chuyển ống khí nén có khả năng gây tăng kali máu giả bởi vì việc điều trị tình trạng tăng kali máu ở những trường hợp này có thể gây hại cho bệnh nhân.To report a case of pseudohyperkalemia due to a pneumatic tube transport system. Case Summary: A 41-year-old male was diagnosed with Chronic Myeloid Leukaemia Ph(+) (CML Ph (+)) in 2019 and presented to the emergency medicine department with chest pain and fatigue the previous 2 days. Laboratory studies revealed a potassium value of 6.75 mmol/L and a white blood cell count of 394 x 109/L, with otherwise normal electrolytes and renal function. A 12-lead electrocardiogram was normal, with no changes suggestive of hyperkalaemia. Emergent treatment for hyperkalaemia was instituted. Repeat plasma potassium values obtained after treatment for the hyperkalemia remained significantly elevated. Pseudohyperkalaemia was suspected, and further samples transported to the laboratory by foot showed normal plasma potassium levels. It was subsequently demonstrated that the pseudohyperkalemia was due to the lysis of leukaemic white cells during the transport of blood samples from the ward to the laboratory within the pneumatic tube system. Discussion: Hyperkalemia is a potentially fatal electrolyte abnormality that must be differentiated from pseudohyperkalemia. Pseudohyperkalemia is defined as a spurious elevation of potassium levels usually due to mechanical trauma during venipuncture resulting in hemolysis and release of potassium from the cellular elements of blood. Pneumatic tube transport systems should be listed in the scientific literature as another potential cause of pseudohyperkalemia, especially in patients with high WBC. Conclusion: Clinicians should be aware of pneumatic tube transport systems potentially causing pseudohyperkalemia, because regular treatments for hyperkalemia for this problem may cause patient harm.

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