Riba:
- Ƙarfin fahimtar cewa yawancin kurakuran dakin gwaje-gwaje suna faruwa a cikin lokacin nazari kafin a yi amfani da basirar wucin gadi a cikin samfurin dacewa da kulawa.
- Ikon fassara alamun HIL (hemolysis, icterus, lipemia) da kuma yadda tsangwama ke shafar waɗanne gwaje-gwaje
- Ikon ɗaukar samfurin kin amincewa/ yarda da bayanan ɗan adam a matsayin daftari da kuma tabbatar da yanke shawara ta ƙarshe tare da ka'idodin dakin gwaje-gwaje
Lokacin tattaunawa akan kurakuran dakin gwaje-gwaje, yawancin mutane suna zargin kayan aiki da aunawa. Duk da haka, akwai gaskiyar da aka maimaita shekaru da yawa: yawancin kurakurai na dakin gwaje-gwaje ba su faruwa a cikin na'urar (lokacin nazari), amma kafin samfurin ya shiga cikin na'urar, wato, a cikin lokaci kafin nazari. Jinin da aka ɗauka daga majinyacin da ba daidai ba, samfurin da aka sanya a cikin bututu mara kyau, ƙarancin ƙararrawa, dogon jira, sel sun lalace ta hanyar girgiza-babu ɗaya daga cikin waɗannan laifin na'urar, amma duk suna karkatar da sakamakon. Mafi mahimmancin sashi shine wannan: samfurin tare da kuskuren bincike na farko an auna shi daidai a cikin kayan aiki kuma yana samar da lambar "tsabta"; Wannan adadin ba daidai ba ne, amma ba a bayyane yake cewa kuskure ba ne. Sabili da haka, lokacin nazari na farko shine farkon kuma mafi mahimmancin layin tsaro don amincin haƙuri.
Me yasa kurakurai kafin nazari suka zama ruwan dare a cikin wannan rukunin; Babban tsangwama wanda ke lalata ingancin samfurin-musamman ma'anar HIL (hemolysis, icterus, lipemia) - da kuma yadda suke shafar wane gwaje-gwaje; da kuma yadda ake amfani da AI cikin aminci a cikin samfurin dacewa da kulawa. Ka'ida ta asali: AI yana duba samfurin dacewa kuma yana samar da daftarin ƙin yarda / yarda; ƙwararren ƙwararren ne ya yanke shawarar ƙarshe, bisa ga ka'idodin dakin gwaje-gwaje.
Me yasa kurakurai suka taru a cikin lokacin nazari kafin nazari
Matakin farko na nazari shine lokaci inda mafi yawan hannayen mutane da mafi yawan masu canji suka shigo cikin wasa. Manyan tushen kurakurai:
- Mara lafiya da samfurin ganewa: Lakabi mara lafiya mara kyau shine kuskure mafi haɗari; sakamakon wani yana dangana ga majiyyaci.
- Bututu mara kyau: Kowane bututu yana da ƙari daban-daban (anticoagulant ko gel) a ciki. EDTA tube yana ɗaure potassium kuma yana rage calcium; Zaɓin bututu mara kyau yana karkatar da sakamakon sosai.
- Rashin isasshe / wuce gona da iri: Idan an rushe rabon maganin-jini, gwajin jini (coagulation) ba daidai bane.
- Hemolysis: Dabarar zubar jini, ta amfani da allura mai kyau, matsananciyar buri, ko girgiza, tana rushe jajayen ƙwayoyin jini.
- Jira da ajiya: A cikin samfurin jira na dogon lokaci, glucose yana raguwa kuma potassium yana ƙaruwa; Bilirubin da aka bari a cikin haske yana raguwa.
- Lalacewar layin IV: Jinin da aka ɗauka daga hannun mai karɓar ruwa yana haɗuwa da abubuwan da ke cikin wannan ruwan.
Babban fasalin waɗannan kurakuran shine cewa na'urar ba zata iya ganin su ba. Kayan aiki irin su duba delta da fihirisar HIL suna kama wasu kurakurai kafin nazari, amma yawancin ana kaucewa ta hanyar tsarin karɓuwa a hankali.
