1
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Tintu AN, Buño Soto A, Van Hoof V, Bench S, Malpass A, Schilling UM, Rooney K, Oliver Sáez P, Relker L, Luppa P. The influence of undetected hemolysis on POCT potassium results in the emergency department. Clin Chem Lab Med 2024; 0:cclm-2024-0202. [PMID: 38726766 DOI: 10.1515/cclm-2024-0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/26/2024] [Indexed: 05/15/2024]
Abstract
OBJECTIVES This study aimed to evaluate discrepancies in potassium measurements between point-of-care testing (POCT) and central laboratory (CL) methods, focusing on the impact of hemolysis on these measurements and its impact in the clinical practice in the emergency department (ED). METHODS A retrospective analysis was conducted using data from three European university hospitals: Technische Universitat Munchen (Germany), Hospital Universitario La Paz (Spain), and Erasmus University Medical Center (The Netherlands). The study compared POCT potassium measurements in EDs with CL measurements. Data normalization was performed in categories for potassium levels (kalemia) and hemolysis. The severity of discrepancies between POCT and CL potassium measurements was assessed using the reference change value (RCV). RESULTS The study identified significant discrepancies in potassium between POCT and CL methods. In comparing POCT normo- and mild hypokalemia against CL results, differences of -4.20 % and +4.88 % were noted respectively. The largest variance in the CL was a +4.14 % difference in the mild hyperkalemia category. Additionally, the RCV was calculated to quantify the severity of discrepancies between paired potassium measurements from POCT and CL methods. The overall hemolysis characteristics, as defined by the hemolysis gradient, showed considerable variation between the testing sites, significantly affecting the reliability of potassium measurements in POCT. CONCLUSIONS The study highlighted the challenges in achieving consistent potassium measurement results between POCT and CL methods, particularly in the presence of hemolysis. It emphasised the need for integrated hemolysis detection systems in future blood gas analysis devices to minimise discrepancies and ensure accurate POCT results.
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Affiliation(s)
- Andrei N Tintu
- Department of Clinical Chemistry Rotterdam, Erasmus Medical Center, Zuid-Holland, Netherlands
| | - Antonio Buño Soto
- Clinical Pathology, 16268 Hospital Universitario La Paz , Madrid, Spain
| | - Viviane Van Hoof
- Faculty of Medicine and Health Sciences, 26660 University of Antwerp , Wilrijk, Belgium
| | | | - Anthony Malpass
- IDS, Formerly of Becton and Dickinson UK Ltd, Wokingham, Berkshire, UK
| | | | | | - Paloma Oliver Sáez
- Laboratory Medicine, 16268 La Paz - Cantoblanco - Carlos III University Hospital , Madrid, Spain
| | - Lasse Relker
- Institute for Clinical Chemistry and Pathobiochemistry, 9184 Eberhard Karls Universitat Tubingen , Tubingen, Germany
| | - Peter Luppa
- Institut für Klinische Chemie, 9184 Klinikum rechts der Isar der Technischen Universitat Munchen , Munchen, Germany
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2
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Tang NY, Mitchell KR, Groboske SE, Baldwin AD, Lenza M, Yeo KTJ, van Wijk XMR. Reducing Specimen Rejection Rates Using Concentration-Dependent Hemolysis Rejection Thresholds. J Appl Lab Med 2023; 8:285-295. [PMID: 36592084 DOI: 10.1093/jalm/jfac095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Using middleware solutions, it is possible to implement concentration-dependent analyte-specific hemolysis rejection limits. This makes day-to-day reporting of clinical specimens more efficient and potentially lowers sample rejection rates compared to a "one-size-fits-all" approach (i.e., solely based on a single cutoff provided in the package insert). METHODS Hemolysis interference studies were performed at multiple analyte concentrations for three frequently ordered tests. For each assay, concentration-dependent hemolysis rejection limits were designed based on the total allowable error (TAE) for the analyte as well as the clinical significance of such incurred inaccuracy at the respective concentrations. In general, the following rationale was used: if the interference exceeds 10% (or package insert cutoffs), a comment is placed on the result. If the interference exceeds the TAE, the result will not be reported. Reduction in specimen rejection rates were estimated by comparing the incurred specimen rejection rates when package inserts' vs concentration-dependent hemolysis interference limits were applied to a data set in our institute during a three-month period. RESULTS Concentration-dependent analyte-specific hemolysis rejection thresholds were designed for three commonly ordered assays that are especially susceptible to hemolysis interference. It is estimated that these novel thresholds for aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and direct bilirubin (DBIL) reduced specimen rejection rates from 9.3% to 1.3%, 31.4% to 4.8%, and 19.9% to 7.1%, respectively. CONCLUSIONS Concentration-dependent analyte-specific hemolysis rejection thresholds for three commonly ordered assays can reduce rejection rates without significantly compromising the quality of test results.
