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Wu AHB, Peacock WF. Potential medical impact of unrecognized in vitro hypokalemia due to hemolysis: a case series. Clin Chem Lab Med 2024; 62:1975-1979. [PMID: 38618746 DOI: 10.1515/cclm-2024-0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES The destruction of red cells during blood collection or with the processing of the sample continues to occur at a high rate, especially among emergency department (ED) patients. This can produce pre-analytical laboratory errors, particularly for potassium. We determined the incidence of hemolyzed samples and discuss the potential medical impact for hypokalemic patients who potassium level is artificially normal (pseudoeukalemia). METHODS Potassium results were obtained for a 6-month period. Using a measured hemolysis index (HI), hemolysis was present in 3.1 % for all potassium ordered (n=94,783) and 7.5 % for ED orders (n=22,770). Most of these samples were reported as having high normal result or were hyperkalemic. There were 22 hemolytic samples with a potassium of <3.5 mmol/L, and 57 hemolytic samples with a potassium in lower limit of normal (3.5-3.8 mmol/L). From this group, we examined the medical histories of 8 selected patients whose initially normal potassium levels were subsequently confirmed to have a potassium values that were below, at, or just above the lower limit of normal due to hemolysis. RESULTS The primary complaint for these patients were: necrotizing soft tissue infection, pancreatitis, volume overload from heart failure with reduced ejection fraction, hypertension treated with hydrochlorothiazide, and presence of a short bowel syndrome. A subsequent non-hemolyzed sample was collected demonstrating hypokalemia in all of these patients. Within these cases, there was a potential for harm had hemolysis detection not been performed. CONCLUSIONS We demonstrate the medical importance of detecting hemolysis for patients who have pseudoeukalemia. This is relevant because the HI cannot be obtained when electrolytes are tested using whole blood samples, and a normal potassium may lead to inappropriate patient management.
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Affiliation(s)
- Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - W Franklin Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
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2
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Ilardo C, Coulon G, Lancien A, Olejnik Y, Barthes J. Adjustment of lactate dehydrogenase concentration results according to the haemolysis index following in vitro haemolysis. Scand J Clin Lab Invest 2024; 84:350-355. [PMID: 39153181 DOI: 10.1080/00365513.2024.2392633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/18/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024]
Abstract
In the presence of haemolysis, the interpretation of the Lactate dehydrogenase (LDH) activity result is a major operational challenge for medical laboratories: if the origin is intravascular, then the measurement will reflect the clinical reality, but in extravascular haemolysis, the laboratory will be confronted with an artefactual increase leading to false-positive high results. The aim of our study was to evaluate the adjustment of LDH concentration results according to the haemolysis index (HI). After designed a mathematical model to correct the LDH measured as a function of the haemolysis index using a Cobas 8000 analyser (Roche diagnostics, Mannheim, Germany), LDH measurement of seventy-four duplicate samples were tested before and after exposure to extravascular haemolysis process. After in vitro haemolysis process, a significant increase haemolysis index (Man-Whitney U-Test p < 0.0001) were observed. Before process the HI median was 4 [2.0 - 6.75] and after HI median was 18 [10 - 35.75]. Without correction, LDH results showed a significant increase (p < 0.001) after haemolysis process and substantial analytical discrepancies (31/74) were observed according to TEa of CLIA. After correction, data showed no significant difference (p = 0.497) and the mathematical algorithm allowed to reduce the analytical discrepancies (2/74). If haemolysis was present in vitro, the mathematical algorithm increased the accuracy of the LDH results. However, the lack of discrimination between in vivo and in vitro haemolysis requires caution and the results should be reported only as a commentary to inform the clinician.
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Affiliation(s)
| | | | | | - Yann Olejnik
- LABOSUD Laboratory (Inovie member), Montpellier, France
| | - Joel Barthes
- LABOSUD Laboratory (Inovie member), Montpellier, France
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3
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Colak S, Tasdemir O, van der Schaaf M, Opdam F, van den Noort V, van den Broek D, van Rossum HH. Design, validation and performance of aspartate aminotransferase- and lactate dehydrogenase-reporting algorithms for haemolysed specimens including correction within quality specifications. Ann Clin Biochem 2024; 61:239-247. [PMID: 31495183 DOI: 10.1177/0004563219878475] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND In vitro haemolysis is a major operational challenge for medical laboratories. A new experimental design was used to investigate under what conditions algorithms could be designed to report either quantitative or qualitative aspartate aminotransferase and lactate dehydrogenase results outside the manufacturer's haemolysis specifications. Quantitative corrections were required to meet prespecified quality specifications. METHODS Twenty-five patient samples were used to design reporting algorithms and another 41 patient samples were used to validate the algorithms. Aspartate aminotransferase, lactate dehydrogenase and haemolysis index were determined using a Cobas 6000 analyser (Roche diagnostics, Mannheim, Germany). Correction factors were determined, and the accuracy of the correction was investigated. Reporting algorithms were designed based on (i) the manufacturer's cut-off for the haemolysis index, (ii) corrections within the total allowable error specification and (iii) qualitative reporting based on obtained results. The impact of the reporting algorithms was retrospectively determined by recalculating six months of aspartate aminotransferase and lactate dehydrogenase results. RESULTS No correction for aspartate aminotransferase/lactate dehydrogenase was possible for results below the upper reference interval limit, while results equal to or greater than the upper reference interval limit could, up to mild haemolysis, be corrected within the total error criterion. All samples generated from the validated patient cohort fulfilled the set criteria. The algorithms allowed reporting 88.5% and 85.9% of otherwise unreported aspartate aminotransferase and lactate dehydrogenase results, respectively. CONCLUSIONS An approach is presented that allows to generate and validate reporting algorithms for aspartate aminotransferase and lactate dehydrogenase compatible with prespecified quality specifications. The designed algorithms resulted in a significant reduction of otherwise unreported aspartate aminotransferase and lactate dehydrogenase results.