Alamar HIL: hemolysis, icterus, lipemia
Masu nazarin ilmin halitta na zamani suna auna launi da turbidity na maganin kuma suna ba da rahoton tsangwama guda uku: fihirisar HIL.
- Hemolysis (H): Rugujewar ƙwayoyin jajayen jini da haɗa abubuwan da ke cikin su cikin jini; ruwan magani yana bayyana ruwan hoda-ja. Ƙarya yana ƙara abubuwa (potassium, LDH, AST) waɗanda aka tattara a cikin tantanin halitta.
- Icterus (I): bayyanar launin rawaya-orange na ruwan magani saboda yawan bilirubin; auna son zuciya a wasu gwaje-gwajen launi.
- Lipemia (L): Yana da gajimare / bayyanar madara saboda babban mai (triglycerides) a cikin jini; Yana tsoma baki tare da gwaje-gwaje da yawa ta hanyar ɓata watsa haske kuma yana iya nuna ƙarancin ƙarancin matakan wasu electrolytes.
Tebu mai zuwa yana taƙaita tasirin kutsewar HIL akan wasu gwaje-gwaje (sakamakon ya bambanta ta hanya; koma zuwa takamaiman sashe na na'urar ku):
tsangwama
Zai iya tayar da karya
Za a iya sauke karya
alamar al'ada
Hemolysis (H)
Potassium, LDH, AST, baƙin ƙarfe
haptoglobin (a wasu gwaje-gwaje)
ruwan hoda-janye ruwan magani
Icterus (I)
(dangane da hanya)
Wasu gwaje-gwajen launi
ruwan magani rawaya-orange
Lipemia (L)
(saboda blur)
Sodium (a wasu hanyoyi)
Milky, ruwan magani mai hazo
Mahimmin mahimmanci: Tsangwama na HIL ba wai kawai bayyanar samfurin ba amma har ma da daidaiton sakamakon. Karatun potassium na 6.5 mmol/L a cikin samfurin hemolyzed na iya zama haɓakar ƙarya ba hyperkalemia na gaskiya ba (duba Raka'a 4).
Tsanaki: Sakin samfurin tare da babban maƙasudin tsoma baki ta hanyar faɗin "sakamakon ya fita, bari mu aika" yana nufin ba da rahoton sakamakon ƙarya kamar dai daidai ne. Ana tabbatar da masu binciken da tsangwama ta shafa tare da sabon samfuri ko kuma an ruwaito tare da bayanin tsangwama ta amfani da hanyar da ta dace.
Yadda AI ke taimakawa tare da bin ka'ida
AI yana da daraja a matsayin na'urar daukar hotan takardu da kuma mnemonic a cikin pre-nalytical control. Yana iya ƙididdige fihirisar HIL akan gwajin gwaji kuma ya haifar da gargaɗi kamar "matakin hemolysis a cikin wannan samfurin yana rinjayar sakamakon potassium, tabbatarwa da ake buƙata"; na iya nuna rashin daidaituwar bututu mai sauri; na iya ƙaddamar da jita-jita dangane da ƙa'idodin dakin gwaje-gwaje don ƙin / yarda da yanke shawara; Maiyuwa shirya taƙaitaccen bayani ga ma'aikata don haɓaka ingancin samfur (dabarun tattara jini, lokacin sarrafawa). Amma ƙwararrun ƙwarar ne suka yanke shawarar kin amincewa da karɓa bisa ga ƙa'idodin yarda da samfurin gwajin gwajin ku; Shawarar AI daftarin ne.
Rauni mai ƙarfi / Ƙarfi mai ƙarfi
Rawanin faɗakarwa:
Shin wannan samfurin yana da kyau, ya kamata mu aika da sakamakon? Ina tsammanin akwai hemolysis.
Wannan da'awar ba ta ƙididdige ma'aunin hemolysis ba, baya haɗa da waɗanne gwaje-gwajen da aka gudanar, kuma baya haɗa da ma'aunin dakin gwaje-gwaje. AI yana ba da amsa gabaɗaya; Ba zai iya fayyace abin da aka shafa ba da abin da za a yi.
