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Schlüter K, Cadamuro J. Erroneous potassium results: preanalytical causes, detection, and corrective actions. Crit Rev Clin Lab Sci 2023; 60:442-465. [PMID: 37042478 DOI: 10.1080/10408363.2023.2195936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/14/2023] [Accepted: 03/23/2023] [Indexed: 04/13/2023]
Abstract
Potassium is one of the most requested laboratory tests. Its level is carefully monitored and maintained in a narrow physiological range. Even slightly altered potassium values may severely impact the patient's health, which is why an accurate and reliable result is of such importance. Even if high-quality analytics are available, there are still numerous ways in which potassium measurements may be biased, all of which occur in the preanalytical phase of the total laboratory testing process. As these results do not reflect the patient's in-vivo status, such results are referred to as pseudo-hyper/hypokalemia or indeed pseudo-normokalemia, depending on the true potassium result. Our goal in this review is to present an in-depth analysis of preanalytical errors that may result in inaccurate potassium results. After reviewing existing evidence on this topic, we classified preanalytical errors impacting potassium results into 4 categories: 1) patient factors like high platelet, leukocytes, or erythrocyte counts; 2) the sample type 3) the blood collection procedure, including inappropriate equipment, patient preparation, sample contamination and others and 4) the tube processing. The latter two include sample transport and storage conditions of whole blood, plasma, or serum as well as sample separation and subsequent preanalytical processes. In particular, we discuss the contribution of hemolysis, as one of the most frequent preanalytical errors, to pseudo-hyperkalemia. We provide a practical flow chart and a tabular overview of all the discussed preanalytical errors including possible underlying mechanisms, indicators for detection, suggestions for corrective actions, and references to the according evidence. We thereby hope that this manuscript will serve as a resource in the prevention and investigation of potentially biased potassium results.
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Affiliation(s)
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
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Simundic AM, Bölenius K, Cadamuro J, Church S, Cornes MP, van Dongen-Lases EC, Eker P, Erdeljanovic T, Grankvist K, Guimaraes JT, Hoke R, Ibarz M, Ivanov H, Kovalevskaya S, Kristensen GBB, Lima-Oliveira G, Lippi G, von Meyer A, Nybo M, De la Salle B, Seipelt C, Sumarac Z, Vermeersch P. Joint EFLM-COLABIOCLI Recommendation for venous blood sampling. Clin Chem Lab Med 2019; 56:2015-2038. [PMID: 30004902 DOI: 10.1515/cclm-2018-0602] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/10/2018] [Indexed: 11/15/2022]
Abstract
This document provides a joint recommendation for venous blood sampling of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE) and Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI). It offers guidance on the requirements for ensuring that blood collection is a safe and patient-centered procedure and provides practical guidance on how to successfully overcome potential barriers and obstacles to its widespread implementation. The target audience for this recommendation are healthcare staff members directly involved in blood collection. This recommendation applies to the use of a closed blood collection system and does not provide guidance for the blood collection with an open needle and syringe and catheter collections. Moreover, this document neither addresses patient consent, test ordering, sample handling and transport nor collection from children and unconscious patients. The recommended procedure is based on the best available evidence. Each step was graded using a system that scores the quality of the evidence and the strength of the recommendation. The process of grading was done at several face-to-face meetings involving the same mixture of stakeholders stated previously. The main parts of this recommendation are: 1) Pre-sampling procedures, 2) Sampling procedure, 3) Post-sampling procedures and 4) Implementation. A first draft of the recommendation was circulated to EFLM members for public consultation. WG-PRE-LATAM was also invited to comment the document. A revised version has been sent for voting on to all EFLM and COLABIOCLI members and has been officially endorsed by 33/40 EFLM and 21/21 COLABIOCLI members. We encourage professionals throughout Europe and Latin America to adopt and implement this recommendation to improve the quality of blood collection practices and increase patient and workers safety.
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Affiliation(s)
- Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, Clinical Hospital "Sveti Duh", Zagreb, Croatia, E-mail:
| | | | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | - Michael P Cornes
- Department of Clinical Biochemistry, Worcester Acute Hospitals NHS Trust, Worcester, UK
| | | | - Pinar Eker
- Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Tanja Erdeljanovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | - Joao Tiago Guimaraes
- Department of Clinical Pathology, São João Hospital Center, Department of Biomedicine, Faculty of Medicine, Porto, Portugal; and EPI Unit,Institute of Public Health, University of Porto, Porto, Portugal
| | - Roger Hoke
- National Association of Phlebotomists, London, UK
| | - Mercedes Ibarz
- Department of Clinical Laboratory, University Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Svetlana Kovalevskaya
- Clinical Laboratory Diagnostic and Pathomorphology Department, Autonomous non-profit organization of additional professional education "Institute of Laboratory Medicine", Moscow, Russia
| | | | - Gabriel Lima-Oliveira
- Section of Clinical Biochemistry, University of Verona, Verona, Italy; andLatin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
| | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Mads Nybo
- Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Barbara De la Salle
- West Hertfordshire Hospitals NHS Trust, Operating UK NEQAS for Haematology and Transfusion, Watford, UK
| | | | - Zorica Sumarac
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Pieter Vermeersch
- Department of Laboratory Medicine, University of Leuven, Leuven, Belgium
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Lima-Oliveira G, Guidi GC, Salvagno GL, Brocco G, Danese E, Lippi G. Estimation of the imprecision on clinical chemistry testing due to fist clenching and maintenance during venipuncture. Clin Biochem 2016; 49:1364-1367. [DOI: 10.1016/j.clinbiochem.2016.07.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/26/2022]
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