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Affiliation(s)
- Selcuk Colak
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Onur Tasdemir
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marianne van der Schaaf
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frans Opdam
- Division of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Vincent van den Noort
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daan van den Broek
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Huub H van Rossum
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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4
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Dietzen DJ, Jackups R, Zaydman MA. Clinical implications of inaccurate potassium determination in hemolyzed pediatric blood specimens. Clin Chim Acta 2024; 557:117862. [PMID: 38460583 DOI: 10.1016/j.cca.2024.117862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Analysis of whole blood specimens is rapid and saves blood, but hemolysis may go undetected and compromise the accuracy of potassium measurement. We aimed to define the frequency and magnitude of error in whole blood potassium measurement. METHODS 34 months of whole blood and plasma potassium data were extracted from patients aged less than 2 years at the time of sample acquisition. Hemolysis was detected using the plasma "H index." The magnitude of potassium bias was estimated from the difference between paired whole blood and plasma measurement separated by less than 2 h. RESULTS 56,000 of the 105,000 data points were from plasma and 20 % of these had significant hemolysis. Rates of hemolysis (nearing 50 %) were greatest in the neonatal nursery. Of 662 proximal whole blood and plasma paired results, 8 % had elevated whole blood potassium with a normal plasma value and 4 % had a normal whole blood potassium with reduced plasma potassium. The bias between whole blood and plasma potassium ranged from -1.0 to 4.0 mmol/L. CONCLUSIONS The use of whole blood analysis brings with it significant risk for error in potassium measurement. Better tools to detect hemolysis in these types of specimens are indicated.
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Affiliation(s)
- Dennis J Dietzen
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States; Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.
| | - Ronald Jackups
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Mark A Zaydman
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, United States
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5
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Umemura H, Takahashi H, Fukuda Y, Soma H, Aoki R, Takei N, Nakayama T. Use of finer needles for venipuncture increases in vitro haemolysis despite reducing persistent pain and nerve injury: A retrospective study. Ann Clin Biochem 2024; 61:107-114. [PMID: 37542363 DOI: 10.1177/00045632231196045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
BACKGROUND Although venipuncture is minimally invasive, and is the most frequently performed medical procedure, it carries the small risk of causing persistent pain, including nerve damage. Recently, our hospital stopped using 22-gauge needles for venipuncture in outpatients and switched to using only 23- and 25-gauge needles. We investigated the impact of using only the finer needles on the incidence of persistent or neuropathic pain and the prevalence of haemolysis, as well as the impact of haemolysis associated with the needle change on other laboratory data. METHODS We retrospectively collected and analysed data on venipuncture-associated pain complaints made during the 1-year period prior and 1-year period after the change in needles, as well as the frequency of haemolysis before and after the change. We also focused on 90 cases that showed significant haemolysis after the needle change and compared the serum aspartate aminotransferase, lactate dehydrogenase, and potassium levels before and after the needle change. RESULTS The incidence of persistent pain was significantly reduced from 1 in 10,825 venipunctures before the change to 1 in 29,747 venipunctures after the change. Notably, no patients experienced neuropathic pain after the change. However, the prevalence of haemolysis was significantly increased. Additionally, the serum aspartate aminotransferase, lactate dehydrogenase, and potassium levels were significantly elevated in the cases that showed moderate to gross haemolysis after the needle change. CONCLUSION Using finer needles involves both advantages and disadvantages, and careful consideration is needed to determine which type of needle is in the best interests of the patient.
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Affiliation(s)
- Hiroshi Umemura
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Hiromichi Takahashi
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiaki Fukuda
- Department of Clinical Laboratory, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Hitoshi Soma
- Department of Clinical Laboratory, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Rumiko Aoki
- Department of Clinical Laboratory, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Norihisa Takei
- Department of Clinical Laboratory, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Tomohiro Nakayama
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
- Department of Clinical Laboratory, Nihon University Itabashi Hospital, Tokyo, Japan
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Ishiguro A, Nishioka M, Morishige A, Yoneshiro M, Shinkawa K, Fujinaga A, Kobayashi T, Suehiro Y, Yamasaki T. Determination of the Optimal Wavelength of the Hemolysis Index Measurement. J Clin Med 2023; 12:5864. [PMID: 37762805 PMCID: PMC10531830 DOI: 10.3390/jcm12185864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Many biochemical auto-analyzers have methods that measure the hemolysis index (HI) to quantitatively assess the degree of hemolysis. Past reports on HI are mostly in vitro studies. Therefore, we evaluated the optimal wavelength of HI measurement ex vivo using clinical samples. Four different wavelengths (410/451 nm: HI-1, 451/478 nm: HI-2, 545/596 nm: HI-3 and 571/596 nm: HI-4) were selected for HI measurement, and correlations were examined from the measurement results of 3890 clinical samples. Another set of 9446 clinical samples was used to examine the correlation of HI with lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and potassium (K). Strong correlations were found between HI-4 and HI-1 and between HI-4 and HI-3. HI-1 and HI-2 cannot correctly assess hemolysis for high bilirubin samples, and HI-3 cannot correctly assess hemolysis for high triglyceride samples. LDH, AST and K correlated positively with HI-4 in clinical samples. For every 1-unit increase in HI-4, LDH increased by 19.51 U/L, AST by 1.03 U/L and K by 0.061 mmol/L, comparable to reports of other studies. In clinical samples, HI-4 was less susceptible to bilirubin and chyle and reflected well the changes in LDH, AST and K caused by hemolysis. This suggested that the optimal wavelength for HI measurement is 571 nm.