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Affiliation(s)
- Nga Yeung Tang
- Department of Pathology, The University of Chicago, Chicago, IL.,Department of Pathology and Laboratory Medicine, Beaumont Health, Royal Oak, MI.,Department of Pathology and Laboratory Medicine, Oakland University William Beaumont School of Medicine, Auburn Hills, MI
| | - Kelly R Mitchell
- Section of Clinical Chemistry, The University of Chicago Medicine, Chicago, IL
| | - Sarah E Groboske
- Section of Clinical Chemistry, The University of Chicago Medicine, Chicago, IL
| | - Angel D Baldwin
- Section of Clinical Chemistry, The University of Chicago Medicine, Chicago, IL
| | - Michael Lenza
- Section of Clinical Chemistry, The University of Chicago Medicine, Chicago, IL
| | | | - Xander M R van Wijk
- Department of Pathology, The University of Chicago, Chicago, IL.,Medical and Scientific Affairs, Beckman Coulter, Brea, CA
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3
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Jones AD, Sapatnekar S, Bakdash S. Drugs and Conditions That May Mimic Hemolysis. Am J Clin Pathol 2023; 159:34-42. [PMID: 36367367 DOI: 10.1093/ajcp/aqac130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Visual inspection of posttransfusion plasma for hemolysis is a key laboratory method in the investigation of possible acute hemolytic transfusion reactions (AHTRs). Many substances and physiologic conditions can mimic hemolysis in vitro. Isolated reports describe specific cases of interference, but a comprehensive listing is lacking. METHODS Using an illustrative case, we summarize available literature on substances and conditions that may mimic hemolysis in vitro. We further describe other substances and conditions that may discolor plasma but are unlikely to be mistaken for hemolysis on visual inspection. RESULTS At least 11 substances and conditions have been reported to discolor plasma, in colors ranging from orange to red to brown, including relatively common therapies (eg, eltrombopag, hydroxocobalamin, iron dextran). Other substances are unlikely to be encountered in everyday practice but may mimic hemolysis in particular patient populations. Additional substances may cause plasma discoloration, ranging from blue to green to white, and are associated with a wide variety of therapies and conditions. CONCLUSIONS An awareness of the possible preanalytic confounding factors that may mimic hemolysis can aid in the workup of a suspected AHTR. Review of the medical record, use of ancillary testing, and consideration for nonimmune causes of hemolysis can aid in ruling out AHTR.
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Affiliation(s)
- Andrew D Jones
- From the Section of Transfusion Medicine, The Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Suneeti Sapatnekar
- From the Section of Transfusion Medicine, The Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Suzanne Bakdash
- From the Section of Transfusion Medicine, The Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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4
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Costelloe SJ, Rico Rios N, Goulding N, Mistry H, Stretton A, De la Salle B, Hepburn S, Thomas A, Atherton J, Cornes M. A survey of practice in the management of haemolysis, icterus and lipaemia in blood specimens in the United Kingdom and Republic of Ireland. Ann Clin Biochem 2021; 59:222-233. [PMID: 34719993 DOI: 10.1177/00045632211059755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Haemolysis, icterus and lipaemia (HIL) are common interferants in laboratory medicine, potentially impacting patient care. This survey investigates HIL management in medical laboratories across the UK and Republic of Ireland (ROI). METHODS A survey was sent to members of key professional organisations for laboratory medicine in the UK and ROI. Questions related to the detection, monitoring, quality control, and management of HIL. RESULTS In total, responses from 124 laboratories were analysed, predominantly from England (52%) and ROI (36%). Most responses were from public hospitals with biochemistry services (90%), serving primary care (91%), inpatients (91%), and outpatients (89%). Most laboratories monitored H (98%), I (88%), and L (96%) using automated indices (93%), alone or in combination with visual inspection.Manufacturer-stated cut-offs were used by 83% and were applied to general chemistries in 79%, and immunoassays in 50%. Where HIL cut-offs are breached, 64% withheld results, while 96% reported interference to users. HIL were defined using numeric scales (70%) and ordinal scales (26%). HIL targets exist in 35% of laboratories, and 54% have attempted to reduce HIL. Internal Quality Control for HIL was lacking in 62% of laboratories, and just 18% of respondents have participated in External Quality Assurance. Laboratories agree manufacturers should: standardise HIL reporting (94%), ensure comparability between platforms (94%), and provide information on HIL cross-reactivity (99%). Respondents (99%) showed interest in evidence-based, standardised HIL cut-offs. CONCLUSIONS Most respondents monitor HIL, although the wide variation in practice may differentially affect clinical care. Laboratories seem receptive to education and advice on HIL management.
