D Dimer ve Preanalitik Hata Kaynakları
Özet
"Güncel Biyokimya Çalışmaları II" kitabında yer alan "D Dimer ve Preanalitik Hata Kaynakları" başlıklı bu bölümde, hemostaz ve fibrinoliz mekanizmaları çerçevesinde D-dimer biyobelirtecinin oluşum süreçleri, klinik kullanım alanları, güncel ölçüm yöntemleri ve test sonuçlarının doğruluğunu belirleyen preanalitik değişkenler ayrıntılı bir şekilde ele alınmaktadır. Fibrinojenin trombin ve faktör XIIIa vasıtasıyla çapraz bağlı fibrin polimerlerine dönüşmesi ve ardından plazmin ile parçalanması sonucu ortaya çıkan D-dimer; derin ven trombozu, pulmoner tromboemboli, dissemine intravasküler koagülasyon ve akut aort anevrizması gibi tabloların tanı ile takibinde temel klinik parametrelerden biridir. Çalışmada; ELISA, ELFA, kemilüminesan (CLIA), lateks bazlı immünotürbidimetrik ve hasta başı test (POC) yöntemleri; duyarlılık, özgüllük, analiz süreleri, cihaz otomasyonu ve örnek türleri bazında karşılaştırmalı olarak sunulmaktadır. Toplam laboratuvar hatalarının yaklaşık %60-70'inden sorumlu olan preanalitik evreye odaklanan bölümde; kan alımı sırasında kullanılan iğne ucu kalınlığı, sodyum sitrat antikoagülan dolum oranları, kelebek set ve turnike kullanım süreleri, numunelerin pnömatik tüp sistemleriyle taşınması, santrifüj hızı ve saklama koşulları detaylandırılmaktadır. Bunun yanı sıra in vitro hemoliz, lipemi ve hiperbilirubinemi gibi ana spektrofotometrik ve biyolojik interferans kaynaklarının D-dimer test sonuçları üzerindeki etkileri ve tolerans limitleri uluslararası kılavuzlar doğrultusunda açıklanmaktadır.
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