Ƙarfi mai ƙarfi:
Matsayin ku: mataimaki ga ƙwararren ƙwararren ƙwanƙwasa yana shirya samfurin dacewa da rubutawa. Hukuncin nawa ne. Misali: jini. Fihirisar HIL: hemolysis 3+ (high), icterus al'ada, lipemia na al'ada. Gwaje-gwajen da aka yi nazari: potassium, sodium, AST, ALT, creatinine, LDH. Aiki: (1) Alama waɗanne gwaje-gwajen da wannan matakin na hemolysis ya shafa, (2) bayar da shawarar "sabon samfurin / rahoto tare da bayanin tsangwama / ba a shafa ba" ga kowane gwajin da abin ya shafa, (3) Ƙayyade gwaje-gwajen da ba a shafa daban. Har ila yau rubuta waɗanne ƙofofin da ya kamata in duba don kammala ƙa'idodin ƙi na dakin gwaje-gwaje. Shirya daftarin aiki domin in iya yanke shawara ta ƙarshe.
Ƙarfi mai ƙarfi yana ba da fihirisar HIL lambobi, ya haɗa da jerin gwajin, ya nemi shawarwarin gwaji-ta-gwaji, kuma ya bar yanke shawara ga gwani.
uku mini lokuta
Case na 1 - Daidaitaccen rarrabawa. Ɗaya daga cikin samfurin ya nuna hemolysis 3+ kuma gwaje-gwajen da aka yi nazari sun hada da potassium, LDH, AST. AI yana samar da daftarin "waɗannan gwaje-gwaje guda uku suna da tasiri sosai ta hanyar hemolysis, ana ba da shawarar sabon samfurin; creatinine da sodium ba su da tasiri ta wannan matakin". Kwararrun yana duba ma'aunin dakin gwaje-gwaje, yana buƙatar sabon samfur don potassium/LDH/AST, kuma ya ba da rahoton sauran tare da bayanin tsangwama. An hana rahoton karya na hyperkalemia.
Case 2 - Ba daidai ba kama bututu. Ƙarar jini a cikin bututu mai shigowa don gwajin coagulation yana ƙasa da layin alamar. A cikin buƙatar-tube-girma iko, AI yayi kashedin "citrate tube rashin isasshen girma, anticoagulant-jini rabo ya lalace, INR / aPTT ne unreliable". Masanin ya ƙi samfurin kuma ya nemi sabon samfurin. An hana sakamakon zubar jini mara daidai da yiwuwar adadin magani ba daidai ba. Darasi: rabon girma yana da mahimmanci a cikin coagulation.
Hali na 3 - Lipemia tarkon. Samfurin daga majinyacin ciyarwa yana da alamar lipmic. YZ yana tunatar da cewa lipemia na iya haifar da ƙarancin ƙarancin sodium a wasu hanyoyin electrolyte. Kwararren yana duba ko sakamakon ya shafi hanyar dakin gwaje-gwaje kuma, idan ya cancanta, ya tabbatar da shi tare da samfurin azumi ko hanyar da ta dace. Darasi: tsangwama ya dogara da hanyar; Tunasarwar tana da mahimmanci, amma an yanke shawara ta hanyar ku.
Samfuran gaggawar da za a iya kwafi
MISALIN KIMANIN KIYAYEWA TEMPLATESample Nau'in: [serum/plasma/jini duka]. Alamar HIL: hemolysis [x], icterus [x], lipemia [x]. Gwaje-gwaje suna gudana: [list]. Ga kowane gwaji, yi alama ko tsangwama ya shafe shi kuma bayar da shawarar "sabon samfurin / rahoto tare da bayanin tsangwama / ba a shafa ba". Hukuncin nawa ne; Hakanan rubuta ƙofofin da zan fayyace maƙasudi na.
TEMPLATE TAMFANIN DA'AWA-TUBE Akwai umarni na gwaji masu zuwa da nau'ikan bututu masu dacewa. Bincika idan an yi amfani da madaidaicin bututu da isasshen ƙara don kowane tsari; Idan akwai rashin jituwa, duba "[dan takarar kin amincewa - dalili]". Bincika rabon ƙara musamman don coagulation. Data: [list].
Samfurin rarrabuwar Kuskuren PRE-ANALYTICAL Rarraba dalilan ƙin yarda na waɗannan samfuran da aka ƙi (bayani, bututu mara kyau, hemolysis, rashin isasshen girma, gudan jini, rikewa/riƙe). Nuna nau'in gama gari da shawarwarin ingantawa. Wannan taƙaitaccen ingantaccen inganci ne; Ba ya ƙunshi bayanan sirri/majiyyaci. Data: [list].