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Affiliation(s)
- Akiyo Ishiguro
- Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine, Ube 755-8505, Japan; (A.I.); (Y.S.)
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Mitsuaki Nishioka
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Akihiro Morishige
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Mai Yoneshiro
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Kanae Shinkawa
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Aki Fujinaga
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Toshihiko Kobayashi
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Yutaka Suehiro
- Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine, Ube 755-8505, Japan; (A.I.); (Y.S.)
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Takahiro Yamasaki
- Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine, Ube 755-8505, Japan; (A.I.); (Y.S.)
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
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7
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DiToro DF, Conrad MJ, Jarolim P. Hemolysis Index and Potassium Reporting. Am J Clin Pathol 2022; 157:809-813. [PMID: 35038719 DOI: 10.1093/ajcp/aqab217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/08/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES In vitro hemolysis generates a spurious increase in potassium. Roche Diagnostics recently revised its recommended guidelines for potassium reporting on cobas analyzers. By dramatically reducing the allowable degree of hemolysis, these guidelines would increase specimen rejection rates. We attempted to balance the desire to avoid inaccurate results with the clinical implications of increased specimen rejection rates. METHODS We downloaded hemolytic indices (HI) for 80,795 specimens tested at our institution on cobas chemistry analyzers in 1 month and evaluated potential specimen rejection rates based on the new criteria. We also spiked nonhemolyzed samples with hemolyzed blood to assess the influence of HI values on potassium measurements. RESULTS The new recommendations would lead to specimen rejection rates of 76% in the neonatal intensive care unit (NICU), 41% in the emergency department (ED), 16% in inpatient specimens, and 9% in outpatient samples. Our current criteria of reporting potassium concentrations in inpatient and outpatient specimens with HI ≤100 and in NICU and ED specimens with HI ≤300 and additional interpretive guidance for HI values between 100 and 300 reduce unnecessary specimen rejections to 3% in NICU, 2% in ED and inpatients, and less than 1% in outpatients without significantly increasing the number of clinically consequential incorrect results. CONCLUSIONS The new recommendations would lead to unacceptably high specimen rejection rates. Laboratories should develop context-specific, evidence-based reporting criteria that minimize reporting of inaccurate results without disrupting delivery of care.
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Affiliation(s)
- Daniel F DiToro
- Department of Pathology, Brigham and Women’s Hospital , Boston, MA , USA
- Harvard Medical School , Boston, MA , USA
| | - Michael J Conrad
- Department of Pathology, Brigham and Women’s Hospital , Boston, MA , USA
| | - Petr Jarolim
- Department of Pathology, Brigham and Women’s Hospital , Boston, MA , USA
- Harvard Medical School , Boston, MA , USA
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8
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van Rossum HH. Demonstrating the feasibility of accurately and reliably correcting potassium results for mildly hemolytic samples using a new experimental design. Clin Chim Acta 2021; 522:83-87. [PMID: 34418365 DOI: 10.1016/j.cca.2021.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS For several decades, there has been an ongoing debate about the appropriateness and reliability of correcting potassium concentration results for hemolyzed samples. As part of implementing a new Roche Cobas Pro analyzer system the possibility of correcting potassium results in hemolytic samples using a new, thorough experimental design, was investigated. MATERIALS AND METHODS The relationship between hemolytic index (HI) and increases in potassium concentration was studied by performing a linear regression on hemolysate dilution series (HI 0-160 mg/dL) from 20 left-over patient samples. The obtained correction procedure was validated using another 20 left-over patient samples. Corrections were accepted according to a correction concordance of 100% within the total allowable error criterion of 4.85%. RESULTS The obtained reporting procedure was: HI 0-17 quantitative potassium reporting, HI 18-100 correct potassium for HI, and report as text including a disclaimer for in vivo hemolysis; samples were rejected for HI > 100. In the validation cohort, 70/70 samples eligible for correction were within the TEa criterion. The maximum negative and positive errors were -2.8% and 2.9%, respectively. CONCLUSION Correcting potassium concentration results in a designated HI range is feasible and increases the accuracy the potassium results in samples with mild in vitro hemolysis.
