Effects of hemolysis interference on routine biochemistry parameters

Abstract

In tro duc tion: He mo lysis is sti ll the mo st com mon rea son for re jec ti ng sam ples, whi le reob tai ni ng a new sam ple is an im por ta nt prob lem. The aim of this stu dy was to in ves ti ga te the eff ec ts of he mo lysis in diff e re nt he mo lysis le ve ls for mos tly used bioc he mi cal pa ra me te rs to pre ve nt un ne ces sa ry re jec tio ns. Ma te ria ls and met ho ds: Sixteen heal thy vo lun tee rs we re en rol led in the stu dy. Four he mo lysis le ve ls we re con sti tu ted ac cor di ng to he mog lo bin con cen tra tio ns and they we re di vi ded in to fi ve grou ps: Group I: 0-0.10 g/L, Group II: 0.10-0.50 g/L, Group III: 0.51-1.00 g/L, Group IV: 1.01-2.50 g/L, Group V: 2.51-4.50 g/L. Lysis was ac hie ved by mec ha ni cal trau ma. Re sul ts: Hemo lysis in ter fe ren ce aff ec ted lac ta te de hydro ge na se (LD) and as par ta te ami not ran sfe ra se (AST) al mo st at un de tec tab le he mo lysis by vi sual in spec tion (plas ma he mog lo bin < 0.5 g/L). Cli ni cal ly mea nin gful va ria tio ns of po tas sium and to tal bi li ru bin were ob ser ved in mo de ra te ly hemo lyzed sam ples (he mog lo bin > 1 g/L). Ala ni ne ami not ran sfe ra se (ALT), cho les te rol, gam ma glu ta myltran sfe ra se (GGT), and inor ga nic phos pha te (P) con cen tra tio ns we re not in ter fe red up to se ve re ly he mo lyzed le ve ls (he mog lo bin: 2.5-4.5 g/L). Albu min, al ka li ne phos pha ta se (ALP), amyla se, chlo ri de, HDL-cho les te rol, crea ti ne ki na se (CK), glu co se, mag ne sium, to tal pro tein, trig lyce ri des, un sa tu ra ted iron bin di ng ca pa ci ty (UIBC) and uric acid diff e ren ces we re sta tis ti cal ly sig ni fi ca nt, but re mai ned wit hin the CLIA li mi ts. Con clu sion: To avoid prea na lyti cal vi sual in spec tion for he mo lysis de tec tion, im pro per sam ple re jec tion, and/or re run be cau se of he mo lysis, it is recom men ded in this stu dy that, rou ti ne deter mi na tion of plas ma or se rum free he mog lo bin con cen tra tio ns is important. For the ana lytes in ter fe red wi th he mo lysis, new sam ples ha ve to be reques ted. Key wor ds: he mo lysis; prea na lyti cal er ro rs; in ter fe ren ce; ana lytes.

Preanalytical variables and factors that interfere with the biochemical parameters: A review

“…As an example, invisible haemolysis can mask hypokalaemia thus may cause misdiagnosis and not many laboratories use analysers that detect serum indices; therefore haemolysis is still a continuing challenge for laboratories 35,47 . In this context, for unexpected test results, communication with physician is important and the test has to be repeated after obtaining meaningful information on the quality of sample collection, but Protein As mentioned above, high protein concentrations in serum or plasma causes a misappropriate gel formation in serum separator tubes 18 .…”

“…Due to the haemolysis, total bilirubin concentrations were found as decreased even at mildly haemolysed specimens (0.5-1 g/L) 35 . Because bilirubin is photosensitive, samples have to be protected from the light exposure up to analysis.…”

“…The 0.27 g/L of free Hb in plasma resulted in an increase in levels of more than 20% which is at a degree of an invisible haemolysis 35 .…”

“…Breakdown of RBCs and release of haemoglobin and other intracellular components into the plasma is called haemolysis and the colour changes to rose or even red. Haemolysis caused sample rejection rate is high (60%) for which the worst part is the interference detected even in invisible haemolysis 35,36 . Pseudohyperkalemia may result from leukocyte lysis during phlebotomy and during whole blood coagulation in patients with malignant leucocytosis and platelet lysis in myeloproliferative disorders 37,38 .…”

Pulmonary Mycobacterium tuberculosis infection with giant tubercle formation in a dog: a case report

“…In this case, the concentrations of other liver enzymes, including serum ALT, bilirubin, and gamma-glutamyl transferase, were not increased. Further, serum potassium levels and lactate dehydrogenase concentrations were in the normal range; haemolysis was thus ruled out as a cause of AST elevation (Stockham and Scott 2008;Koseoglu et al 2011). Given these findings, further hepatic investigation was not performed.…”