JININ JININ GASKIYAR BAYANIN GASKIYAR JINI Adadin hawan jini yana da yawa a cikin wani yanki na musamman. Zana bayanin horon da ke bayyana yuwuwar abubuwan da ke haifar da tarin jini da kulawa (diamita na allura, buri, girgiza, lokacin sarrafa, zazzabi) da shawarwarin gyarawa. Yi amfani da ingantaccen harshe, ba na zargi ba.
Kuskuren gama gari
- Tunanin cewa tsangwama launi ne kawai. HIL yana lalata daidaiton sakamakon; ba a bayar da rahoto ba har sai an tabbatar da binciken da abin ya shafa.
- Kuskure babban potassium a cikin samfurin hemolyzed a matsayin gaske. Spurious hyperkalemia shine mafi kyawun tarko kafin nazari.
- Tsallake rabon ƙara a cikin coagulation. Rashin isassun bututun citrate yana sa INR/aPTT ta zama abin dogaro.
- Ba tambayar samfurin da aka ɗauka daga layin IV ba. Gurɓataccen ruwa yana gurbata sakamako sosai.
- Kuskure shawarar kin amincewa da AI don yanke shawara. An ba da ƙin yarda / karɓa da ƙwarewa bisa ga ƙa'idodin da aka amince da dakin gwaje-gwaje.
Tukwici: Yi tambayoyi biyu su zama reflex tare da kowane samfurin: "Shin an tattara wannan samfurin ta hanyar da ta dace, daga majinyacin da ya dace, a cikin bututu mai kyau?" da "Wane gwaji ne tsangwama (HIL) ke shafar?" Hankalin ku kafin nazari yana ƙayyade daidaiton duk matakan da ke gaba.
A takaice
Yawancin kurakuran dakin gwaje-gwaje suna faruwa ne a cikin lokacin nazari kafin samfurin ya shiga cikin na'urar, kuma ana auna waɗannan kurakuran daidai a cikin na'urar, suna haifar da sakamako "tsabta amma kuskure". Identity, nau'in bututu, ƙara, hemolysis, riƙewa, da gurɓatawa sune tushen farko. Fihirisar HIL (hemolysis, icterus, lipemia) yana haɓaka ko rage wasu gwaje-gwaje; Ba a ba da rahoton manazarta da abin ya shafa ba tare da tabbatarwa ba. Leken asiri na wucin gadi na iya duba dacewa da samfurin, tsangwama ga tuta da rashin yarda, da kuma samar da daftarin ƙin yarda / yarda; amma an yanke shawara ta ƙarshe da ƙwarewa bisa ga ƙa'idodin da aka amince da ɗakin binciken ku. Hankalin farko na nazari shine layin farko na tsaro don amincin haƙuri.
Aikin aikace-aikace
Ƙirƙirar yanayin samfurin (tare da firikwensin HIL da jerin gwaje-gwajen da aka gudanar) kuma karɓar jigon gwaji-ta-gwaji daga AI tare da samfurin "Samfurin Dacewar Dace". Ga kowane gwajin da abin ya shafa, ba da hujjar shawararku bisa ka'idojin kin amincewa da dakin gwaje-gwajenku. Sa'an nan kuma rarraba jerin samfuran da aka ƙi tare da samfurin "Kafin-Nazari Kuskuren Rarraba" don gano mafi yawan sanadi da shawarwarin ingantawa.
jerin abubuwan dubawa
- [ ] Na duba samfurin ID, nau'in bututu da dacewa da girma.
- [ ] Na kimanta ma'anar HIL akan gwajin gwaji.
- [ ] Ban bayar da rahoton manazarta da tsangwama suka shafa ba tare da tabbatarwa ba.
- [] Na duba girman girman/matsayin maganin anticoagulant a cikin samfuran coagulation.
- [ ] Na yanke shawarar kin amincewa/karba bisa ka'idojin da aka amince da dakin gwaje-gwaje na.
- [ ] Na shirya taƙaitaccen taƙaitaccen bayani game da matsalolin da ke faruwa kamar hawan jini.