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Affiliation(s)
- Huub H van Rossum
- Department of Laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
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9
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Lookadoo DB, Schonhorn JE, Harpaldas H, Uherek CM, Schatz P, Lindgren A, Depa M, Kumar AA. Paper-Based Optode Devices (PODs) for Selective Quantification of Potassium in Biological Fluids. Anal Chem 2021; 93:9383-9389. [PMID: 34192456 DOI: 10.1021/acs.analchem.1c00794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This paper describes the design, fabrication, and feasibility of paper-based optode devices (PODs) for sensing potassium selectively in biological fluids. PODs operate in exhaustive mode and integrate with a handheld, smartphone-connected optical reader. This integrated measuring system provides significant advantages over traditional optode membranes and other paper-based designs, by obtaining a linear optical response to potassium concentration via a simple, stackable design and by harnessing a smartphone to provide an easy-to-use interface, thus enabling remote monitoring of diseases.
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Affiliation(s)
| | | | | | | | - Philipp Schatz
- Precision Medicine & Biosamples, R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Lindgren
- Precision Medicine & Biosamples, R&D, AstraZeneca, Gothenburg, Sweden
| | - Michal Depa
- Jana Care, Inc., Boston, Massachusetts 02215, United States
| | - Ashok A Kumar
- Jana Care, Inc., Boston, Massachusetts 02215, United States
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10
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Mukerji S, Jones GRD. Uncertainty should not be neglected in potassium correction for haemolysis. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:423. [PMID: 34092155 DOI: 10.1080/00365513.2021.1931710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Shohini Mukerji
- Department of Chemical Pathology, SydPath, St Vincent's Hospital, Sydney, Australia
| | - Graham R D Jones
- Department of Chemical Pathology, SydPath, St Vincent's Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Kensington, Australia
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11
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Pan LL, Lee CH, Hung KC, Tsai IT, Wang MC, Sun CK. Differential impacts of hemolysis on coagulation parameters of blood samples: A STROBE-compliant article. Medicine (Baltimore) 2021; 100:e25798. [PMID: 33950978 PMCID: PMC8104210 DOI: 10.1097/md.0000000000025798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
This study aimed at investigating the impact of hemolysis on different coagulation parameters.A total of 216 venous blood samples without visible hemolysis were collected from adult patients at a tertiary referral center over six months. The plasma obtained was quantified for six coagulation parameters including prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, antithrombin III, and protein C. The rest of the plasma from each blood sample was aliquoted into three tubes, each containing 1 mL of plasma with three different volumes of cell-free hemoglobin (i.e., 2, 4, 8 μL) from lysed RBCs to create simulated hemolyzed blood samples with hemoglobin concentration of approximately 0.1, 0.2, and 0.4 g/dL to mimic mild (1+), moderate (2+), and severe (3+) hemolysis, respectively, before repeating the coagulation tests to determine possible correlation between the simulated degree of hemolysis and the changes in test results of the coagulation parameters.Spearman correlation analysis showed significant decreases in the values of activated partial thromboplastin time, fibrinogen, D-dimer, and protein C values with an increasing degree of simulated hemolysis (all P < .01). Comparison of the percentage bias of biological variance showed significant positive associations of cell-free hemoglobin concentrations with the percentage bias of D-dimer and protein C. However, only the former was still within the range of biological variance under condition of simulated hemolysis. Besides, the presence of cell-free hemoglobin regardless of concentration had a notable impact on the percentage bias of activated partial thromboplastin time, whereas the influence was non-significant for prothrombin time, fibrinogen, and antithrombin III.The results showed different impacts of simulated hemolysis on six coagulation parameters, highlighting the dependence of clinical reliability on the coagulation parameter to be investigated in hemolytic blood samples.
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Affiliation(s)
- Lin-Lin Pan
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chiayi
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology (CUMT)
| | - Ching-Hui Lee
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chiayi
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan
| | - I-Ting Tsai
- Department of Emergency Medicine, E-Da Hospital
- School of Medicine, College of Medicine, I-Shou University
| | - Ming-Chung Wang
- Department of Internal medicine, Division of Hematology/Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital
- School of Medicine, College of Medicine, I-Shou University
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12
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Clifford-Mobley O, Sheerin S. Verifying the haemolysis index limit for non-reporting potassium. Ann Clin Biochem 2020; 58:385-387. [PMID: 33302691 DOI: 10.1177/0004563220978686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Oliver Clifford-Mobley
- Department of Clinical Biochemistry, 1984University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sam Sheerin
- Department of Clinical Biochemistry, 1984University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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13
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Zhen Zhan C, Harun A, Salleh MN. Preliminary study on the correlation of plasma hemolysis index and potassium measurement of inpatient in the Biochemistry Laboratory of General Hospital Kuala Lumpur. LIFE SCIENCES, MEDICINE AND BIOMEDICINE 2020. [DOI: 10.28916/lsmb.4.9.2020.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Potassium (K+) is the essential micronutrient and major intracellular fluid cation which involves in various cellular metabolism activities, maintaining fluid and electrolyte balance. Measurement of blood concentration in a medical laboratory has often encountered disturbances such as hemolysis, which may lead to the elevation in measurement and affects the medical diagnosis and treatment of the patient, conceivably fatal. Hemolysis can be decided using hemolysis index (H-index) through automation. Methods: In this study, H-index and concentration of fifty hospitalized patients (n=50) hemolysed blood samples were measured and correlated. Freezing-and-thaw method was used to hemolyse the blood samples. Different concentrations were diluted and analyzed using COBAS 8000 biochemistry analyser. Data were collected and analyzed using SPSS version 25. Results: Our findings showed significant mean differences, 0.001 (p ≤ 0.05) and strong positive linear relationship between two variables (H-index and ) (r=0.764, p ≤ 0.05). By applying calculated linear equation [y = 0.0048x + 5.146, = 0.5838], critical value of 6.0 mmol/l gives H-index of 178, H-index above 178 is suggested to be critical. Discussion and Conclusion: concentration increases in proportion to H-index. A greater degree of hemolysis causes more ions to be released into extracellular fluid, respectively. In conclusion, when H-index less than 178 in measurement and there is no analytical significance bias generated, the result is acceptable, whilst H-index with analyte variation between clinically significant bias range can be released with a comment regarding the potential of data alteration. Meanwhile, result with H-index exceeding the cut-offs should be suppressed and recollection of sample is required.