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Affiliation(s)
- Seán J Costelloe
- Department of Clinical Biochemistry, 57983Cork University Hospital, Cork, Republic of Ireland.,Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK
| | - Natividad Rico Rios
- Department of Clinical Biochemistry, 57983Cork University Hospital, Cork, Republic of Ireland
| | - Nicola Goulding
- Department of Clinical Biochemistry, 57983Cork University Hospital, Cork, Republic of Ireland
| | - Hema Mistry
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,Serious Hazards of Transfusion Office, Manchester, UK
| | - Adam Stretton
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,6398Becton, Dickinson and Company, Wokingham, UK
| | - Barbara De la Salle
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,UK NEQAS Haematology, Watford, UK
| | - Sophie Hepburn
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,Blood Sciences, 2592East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Annette Thomas
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,Cardiff and Vale University Health Board, Cardiff, UK
| | - Jennifer Atherton
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,Blood Sciences Department, Liverpool Clinical Laboratories, 4595Aintree University Hospital, Liverpool, UK
| | - Michael Cornes
- Association for Clinical Biochemistry and Laboratory Medicine (ACB) Preanalytical Special Interest Group, London, UK.,Biochemistry Department, 156747Worcestershire Acute Hospitals NHS Trust, Worcester, UK
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5
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Medipally DKR, Cullen D, Untereiner V, Bryant J, Sockalingum GD, Nguyen TNQ, Noone E, Bradshaw S, Finn M, Dunne M, Shannon AM, Armstrong J, Meade AD, Lyng FM. Effect of hemolysis on Fourier transform infrared and Raman spectra of blood plasma. JOURNAL OF BIOPHOTONICS 2020; 13:e201960173. [PMID: 32162465 DOI: 10.1002/jbio.201960173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/19/2020] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
Hemolysis is a very common phenomenon and is referred as the release of intracellular components from red blood cells to the extracellular fluid. Hemolyzed samples are often rejected in clinics due to the interference of hemoglobin and intracellular components in laboratory measurements. Plasma and serum based vibrational spectroscopy studies are extensively applied to generate spectral biomarkers for various diseases. However, no studies have reported the effect of hemolysis in blood based vibrational spectroscopy studies. This study was undertaken to evaluate the effect of hemolysis on infrared and Raman spectra of blood plasma. In this study, prostate cancer plasma samples (n = 30) were divided into three groups (nonhemolyzed, mildly hemolyzed, and moderately hemolyzed) based on the degree of hemolysis and FTIR and Raman spectra were recorded using high throughput (HT)-FTIR and HT-Raman spectroscopy. Discrimination was observed between the infrared and Raman spectra of nonhemolyzed and hemolyzed plasma samples using principal component analysis. A classical least square fitting analysis showed differences in the weighting of pure components in nonhemolyzed and hemolyzed plasma samples. Therefore, it is worth to consider the changes in spectral features due to hemolysis when comparing the results within and between experiments.
