目的：分析不合格血液标本产生的原因和制定相应对策，确保分析前环节的标本质量。方法回顾性分析2008年至2012年复旦大学附属中山医院检验科接收住院患者不合格血液标本5933例。以不合格率描述不合格标本的情况，采用PearsonX2检验比较不同种类的抗凝管发生标本凝块和标本量少的风险。结果2008年至2012年真空采血系统采集的血液标本的不合格率分别为1．49‰、0．76‰、0．52‰、0．50‰和0．47‰，呈现明显的下降趋势；血液标本的6大不合格原因依次为标本凝块、标本量少、标本抽错管、条码问题、送检超时和重复采血。其中以柠檬酸钠抗凝管发生标本凝块和标本量少的情况最多。结论检验科需加强与护理部和临床部门之间的联系，及时沟通反馈不合格标本的情况，寻找原因并制定和实施改善措施，共同努力确保分析前环节的血液标本质量。%Objective To analyze the cause and countermeasure of the rejection of blood specimens,and to find solutions to decrease the number of rejected blood specimens for laboratory quality improvement.Methods A total of 5 933 rejected blood specimens were analyzed retrospectively from 2008 to 2012 in Department of Clinical Laboratory, Zhongshan Hospital,Fudan University.Results were shown by the frequency of rejected blood specimens in which Pearson X2 test was used to evaluate the percentages of clotted specimens and insufficient specimens with different types of tubes.Results The frequencies of rejected blood specimens from 2008 to 2012 were 1.49 ‰,0.76 ‰,0.52 ‰, 0.50‰ and 0.47‰,respectively,with decreasing tendency.The 6 major causes of rejection were clotted blood specimen,insufficient blood volume,inappropriate anticoagulant,error in sample identification,specimen transfer overtime and repeated blood collection.Clotted blood specimen and insufficient blood volume were common in sodium citrate anticoagulant tube specimens compared with others.Conclusions Clinical laboratories should strengthen the ties with the nurses and clinical doctors whom would be informed with the rejection of blood samples in time,in order to figure out and carry out the solutions,reduce the number of rejected blood specimens and improve the pre-analytical quality.
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