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Bialkower M, McLiesh H, Manderson CA, Tabor RF, Garnier G. Rapid, hand-held paper diagnostic for measuring Fibrinogen Concentration in blood. Anal Chim Acta 2019; 1102:72-83. [PMID: 32043998 DOI: 10.1016/j.aca.2019.12.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/22/2019] [Accepted: 12/16/2019] [Indexed: 12/20/2022]
Abstract
Critical bleeding causes over 2 million deaths a year. Early hypofibrinogenemia is a strong predictor of mortality in critically bleeding patients. The early replenishment of fibrinogen can significantly improve outcomes. However, over replenishment can also be dangerous. Furthermore, there is no rapid, cheap, hand-held diagnostic that can aid critically bleeding patients in fibrinogen replacement therapy. In this study, we have developed a hand-held paper diagnostic that measures plasma fibrinogen concentrations. The diagnostic has the potential to be used as a point of care device both inside and outside of hospital settings. It can vastly reduce the time to treatment for fibrinogen replacement therapy. The diagnostic is a two-step process. First, thrombin and plasma are added onto horizontially-orientated paper strips where the fibrinogen is converted into fibrin, drastically increasing the plasma's hydrophobicity. Second, an aqueous blue dye is pipetted onto the strips and allowed to wick through the fibrin. The distance the blue dye wicks through the strip correlates precisely to the fibrinogen concentration. The diagnostic can provide results within a minute. It can distinguish low fibrinogen concentrations (ie. <2 g/L) from normal fibrinogen concentrations. It shows remarkable reproducibility between healthy individuals. It is unaffected by common blood conditions such as acidosis, blood alcohol, severe hypertriglyceridemia, severe haemolysis and warfarin administration. Finally, it is unaffected by humidity and can withstand cold temperatures.
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Affiliation(s)
- Marek Bialkower
- BioPRIA and Department of Chemical Engineering, Monash University, Australia
| | - Heather McLiesh
- BioPRIA and Department of Chemical Engineering, Monash University, Australia
| | - Clare A Manderson
- BioPRIA and Department of Chemical Engineering, Monash University, Australia
| | - Rico F Tabor
- School of Chemistry, Monash University, Clayton, Vic, 3800, Australia
| | - Gil Garnier
- BioPRIA and Department of Chemical Engineering, Monash University, Australia.
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Stacy NI, Chabot RM, Innis CJ, Cray C, Fraser KM, Rigano KS, Perrault JR. Plasma chemistry in nesting leatherback sea turtles (Dermochelys coriacea) from Florida: Understanding the importance of sample hemolysis effects on blood analytes. PLoS One 2019; 14:e0222426. [PMID: 31504062 PMCID: PMC6736308 DOI: 10.1371/journal.pone.0222426] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/28/2019] [Indexed: 11/18/2022] Open
Abstract
Plasma chemistry is widely used in diagnostic and research settings in sea turtles. However, plasma discolorations such as hemolysis are often not considered in data interpretation. The objectives of this study were to (1) evaluate the effects of moderate hemolysis on plasma electrolytes, minerals, and proteins using dry chemistry analysis (DCA) and protein electrophoresis from nesting leatherback sea turtles (Dermochelys coriacea) from Florida and to (2) establish blood analyte reference intervals. Twenty-six plasma samples with absence of hemolysis were selected and sub-divided into one non-hemolytic aliquot and an aliquot that was experimentally manipulated to mimic moderate hemolysis. Plasma samples were analyzed for hemoglobin using a handheld photometer; sodium, potassium, chloride, magnesium, calcium, phosphorus, and total protein using DCA; and protein electrophoresis. Packed cell volume and hemoglobin were measured in corresponding whole blood samples. Reference intervals were established. All analytes except calcium and pre-albumin were significantly higher and the calcium:phosphorus and albumin:globulin ratios were significantly lower in hemolytic plasma compared to non-hemolytic plasma. Alpha2-globulins and potassium were the analytes most impacted by hemolysis, averaging 3.3- and 2.0-fold higher in hemolyzed samples, respectively, indicating that (1) hemoglobin migrates into the alpha2-globulin region in this species and (2) notable intracellular potassium is released into plasma with hemolysis. Attempted conversion factors for compensation of hemolysis were considered inaccurate for 4 of 16 analytes due to non-significant regression lines. We also report that PCV provides an estimate of hemoglobin (g/L) using the formula: (2.59 × PCV) + 24.59. Given the spurious effects of hemolysis, the degree of this artifact should be reported with biochemistry data, and samples with moderate to severe hemolysis should be excluded from datasets when interpreting electrolyte, mineral, and protein results. This will ensure accurate data interpretation for individual turtles in rehabilitation or research settings and population-level data relevant to conservation-focused projects.