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Affiliation(s)
- Dinesh K R Medipally
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Daniel Cullen
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Valérie Untereiner
- BioSpecT EA 7506, Université de Reims Champagne-Ardenne, UFR Pharmacie, Reims, France
- Plateforme en Imagerie Cellulaire et Tissulaire (PICT), Université de Reims Champagne-Ardenne, Reims, France
| | - Jane Bryant
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
| | - Ganesh D Sockalingum
- BioSpecT EA 7506, Université de Reims Champagne-Ardenne, UFR Pharmacie, Reims, France
| | - Thi N Q Nguyen
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Emma Noone
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Shirley Bradshaw
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Marie Finn
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Mary Dunne
- Clinical Trials Unit, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | | | - John Armstrong
- Cancer Trials Ireland, Dublin, Ireland
- Department of Radiation Oncology, St Luke's Radiation Oncology Network, St Luke's Hospital, Dublin, Ireland
| | - Aidan D Meade
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Fiona M Lyng
- Radiation and Environmental Science Centre, Focas Research Institute, Technological University Dublin, Dublin, Ireland
- School of Physics & Clinical & Optometric Sciences, Technological University Dublin, Dublin, Ireland
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6
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O'Hara M, Wheatley EG, Kazmierczak SC. The Impact of Undetected In Vitro Hemolysis or Sample Contamination on Patient Care and Outcomes in Point-of-Care Testing: A Retrospective Study. J Appl Lab Med 2020; 5:332-341. [PMID: 32445387 DOI: 10.1093/jalm/jfz020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/19/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Point-of-care (POC) testing is an integral diagnostic component in clinical settings like the emergency department (ED). However, most POC testing devices are unable to detect endogenous interferents such as hemolysis, which typically occurs during sample collection and handling and can falsely increase measured potassium (pseudohyperkalemia), a phenomenon we hypothesized may significantly impact patient care. METHODS In this retrospective study, we evaluated 100 unique admissions to the Oregon Health & Science University ED, presenting with elevated potassium measured at the POC. To evaluate whether in vitro hemolysis had occurred, POC test results were compared to repeat testing of the original specimen, or other specimens tested within 90 minutes in the Core laboratory. Review of associated Electronic Health Records determined whether elevated potassium initially measured using the POC analyzer was real, or due to in vitro hemolysis or contamination, and whether pseudohyperkalemia impacted patient management or care. RESULTS Of the 100 admissions with hyperkalemia measured using a POC analyzer, 40% were found to have pseudohyperkalemia due to hemolysis or contamination. Of these 40 patients, 6 experienced repeated testing, and an additional 5 were noted to have altered patient management, specifically due to pseudohyperkalemia. CONCLUSIONS This study demonstrates the incidence of in vitro hemolysis, which is unknown to the POC operator, is high in patients who show an elevated potassium as measured at the POC. Furthermore, in vitro hemolysis can significantly impact patient management, suggesting that minimizing the incidence of unrecognized hemolysis will benefit hospital efficiency, decrease waste, and improve patient care.
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Affiliation(s)
- Matthew O'Hara
- Trinity Life Sciences, Waltham, MA (formerly Boston Strategic Partners, Inc. Boston, MA)
| | - Elizabeth G Wheatley
- Trinity Life Sciences, Waltham, MA (formerly Boston Strategic Partners, Inc. Boston, MA)
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7
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Quig K, Wheatley EG, O'Hara M. Perspectives On Blood-Based Point-Of-Care Diagnostics. Open Access Emerg Med 2019; 11:291-296. [PMID: 31814781 PMCID: PMC6861530 DOI: 10.2147/oaem.s223667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background Point of Care (POC) diagnostics are an essential component of modern medicine and are employed in a variety of clinical disciplines to improve patient outcomes and provider efficiency. Despite these benefits, there are aspects of POC testing which may still hold room for improvement. In the present study, a group of healthcare professionals familiar with different facets of blood-based POC testing provided their perspectives on the benefits and challenges of POC testing within their respective fields. Materials and methods The study was conducted from April to June 2019, in Colorado, United States of America. Five healthcare professionals, each working in a distinct field (anesthesiology, nursing, emergency medicine, trauma surgery, and POC management) were interviewed. Results from each of the interviews were transcribed as qualitative perspectives on POC diagnostics. Discussion The general consensus among participants in this study is that POC testing is tremendously beneficial, providing rapid test results, increased access to diagnostics, and improvements in hospital efficiency. However, significant challenges remain in blood-based POC diagnostics, particularly in maintaining sample quality, due to the fact that devices used for sample acquisition and handling are not designed for POC. This raises the possibility for interferents like hemolysis to occur, which may alter diagnostic results. Errors in POC diagnostics, whether due to sample, operator, or instrument error, may cause providers to lose confidence in the test. This lack of confidence can lead to duplicate testing and delayed patient diagnoses. Conclusion The perspectives presented in this study suggest there is a significant need for improvement in the pre-analytical phase of POC testing, and that current practice employs specimen collection technology not designed for POC. Therefore, one hypothesis is that the introduction of a collection device designed specifically for POC could reduce pre-analytical errors, standardize sample quality, improve efficiency, and further benefit patient care.
