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目的研究血小板增多症患者的临床特点,以提高临床医生对血小板增多症引起假性血钾升高这一现象的认识,避免误诊高钾血症或漏诊低钾血症。方法测定9例血小板增多症患者的血浆钾浓度及采取血样后即刻血清钾浓度,进行对比分析,选取其中1例患者血液样本,测定其放置2 h的血清钾浓度。同时测定7例血小板计数正常患者的血清钾及血浆钾浓度作对照观察。结果 9例血小板增多症患者血清钾及血浆钾浓度检测结果显示,血清钾水平均高于血浆钾。9例患者血小板计数在(431~2448)×10~9/L,血清钾与血浆钾浓度差在0.47~2.53 mmol/L,平均浓度差为1.35 mmol/L。3例患者血清钾检测显示有高钾血症,但血浆钾浓度在正常范围内,无高钾病因及临床表现,诊断为假性高钾血症;2例患者血清钾检测在正常范围内,但血浆钾浓度显示有低钾血症。9例患者平均血清钾浓度(5.34±0.70)mmol/L与平均血浆钾浓度(3.99±0.55)mmol/L比较,差异具有统计学意义(P<0.05)。1例患者测定了即刻血浆钾及放置2 h的血清钾浓度,发现血清钾水平随标本放置时间的延长而升高。7例血小板计数正常患者血清钾及血浆钾浓度差在-0.31~0.24 mmol/L,平均浓度差为0.104 mmol/L。7例血小板计数正常患者平均血清钾浓度(3.76±0.38)mmol/L与平均血浆钾浓度(3.65±0.38)mmol/L比较,差异无统计学意义(P>0.05)。结论对于血小板增多症的患者,血浆钾浓度更能反映体内真实血钾水平;标本应在采样后尽快送检;血小板计数正常的患者其血清钾与血浆钾浓度差别较小,不影响临床判断。
Objective To study the clinical features of patients with thrombocythemia in order to improve clinicians’ understanding of the phenomenon of hypokalemia induced by thrombocythemia and to avoid misdiagnosis of hyperkalemia or hypokalemia. Methods Plasma potassium concentration in 9 patients with thrombocythemia and serum potassium concentration immediately after taking blood samples were determined. The blood samples of 1 patient were selected for determination of serum potassium concentration after 2 hours of storage. Simultaneous determination of serum potassium and plasma potassium concentrations in 7 patients with normal platelet count was performed as control. Results Nine patients with thrombocythemia patients serum potassium and plasma potassium concentration test results showed that serum potassium levels were higher than plasma potassium. Nine patients had platelet count (431 ~ 2448) × 10 ~ 9 / L, serum potassium and plasma potassium concentration difference of 0.47 ~ 2.53 mmol / L, the average concentration difference of 1.35 mmol / L. Serum potassium in 3 patients showed hyperkalemia, but plasma potassium concentration was within the normal range, without high potassium etiology and clinical manifestations, the diagnosis of pseudo-hyperkalemia; serum potassium in 2 patients in the normal range, However, plasma potassium concentration showed hypokalemia. The average serum potassium concentration of 9 patients (5.34 ± 0.70) mmol / L and mean plasma potassium concentration (3.99 ± 0.55) mmol / L, the difference was statistically significant (P <0.05). One patient measured the plasma potassium concentration immediately after 2 h and the serum potassium level increased as the specimen placement time increased. The difference of serum potassium and plasma potassium between the seven patients with normal platelet count was -0.31 ~ 0.24 mmol / L, and the average concentration difference was 0.104 mmol / L. There was no significant difference in average serum potassium concentration (3.76 ± 0.38) mmol / L and average plasma potassium concentration (3.65 ± 0.38) mmol / L in 7 patients with normal platelet count (P> 0.05). Conclusions In patients with thrombocytosis, the plasma potassium concentration can reflect the real serum potassium level in vivo. The specimens should be submitted as soon as possible after sampling. The difference between serum potassium and plasma potassium concentration in patients with normal platelet count is small, which does not affect the clinical judgment.