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Affiliation(s)
- Nicole I. Stacy
- Aquatic, Amphibian, and Reptile Pathology Program, Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States of America
- Division of Comparative Pathology, Department of Pathology & Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
- * E-mail:
| | - Ryan M. Chabot
- Inwater Research Group, Inc., Jensen Beach, Florida, United States of America
| | - Charles J. Innis
- New England Aquarium, Boston, Massachusetts, United States of America
| | - Carolyn Cray
- Division of Comparative Pathology, Department of Pathology & Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Katelyn M. Fraser
- Loggerhead Marinelife Center, Juno Beach, Florida, United States of America
| | - Kimberly S. Rigano
- Loggerhead Marinelife Center, Juno Beach, Florida, United States of America
| | - Justin R. Perrault
- Loggerhead Marinelife Center, Juno Beach, Florida, United States of America
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16
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Zhang WZ, Price DJ. A statistical model for restoration of serum potassium level disturbed by hemolysis. Clin Chim Acta 2019; 497:137-140. [PMID: 31356793 DOI: 10.1016/j.cca.2019.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Blood sample hemolysis affects pre-analytical quality and may cause pseudohyperkalemia. We established a statistical model to estimate the corrected potassium (K+) in serum. METHODS Serum K+ and H index were analyzed, and blood cell index was obtained from the examined Full Blood Examination (FBE) results. A linear-regression model was developed using hemolysis (H) index, K+ and covariates of blood cell index from 139 cell lysates of blood samples. The model was then validated against 26 in vitro physically hemolyzed serum samples. RESULTS The final model selected H index, hemoglobin concentration (HGB), and hematocrit (HCT) as important predictors in estimating the K+ content. The model was validated against artificially hemolyzed serum samples, which returned a correlation of 0.942 between observed and predicted net K+ increase by hemolysis. The predictors H index, HCT, and HB contributed 93.7%, 3.5% and 2.8% to the model R2, respectively. CONCLUSION In vitro hemolysis induced pseudohyperkalemia could be accurately predicted and restored by our model for clinical application.
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Affiliation(s)
- Wei-Zheng Zhang
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital & The University of Melbourne, Victoria, Australia.
| | - David J Price
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital & The University of Melbourne, Victoria, Australia
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17
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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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18
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Salvagno GL, Demonte D, Lippi G. A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis. Biochem Med (Zagreb) 2019; 29:011003. [PMID: 30799980 PMCID: PMC6366946 DOI: 10.11613/bm.2019.011003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/03/2019] [Indexed: 02/03/2023] Open
Abstract
A 51-year old male patient was admitted to the hospital with acute dyspnea and history of chronic asthma. Venous blood was drawn into a 3.0 mL heparinized syringe and delivered to the laboratory for blood gas analysis (GEM Premier 4000, Instrumentation Laboratory), which revealed high potassium value (5.2 mmol/L; reference range on whole blood, 3.5-4.5 mmol/L). This result was unexpected, so that a second venous blood sample was immediately drawn by direct venipuncture into a 3.5 mL lithium-heparin blood tube, and delivered to the laboratory for repeating potassium testing on Cobas 8000 (Roche Diagnostics). The analysis revealed normal plasma potassium (4.6 mmol/L; reference range in plasma, 3.5-5.0 mmol/L) and haemolysis index (5; 0.05 g/L). Due to suspicion of spurious haemolysis, heparinized blood was transferred from syringe into a plastic tube and centrifuged. Potassium and haemolysis index were then measured in this heparinized plasma, confirming high haemolysis index (50; 0.5 g/L) and pseudohyperkalemia (5.5 mmol/L). Investigation of this case revealed that spurious haemolysis was attributable to syringe delivery in direct ice contact for ~15 min. This case emphasizes the importance of avoiding sample transportation in ice and the need of developing point of care analysers equipped with interference indices assessment.
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Affiliation(s)
| | - Davide Demonte
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Noulsri E, Abudaya D, Lerdwana S, Pattanapanyasat K. Corrected Lymphocyte Percentages Reduce the Differences in Absolute CD4+ T Lymphocyte Counts between Dual-Platform and Single-Platform Flow Cytometric Approaches. Lab Med 2018; 49:246-253. [PMID: 29546347 DOI: 10.1093/labmed/lmy002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective To determine whether a corrected lymphocyte percentage could reduce bias in the absolute cluster of differentiation (CD)4+ T lymphocyte counts obtained via dual-platform (DP) vs standard single-platform (SP) flow cytometry. Methods The correction factor (CF) for the lymphocyte percentages was calculated at 6 laboratories. The absolute CD4+ T lymphocyte counts in 300 blood specimens infected with human immunodeficiency virus (HIV) were determined using the DP and SP methods. Results Applying the CFs revealed that 4 sites showed a decrease in the mean bias of absolute CD4+ T lymphocyte counts determined via DP vs standard SP (-109 vs -84 cells/μL, -80 vs -58 cells/μL, -52 vs -45 cells/μL, and -32 vs 1 cells/μL). However, 2 participating laboratories revealed an increase in the difference of the mean bias (-42 vs -49 cells/μL and -20 vs -69 cells/μL). Conclusions Use of the corrected lymphocyte percentage shows potential for decreasing the difference in CD4 counts between DP and the standard SP method.