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8
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The relationship between serum potassium concentrations and electrocardiographic characteristics in 163,547 individuals from primary care. J Electrocardiol 2019; 57:104-111. [DOI: 10.1016/j.jelectrocard.2019.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/08/2019] [Accepted: 09/04/2019] [Indexed: 12/17/2022]
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9
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Lippi G, Cadamuro J, von Meyer A, Simundic AM. Practical recommendations for managing hemolyzed samples in clinical chemistry testing. Clin Chem Lab Med 2019; 56:718-727. [PMID: 29373316 DOI: 10.1515/cclm-2017-1104] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/15/2017] [Indexed: 01/04/2023]
Abstract
We suggest here a pragmatic approach for managing results of clinical chemistry testing in hemolyzed samples collected from adults/older children, attempting to balance the need to produce quality laboratory data with clinical urgency of releasing test results. Automatic measurement of the hemolysis index (H-index) in serum or plasma is highly advisable, whilst low-quality assessment of this test remains less good than a visual inspection. Regarding its practical use, when the H-index value does not generate an analytically significant bias, results can be released, whilst when the value is associated with analyte variation in a range between analytically and clinically significant bias (i.e. variation does not exceed the reference change value [RCV]), results of hemolysis-sensitive tests can be released in association with a comment describing the direction in which data are potentially altered, suggesting the need to collect another sample. When the H-index is associated with analyte variation exceeding clinically significant bias (i.e. variation exceeds the RCV), results of hemolysis-sensitive tests should be suppressed and replaced with a comment that biased results cannot be released because the sample is preanalytically compromised and advising the recollection of another sample. If H-index values reach an even higher critical cut-off (i.e. H-index corresponding to a cell-free hemoglobin concentration ≥10 g/L), all laboratory data may be unreliable and should hence be suppressed and replaced with a comment that all data cannot be released because the sample is grossly hemolyzed, also suggesting the recollection of another sample. Due to inaccuracy and imprecision, the use of corrective formulas for adjusting data of hemolysis-sensitive tests is discouraged.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37100 - Verona, Italy
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Alexander von Meyer
- Institute for Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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10
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Lopes KM, da Silva FH, Gil Maldonado AS, Santiago SA, Pires TA, Ferrer CM, Mena SJ, Moura MEG, Domingues PT, Kawakami LM, de Senzi Zancul E. Portable Device for Measuring Blood Test Hemolyzed Samples Based on Computer Vision and Neural Network. J Med Device 2019. [DOI: 10.1115/1.4043078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Hemolysis is a challenging problem and still represents a frequent source of errors in blood test laboratory practice. Due to the broad and heterogeneous bias induced in the measurement of several parameters by hemolysis, inaccurate results may be reported, and the patient may be required to repeat sample collection, delaying diagnosis. Existing automated laboratory devices including hemolysis detection are not suitable for lower volume and smaller sample collection sites. In many situations, hemolysis is still detected by visual inspection of the sample after centrifugation, during the blood test pre-analytical stage. Visual inspection is highly dependent on a qualified workforce, subjective to interpretation discrepancies, and thus difficult to standardize. The paper aims to describe the design and performance of a portable device for measuring hemolyzed samples based on computer vision and neural network. The results indicate that the device provides hemolysis indexes with sufficient accuracy to guide laboratory decision in the blood test pre-analytical stage.
