Một số lưu ý khi lấy máu xét nghiệm huyết học

Trong quá trình chẩn đoán và điều trị ngoài các dấu hiệu lâm sàng người thầy thuốc còn cần đến hỗ trợ từ các xét nghiệm. Các xét nghiệm giúp người thầy thuốc chẩn đoán chính xác hơn, giúp điều trị kịp thời đạt hiệu quả tốt nhất. Trong các xét nghiệm, xét nghiệm máu toàn bộ (Complete blood count) là một xét nghiệm cơ bản quan trọng trong định hướng và điều trị. Để xét nghiệm đạt chất lượng hữu ích cho người thầy thuốc, người kỹ thuật viên ngoài việc tuân thủ đúng đủ quy trình kỹ thuật còn cần một số lưu ý giai đoạn trước xét nghiệm sau.

Một số lưu ý khi lấy máu xét nghiệm huyết học

06/12/2017 205

Trong quá trình chẩn đoán và điều trị ngoài các dấu hiệu lâm sàng người thầy thuốc còn cần đến hỗ trợ từ các xét nghiệm. Các xét nghiệm giúp người thầy thuốc chẩn đoán chính xác hơn, giúp điều trị kịp thời đạt hiệu quả tốt nhất. Trong các xét nghiệm, xét nghiệm máu toàn bộ (Complete blood count) là một xét nghiệm cơ bản quan trọng trong định hướng và điều trị. Để xét nghiệm đạt chất lượng hữu ích cho người thầy thuốc, người kỹ thuật viên ngoài việc tuân thủ đúng đủ quy trình kỹ thuật còn cần một số lưu ý giai đoạn trước xét nghiệm sau.

1. Kỹ thuật garo.

Việc sử dụng garo là quan trọng và cần thiết khi lấy máu tĩnh mạch xét nghiệm. Tuy nhiên ngay sau khi máu chảy vào đốc kim bạn cần tháo garo ngay. Việc garo quá lâu sẽ làm sai số đáng kể do bị tụ máu, đặc biệt là làm tăng nồng độ Hemoglobin từ đó gây nhầm lẫn trong chẩn đoán thiếu máu. Một nghiên cứu cho thấy nồng độ Hb sẽ tăng khoảng 3% (khoảng 4g/L) chỉ sau một phút buộc garo và tăng trung bình 7% (khoảng 9g/L) chỉ sau 3 phút buộc garo. Ở mức nồng độ cao của Hb thời gian buộc garo khoảng 2 phút tạo ra sự tăng Hb có ý nghĩa thống kê.

2. Trộn mẫu ngay sau khi lấy.

Mẫu máu cần được trộn đều với EDTA ngay sau khi lấy để tránh đông máu. Cần làm theo hướng dẫn của nhà sản xuất ống, thông thường sẽ yêu cầu bạn trộn đều ống khoảng 8-10 lần bằng cách trộn ngược hoàn toàn. Các mẫu đã bị đông không thể cho kết quả xét nghiệm huyết học chính xác, đó là nguyên nhân chính để quyết định loại bỏ mẫu. Việc trộn mẫu sau đó cũng không thể làm đảo ngược được tình trạng đông ban đầu.

3. Đường truyền tĩnh mạch

Khi lấy máu từ đường truyền tĩnh mạch hoặc các khóa Heparin, điều quan trọng là toàn bộ các chất lỏng trong đường dây hoặc khóa phải được loại bỏ hoàn toàn trước khi lấy máu vào ống EDTA. Nếu không sẽ gây ra hiện tượng nồng độ Hb thấp giả tạo do bị pha loãng bởi chất lỏng trong đường ống hoặc trong khóa.

4. Lấy mẫu thiếu

Khi không lấy đủ lượng mẫu vào ống chân không sẽ gây ra nồng độ của Bạch cầu, hồng cầu, huyết sắc tố, thể tích khống hồng cầu và tiểu cầu bị thấp khi EDTA ở dạng lỏng. Nguyên nhân là do sự pha loãng mẫu.

5. Sự khác biệt bởi thời gian trong ngày.

Một bệnh nhân có thể nồng độ Hb thay đổi ở các thời điểm trong ngày lên tới 8% (khoảng 11g/L)> Nồng độ Hb cao nhất vào buổi sáng và thấp nhất vào buổi tối. Ngoài ra tư thế lấy máu cũng ảnh hưởng. Nếu lấy máu ở tư thế bệnh nhân đứng thẳng đứng sẽ khác với tư thế bệnh nhân nằm. Thông thường sẽ thấp hơn khoảng 10 g/L đối với người khỏa mạnh thậm chí cao hơn ở một vài bệnh nhân.

6. Nguồn vị trí lấy mẫu

Máu chích đầu ngón tay hoặc gót chân (mao mạch), máu động mạch, máu tĩnh mạch sẽ có nồng độ hemoglobin khác nhau.

7. Bệnh nhân nhịn ăn.

Mẫu ở bệnh nhân nhịn ăn sẽ có giá trị Hb thấp hơn so với sau khi ăn no, do sự gây nhiễu của Lipid. Hơn nữa các chylomicron có thể mô phỏng Bạch cầu và các phép đo trong CBC khác có thể thay đổi. Do vậy mẫu máu từ bệnh nhân nhịn ăn thường được ưu tiên hơn.

8. Thông tin về mẫu

Các ống dùng để lấy mẫu bệnh nhân cần phải ghi đầy đủ thông tin về bệnh nhân ngay tại thời điểm lấy mẫu để tránh các trường hợp nhầm lẫn mẫu máu gây báo cáo sai kết quả cho bệnh nhân.

 

 

                                                                            KHOA XÉT NGHIỆM


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