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Affiliation(s)
- Egarit Noulsri
- Research Division, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Dinar Abudaya
- Department of Immunology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surada Lerdwana
- Office for Research and Development, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kovit Pattanapanyasat
- Office for Research and Development, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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20
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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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21
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Nicolay A, Lorec AM, Gomez G, Portugal H. Icteric human samples: Icterus index and method of estimating an interference-free value for 16 biochemical analyses. J Clin Lab Anal 2017; 32. [PMID: 28397988 DOI: 10.1002/jcla.22229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/11/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hemolysis, Icterus, and Lipemia constituting the HIL index, are the most common causes of interference with accurate measurement in biochemistry. This study focuses on bilirubin interference, aiming to identify the analyses impacted and proposing a way to predict nominal interference-free analyte concentrations, based on both analyte level and Icterus Index (Iict ). METHODS Sixteen common analytes were studied: alanine aminotransferase (ALT), albumin (ALB), alkaline phosphatase (ALP), amylase (AMY), aspartate aminotransferase (AST), total cholesterol (CHOLT), creatinine (CREA, enzymatic method), fructosamine (FRUC), gamma-glutamyl transferase (GGT), HDL cholesterol (HDLc), total iron (Iron), lipase (LIP), inorganic phosphorus (Phos), total protein (PROT), triglycerides (TG), and uric acid (UA). Both the traditional 10% change in concentrations from baseline and the Total Change Level (TCL) were taken as acceptance limits. Nineteen pools of sera covering a wide range of values were tested on the Cobas® 6000 (Roche Diagnostics). Iict ranged from 0 to 60. RESULTS Eight analytes increased (FRUC and Phos) or decreased (CHOLT, CREA, HDLc, PROT, TG, and UA) significantly when Iict increased. FRUC, HDLc, PROT, and UA showed a linear relationship when Iict increased. A non-linear relationship was found for TG, CREA, and for CHOLT; this also depended on analyte levels. Others were not impacted, even at high Iict . CONCLUSIONS A method of estimating an interference-free value for FRUC, HDLc, PROT, Phos, UA, TG, and CREA, and for CHOLT in cases of cholestasis, is proposed. Iict levels are identified based on analytical performance goals, and equations to recalculate interference-free values are also proposed.
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Affiliation(s)
- Alain Nicolay
- Faculté de Pharmacie, Aix Marseille Univ, APHM, Hôpital de la Conception, Service de Biochimie, UMR NORT INSERM 1062, INRA 1260, Marseille, France
| | - Anne-Marie Lorec
- Faculté de Pharmacie, Aix Marseille Univ, APHM, Hôpital de la Conception, Service de Biochimie, Marseille, France
| | - Guy Gomez
- APHM, Hôpital de la Conception, Service de Biochimie, Marseille, France
| | - Henri Portugal
- Faculté de Pharmacie, Aix Marseille Univ, APHM, Hôpital de la Conception, Service de Biochimie, Marseille, France
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22
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Recomendación del uso de ecuaciones de corrección de valores de potasio en presencia de interferencia por hemólisis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.labcli.2016.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Boyd JM, Krause R, Waite G, Hui W, Yazdi E, Wilmink D, Seiden-Long I. Developing optimized automated rule sets for reporting hemolysis, icterus and lipemia based on a priori outcomes analysis. Clin Chim Acta 2015; 450:31-8. [DOI: 10.1016/j.cca.2015.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
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Goyal T, Schmotzer CL. Validation of hemolysis index thresholds optimizes detection of clinically significant hemolysis. Am J Clin Pathol 2015; 143:579-83. [PMID: 25780011 DOI: 10.1309/ajcpdude1hra0ymr] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Automated hemolysis index (HI) measurement has standardized the identification and gradation of sample hemolysis. METHODS This study evaluates whether clinically significant changes in the concentration of intracellular analytes occur at manufacturer-recommended automated HI thresholds (HI ≥3, >25 mg/dL hemoglobin). RESULTS Adult outpatient results for serum potassium (K+), magnesium (Mg), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) were analyzed. Mean ± SD analyte concentration and distribution within the reference interval (RI) were calculated for each HI group (1-7). Potassium results with an HI of 4 or more demonstrated clinically significant differences (≥0.5 mmol/L) in mean K+ concentration and RI classification compared with non-hemolyzed samples (HI = 1). LDH and AST showed clinically significant differences (+20%) for an HI of 3 or more. For Mg, only the group with an HI of 7 demonstrated a clinically significant difference (>25%); however, the number was low. CONCLUSIONS Mean measured potassium concentrations are not clinically significantly affected by hemolysis at the manufacturer-recommended HI threshold, while AST and LDH are. Aligning reporting of sample hemolysis with clinically significant changes provides clinically meaningful alerts regarding this common pre-analytic error.