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Affiliation(s)
- Karyn Martinelli Lopes
- Department of Production Engineering, Polytechnic School at the University of Sao Paulo, Professor Almeida Prado Avenue, 128, Sao Paulo, SP 05508-070, Brazil e-mail:
| | - Flavia Helena da Silva
- Fleury Group, Clinical Analysis, General Valdomiro de Lima Avenue, 508, Sao Paulo, SP 04344-070, Brazil e-mail:
| | - Alessandra S. Gil Maldonado
- Fleury Group, Clinical Analysis, General Valdomiro de Lima Avenue, 508, Sao Paulo, SP 04344-070, Brazil e-mail:
| | - Simone Aparecida Santiago
- Fleury Group, Clinical Analysis, General Valdomiro de Lima Avenue, 508, Sao Paulo, SP 04344-070, Brazil e-mail:
| | - Tavani A. Pires
- Fleury Group, Clinical Analysis, General Valdomiro de Lima Avenue, 508, Sao Paulo, SP 04344-070, Brazil e-mail:
| | - Claudia Maria Ferrer
- Fleury Group, Clinical Analysis, General Valdomiro de Lima Avenue, 508, Sao Paulo, SP 04344-070, Brazil e-mail:
| | - Sara Josa Mena
- Fleury Group, Clinical Analysis, General Valdomiro de Lima Avenue, 508, Sao Paulo, SP 04344-070, Brazil e-mail:
| | - Maria Emilia Germani Moura
- Fleury Group, Clinical Analysis, General Valdomiro de Lima Avenue, 508, Sao Paulo, SP 04344-070, Brazil e-mail:
| | - Pietro Teruya Domingues
- Department of Mechatronics Engineering, Polytechnic School at the University of Sao Paulo, Professor Mello Moraes Avenue, 2231, Sao Paulo, SP 05508-030, Brazil e-mail:
| | - Lincoln Makoto Kawakami
- Department of Electronic Systems Engineering, Polytechnic School at the University of Sao Paulo, Professor Luciano Gualberto Avenue, 158, Sao Paulo, SP 05508-010, Brazil e-mail:
| | - Eduardo de Senzi Zancul
- Department of Production Engineering, Polytechnic School at the University of Sao Paulo, Professor Almeida Prado Avenue, 128, Sao Paulo, SP 05508-070, Brazil e-mail:
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11
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Wan Azman WN, Omar J, Koon TS, Tuan Ismail TS. Hemolyzed Specimens: Major Challenge for Identifying and Rejecting Specimens in Clinical Laboratories. Oman Med J 2019; 34:94-98. [PMID: 30918601 PMCID: PMC6425048 DOI: 10.5001/omj.2019.19] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Pre-analytical quality in clinical chemistry testing is as important as analytical and post-analytical quality. The most prevalent pre-analytical interference and a major source of error producing unreliable laboratory test results is hemolysis of blood samples. In vitro hemolysis may be due to the blood withdrawal technique or sample handling whereas in vivo hemolysis can originate from acquired, hereditary, or iatrogenic conditions and is not technique dependent. Interpreting in vivo or in vitro hemolysis requires clinicians to supply reliable clinical history and findings. Even then, to reject or release the result with interpretation is still under debate. Thus, hemolyzed specimens are a serious pre-analytical problem calling for well-designed and strictly implemented laboratory guidelines. The aim of this non-systematic review (addressed to healthcare professionals) was to highlight the challenges in identifying and rejecting hemolysis specimens.
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Affiliation(s)
- Wan Norlina Wan Azman
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains, Kelantan, Malaysia
| | - Julia Omar
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains, Kelantan, Malaysia
| | - Tan Say Koon
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains, Kelantan, Malaysia
| | - Tuan Salwani Tuan Ismail
- Department of Chemical Pathology, School of Medical Sciences, Universiti Sains, Kelantan, Malaysia
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12
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Phelan MP, Reineks EZ, Schold JD, Hustey FM, Chamberlin J, Procop GW. Preanalytic Factors Associated With Hemolysis in Emergency Department Blood Samples. Arch Pathol Lab Med 2017; 142:229-235. [DOI: 10.5858/arpa.2016-0400-oa] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Hemolysis of emergency department blood samples is a common occurrence and has a negative impact on health care delivery.
Objectives.—
To determine the effect of preanalytic factors (straight stick, intravenous [IV] line, needle gauge, location of blood draw, syringe versus vacuum tube use, tourniquet time) on hemolysis in emergency department blood samples.
Design.—
A single 65 000-visit emergency department's electronic health record was queried for emergency department potassium results and blood draw technique for all samples obtained in calendar year 2014, resulting in 54 531 potassium results. Hemolyzed potassium was measured by hemolysis index. Comparisons of hemolysis by sampling technique were conducted by χ2 tests.
Results.—
Overall hemolysis was 10.0% (5439 of 54 531). Hemolysis among samples obtained from straight stick was significantly less than among those obtained with IV line (5.4% [33 of 615] versus 10.2% [4821 of 47 266], P < .001). For IV-placed blood draws, antecubital location had a statistically significant lower overall hemolysis compared with other locations: 7.4% (2117 of 28 786) versus 14.6% (2622 of 17 960) (P < .001). For blood drawn with a syringe compared with vacuum, hemolysis was 13.0% (92 of 705) and 11.0% (1820 of 16 590), respectively (P = .09, not significant). For large-gauge IV blood draws versus smaller-gauge IV lines, a lower hemolysis was also observed (9.3% [3882 of 41 571] versus 16.7% [939 of 5633]) (P < .001). For IV-drawn blood with tourniquet time less than 60 seconds, hemolysis was 10.3% (1362 of 13 162) versus 13.9% for more than 60 seconds (532 of 3832), P < .001.
Conclusions.—
This study confirmed previous findings that straight stick and antecubital location are significantly associated with reduced hemolysis and indicated that shorter tourniquet time and larger gauge for IV draws were significantly associated with lower hemolysis.
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13
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Li L, Vecellio E, Gay S, Lake R, Mackay M, Burnett L, Chesher D, Braye S, Badrick T, Westbrook JI, Georgiou A. Making sense of a haemolysis monitoring and reporting system: a nationwide longitudinal multimethod study of 68 Australian laboratory participant organisations. ACTA ACUST UNITED AC 2017; 56:565-573. [DOI: 10.1515/cclm-2017-0056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 08/09/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
The key incident monitoring and management systems (KIMMS) quality assurance program monitors incidents in the pre- and postanalytical phases of testing in medical laboratories. Haemolysed specimens have been found to be the most frequent preanalytical error and have major implications for patient care. The aims of this study were to assess the suitability of KIMMS for quality reporting of haemolysis and to devise a meaningful method for reporting and monitoring haemolysis.
Methods:
A structured survey of 68 Australian KIMMS laboratory participant organisations was undertaken. Quarterly haemolysis reports (2011–2014) were analysed.
Results:
Among 110 million accessions reported, haemolysis rates varied according to the reporting methods that participants used for assigning accessions (16% of participants reported haemolysis by specimen and 83% reported by episode) and counting haemolysis rejections (61% by specimen, 35% by episode and 3% by test). More than half of the participants (56%) assigned accessions by episode and counted rejections by specimen. For this group, the average haemolysis rate per 100,000 episodes was 177 rejected specimens with the average rate varying from 100 to 233 over time. The majority of participants (91%) determined rejections using the haemolysis index. Two thirds of participants (66%) recorded the haemolysis manually in laboratory information systems.
Conclusions:
KIMMS maintains the largest longitudinal haemolysis database in the world. However, as a means of advancing improvements in the quality of the preanalytical laboratory process, there is a need to standardise reporting methods to enable robust comparison of haemolysis rejection rates across participant laboratories.
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Affiliation(s)
- Ling Li
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
| | - Elia Vecellio
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
- South Eastern Area Laboratory Services, NSW Health Pathology , Sydney, NSW , Australia
| | - Stephanie Gay
- Royal College of Pathologists Australasia Quality Assurance Programs , St. Leonards, NSW , Australia
| | - Rebecca Lake
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
| | - Mark Mackay
- Royal College of Pathologists Australasia Quality Assurance Programs , St. Leonards, NSW , Australia
| | - Leslie Burnett
- Genome.One, Garvan Institute of Medical Research , Darlinghurst, NSW , Australia
- Northern Clinical School, Sydney Medical School , University of Sydney , NSW , Australia
| | - Douglas Chesher
- Northern Clinical School, Sydney Medical School , University of Sydney , NSW , Australia
- Pathology North, NSW Health Pathology, Royal North Shore Hospital , St. Leonards, NSW , Australia
| | - Stephen Braye
- Pathology North, NSW Health Pathology, Royal North Shore Hospital , St. Leonards, NSW , Australia
- Pathology North, NSW Health Pathology , Newcastle, NSW , Australia
| | - Tony Badrick
- Royal College of Pathologists Australasia Quality Assurance Programs , St. Leonards, NSW , Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
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14
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Killilea DW, Rohner F, Ghosh S, Otoo GE, Smith L, Siekmann JH, King JC. Identification of a Hemolysis Threshold That Increases Plasma and Serum Zinc Concentration. J Nutr 2017; 147:1218-1225. [PMID: 28490675 PMCID: PMC5443468 DOI: 10.3945/jn.116.247171] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/19/2017] [Accepted: 03/28/2017] [Indexed: 12/20/2022] Open