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Affiliation(s)
- Tanu Goyal
- Department of Pathology, University Hospitals Case Medical Center, Cleveland, OH
| | - Christine L. Schmotzer
- Department of Pathology, University Hospitals Case Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
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25
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26
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Jones GRD, Hawkins RC. Correcting laboratory results for the effects of interferences: an approach incorporating uncertainty of measurement. Ann Clin Biochem 2014; 52:226-31. [PMID: 24719215 DOI: 10.1177/0004563214533516] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Results of numerical pathology tests may be subject to interference and many laboratories identify such interferences and withhold results or issue warnings if clinically erroneous results may be issued. Some laboratories choose to correct for the effect of interferences, with the uncertainty of the correction noted as a limitation in this process. We investigate the effect of correcting for the effect of interferences on the ability to release results within defined error goals using the effect of in-vitro haemolysis on serum potassium measurement as an example. METHODS A model was developed to determine the uncertainty of a result corrected for the effect of an interferent with a linear relationship between concentration and effect. The model was used to assess the effect of correction on the results which could be released within specified accuracy criteria. RESULTS Using the effects of haemolysis on potassium results as an example, the maximum amount of haemolysis in a sample that would change the result by > 0.5 mmol/L, with a frequency of 5%, was increased from approximately 1100 mg/L (no correction) to 8000 mg/L (with correction). CONCLUSIONS With modelling of the factors related to the uncertainties of results in the presence of interferences, it is possible to release results in the presence of significantly higher concentrations of interferences after correction than without correction. Correction of a result for a known bias and allowance for the uncertainty of the correction can be considered consistent with the guide to the expression of uncertainty in measurement (GUM).
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27
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Asirvatham JR, Moses V, Bjornson L. Errors in potassium measurement: a laboratory perspective for the clinician. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:255-9. [PMID: 23724399 PMCID: PMC3662091 DOI: 10.4103/1947-2714.110426] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Errors in potassium measurement can cause pseudohyperkalemia, where serum potassium is falsely elevated. Usually, these are recognized either by the laboratory or the clinician. However, the same factors that cause pseudohyperkalemia can mask hypokalemia by pushing measured values into the reference interval. These cases require a high-index of suspicion by the clinician as they cannot be easily identified in the laboratory. This article discusses the causes and mechanisms of spuriously elevated potassium, and current recommendations to minimize those factors. "Reverse" pseudohyperkalemia and the role of correction factors are also discussed. Relevant articles were identified by a literature search performed on PubMed using the terms "pseudohyperkalemia," "reverse pseudohyperkalemia," "factitious hyperkalemia," "spurious hyperkalemia," and "masked hypokalemia."
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Affiliation(s)
- Jaya R Asirvatham
- Department of Pathology, Hofstra North Shore-Long Island Jewish School of Medicine, New York, USA
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28
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Zou J, Nolan DK, LaFiore AR, Scott MG. Estimating the effects of hemolysis on potassium and LDH laboratory results. Clin Chim Acta 2013; 421:60-1. [DOI: 10.1016/j.cca.2013.02.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 11/15/2022]
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Oostendorp M, van Solinge WW, Kemperman H. Potassium but not lactate dehydrogenase elevation due to in vitro hemolysis is higher in capillary than in venous blood samples. Arch Pathol Lab Med 2012; 136:1262-5. [PMID: 23020733 DOI: 10.5858/arpa.2011-0319-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Elevated potassium concentrations due to in vitro hemolysis can lead to errors in diagnoses and treatment. Recently, we observed that potassium elevation in capillary samples appeared higher than expected, based on hemolytic index (H-index). OBJECTIVE To investigate the relation between potassium increase and H-index for capillary samples. As a control, the same analysis was performed for lactate dehydrogenase (LDH). DESIGN Potassium results of 332 760 venous and 2620 capillary samples were selected. For LDH, 135 974 venous and 999 capillary samples were included. Venous and capillary samples were differentiated by using patient age, as we perform mostly capillary blood sampling in children and venous sampling in adults. Results were obtained with Beckman-Coulter DxC800 analyzers. RESULTS The increase in potassium with increasing H-index was considerably higher for capillary samples than venous samples. Linear regression revealed a potassium increase of 0.38 mEq/L per increment in H-index for capillary samples, whereas a 0.17 mEq/L increase was found for venous samples. For LDH, no differences were found between venous and capillary samples. CONCLUSIONS At identical H-index, capillary samples showed higher potassium elevations than venous samples. A possible explanation is that capillary sampling causes increased leakage of ions, such as potassium, from erythrocytes, compared with proteins such as hemoglobin and LDH. These results are especially important considering the increasing use of whole blood point-of-care analyzers, where the H-index is often not determined. Potassium results should therefore be interpreted with caution to avoid severe misdiagnosis of hypokalemia and hyperkalemia.
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Affiliation(s)
- Marlies Oostendorp
- University of Medical Center Utrecht, Laboratory of Clinical Chemistry and Haematology, Utrecht, The Netherlands
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30
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31
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Kazmierczak SC. In Reply. Arch Pathol Lab Med 2010. [DOI: 10.5858/2010-0222-le.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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