Abstract
Background: Plasma or serum zinc concentration (PZC or SZC) is the primary measure of zinc status, but accurate sampling requires controlling for hemolysis to prevent leakage of zinc from erythrocytes. It is not established how much hemolysis can occur without changing PZC/SZC concentrations.Objective: This study determines a guideline for the level of hemolysis that can significantly elevate PZC/SZC.Methods: The effect of hemolysis on PZC/SZC was estimated by using standard hematologic variables and mineral content. The calculated hemolysis threshold was then compared with results from an in vitro study and a population survey. Hemolysis was assessed by hemoglobin and iron concentrations, direct spectrophotometry, and visual assessment of the plasma or serum. Zinc and iron concentrations were determined by inductively coupled plasma spectrometry.Results: A 5% increase in PZC/SZC was calculated to result from the lysis of 1.15% of the erythrocytes in whole blood, corresponding to ∼1 g hemoglobin/L added into the plasma or serum. Similarly, the addition of simulated hemolysate to control plasma in vitro caused a 5% increase in PZC when hemoglobin concentrations reached 1.18 ± 0.10 g/L. In addition, serum samples from a population nutritional survey were scored for hemolysis and analyzed for changes in SZC; samples with hemolysis in the range of 1-2.5 g hemoglobin/L showed an estimated increase in SZC of 6% compared with nonhemolyzed samples. Each approach indicated that a 5% increase in PZC/SZC occurs at ∼1 g hemoglobin/L in plasma or serum. This concentration of hemoglobin can be readily identified directly by chemical hemoglobin assays or indirectly by direct spectrophotometry or matching to a color scale.Conclusions: A threshold of 1 g hemoglobin/L is recommended for PZC/SZC measurements to avoid increases in zinc caused by hemolysis. The use of this threshold may improve zinc assessment for monitoring zinc status and nutritional interventions.
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Affiliation(s)
| | | | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA; and
| | - Gloria E Otoo
- Department of Nutrition and Food Sciences, University of Ghana, Accra, Ghana
| | - Lauren Smith
- Children's Hospital Oakland Research Institute, Oakland, CA
| | | | - Janet C King
- Children's Hospital Oakland Research Institute, Oakland, CA
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15
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Abstract
A body of evidence collected in the last few decades demonstrates that the pre- and post-analytical phases of the testing cycle are more error-prone than the analytical phase. However, the paradigm of errors and quality in laboratory medicine has been questioned, analytical mistakes continuing to be a major cause of adverse clinical outcomes and patient harm. Although the brain-to-brain concept is widely recognized in the community of laboratory professionals, there is lack of clarity concerning the inter-relationship between the different phases of the cycle, interdependence between the pre-analytical phase and analytical quality, and the effect of the post-analytical steps on the quality of ultimate laboratory information. Analytical quality remains the "core business" of clinical laboratories, but laboratory professionals and clinicians alike should never lose sight of the fact that pre-analytical variables are often responsible for erroneous test results and that quality biospecimens are pre-requisites for a reliable analytical phase. In addition, the pressure for expert advice on test selection and interpretation of results has increased hand in hand with the ever-increasing complexity of tests and diagnostic fields. Finally, the data on diagnostic errors and inappropriate clinical decisions made due to delay or misinterpretation of laboratory data underscore the current need for greater collaboration at the clinical-laboratory interface.
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16
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Phelan MP, Reineks EZ, Kovach AC. Intravenous Catheters and Blood Samples. J Emerg Nurs 2016; 42:102-3. [PMID: 27002197 DOI: 10.1016/j.jen.2015.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/10/2015] [Indexed: 11/29/2022]
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17
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Lippi G. Practices for Identifying and Rejecting Hemolyzed Specimens in Europe. Arch Pathol Lab Med 2016; 140:622. [DOI: 10.5858/arpa.2015-0330-le] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
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18
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Phelan MP, Reineks EZ, Schold JD, Kovach A, Venkatesh A. Estimated National Volume of Laboratory Results Affected by Hemolyzed Specimens From Emergency Departments. Arch Pathol Lab Med 2016; 140:621. [DOI: 10.5858/arpa.2015-0434-le] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Edmunds Z. Reineks
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jesse D. Schold
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Arjun Venkatesh
- Department of Emergency Medicine, Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut
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