Is suboptimal phlebotomy technique impacting on potassium results for primary care?

Bailey, Ian R; Thurlow, Vanessa

doi:10.1258/acb.2007.007123

Cited by 26 publications

(13 citation statements)

References 6 publications

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“…Several reports have drawn attention to spurious hyperkalaemia (pseudohyperkalaemia) as a common problem in clinical care [21, 22]. The reasons for spurious hyperkalaemia are multiple, such as inappropriate phlebotomy technique (e.g.…”

Section: Discussionmentioning

confidence: 99%

Increased serum potassium affects renal outcomes: a post hoc analysis of the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial

et al. 2010

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Aims/hypothesisTo assess the effect of an angiotensin receptor blocker (ARB) on serum potassium and the effect of a serum potassium change on renal outcomes in patients with type 2 diabetes and nephropathy.MethodsWe performed a post hoc analysis in patients with type 2 diabetes participating in the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study. Renal outcomes were defined as a composite of doubling of serum creatinine or end-stage renal disease.ResultsAt month 6, 259 (38.4%) and 73 (10.8%) patients in the losartan group and 151 (22.8%) and 34 (5.1%) patients in the placebo group had serum potassium ≥5.0 mmol/l and ≥5.5 mmol/l, (p < 0.001), respectively. Losartan was an independent predictor for serum potassium ≥5.0 mmol/l at month 6 (OR 2.8; 95% CI 2.0–3.9). Serum potassium at month 6 ≥ 5.0 mmol/l was in turn associated with increased risk for renal events (HR 1.22; 95% CI 1.00–1.50), independent of other risk factors. Adjustment of the overall treatment effects for serum potassium augmented losartan’s renoprotective effect from 21% (6–34%) to 35% (20–48%), suggesting that the renoprotective effects of losartan are offset by its effect on serum potassium.Conclusions/interpretationIn this study, we found that treatment with the ARB losartan is associated with a high risk of increased serum potassium levels, which is in turn associated with an increased risk of renal outcomes in patients with diabetes and nephropathy. Whether additional management of high serum potassium would further increase the renal protective properties of losartan is an important clinical question.

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Section: Discussionmentioning

confidence: 99%

Increased serum potassium affects renal outcomes: a post hoc analysis of the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial

et al. 2010

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“…Phlebotomy itself can have an influence on lab results obtained from blood samples. 10 Regarding storage of samples after phlebotomy, a previous study looked at the effect of room temperature storage of serum and plasma. 11 Within 4 h after phlebotomy, the environment of the plasma and serum sample changed significantly, which would cause biological stresses.…”

Section: Discussionmentioning

confidence: 99%

Gene Expression Profiles from Peripheral Blood Mononuclear Cells Are Sensitive to Short Processing Delays

Barnes

Grom²,

Griffin³

et al. 2010

Biopreservation and Biobanking

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In the analysis of peripheral blood gene expression, timely processing of samples is essential to ensure that measurements reflect in vivo biology, rather than ex vivo sample processing variables. The effect of processing delays on global gene expression patterns in peripheral blood mononuclear cells (PBMCs) was assessed by isolating and stabilizing PBMC-derived RNA from 3 individuals either immediately after phlebotomy or after a 4 h delay. RNA was labeled using NuGEN Ovation labeling and probed using the Affymetrix HG U133 Plus 2.0 GeneChip®. Comparison of gene expression levels (≥2-fold expression change and P < 0.05) identified 307 probe sets representing genes with increased expression and 46 indicating decreased expression after 4 h. These differentially expressed genes include many that are important to inflammatory, immunologic, and cancer pathways. Among others, CCR2, CCR5, TLR10, CD180, and IL-16 have decreased expression, whereas VEGF, IL8, SOCS2, SOCS3, CD69, and CD83 have increased expression after a 4 h processing delay. The trends in expression patterns associated with delayed processing were also apparent in an independent set of 276 arrays of RNA from human PBMC samples with varying processing times. These data indicate that the time between sample acquisition, initiation of processing, and when the RNA is stabilized should be a prime consideration when designing protocols for translational studies involving PBMC gene expression analysis.

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“…The ratio between intracellular and extracellular potassium is approximately 40:1 and studies report a change in the ratio as small as 2.5% leading to increases in the potassium concentration by 0.1 mmol/l [25]. Phlebotomy technique has been shown to alter potassium readings due to increased hemolysis [26]. Furthermore, serum samples have been reported to have higher potassium concentrations (by 0.36 ± 0.18 mmol/l ) compared with plasma samples due to clotting-associated potassium release from platelets [20].…”

Section: Discussionmentioning

confidence: 99%

The Benefits and Limitations of Point of Care Testing for Patients with Diabetes Who are Acutely Unwell

Lightbody¹,

Reddy‐Kolanu²,

Sapey³

2017

J Diabetes Metab

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Diabetic emergencies are associated with derangements in glucose and electrolytes with guidelines supporting treatment and serial monitoring. In clinical practice this is often achieved using a venous blood sample assessed using a blood gas analyzer (BGA), however their accuracy in measuring glucose, potassium and sodium in acutely unwell adults is unknown. Capillary blood tests can measure these parameters using a BGA and may be more acceptable to patients. We compared capillary and venous BGA results to gold standard venous laboratory sodium, potassium and glucose in acutely unwell diabetic patients and healthy controls to determine their accuracy and acceptability.Methods: 48 acutely unwell diabetic patients and 23 healthy adults had consecutive bloods taken from arterialized ear lobe (EP) and finger prick (FP) (capillary bloods) and a standard venous sample. Venous samples were sent to an accredited NHS hospital biochemistry laboratory (VL) for reporting as well as being analyzed in a BGA (VBG). Results were compared to internationally agreed acceptability criteria using Bland-Altman limits of agreements. Patient preferences were recorded.Results: VBG glucose met acceptability criteria (results within 20% of VL result) as did FP glucose when glucose values were ≥ 11.2 mmol/l but not when results were within the normoglycaemic range. Venous and capillary BGA potassium did not meet acceptability criteria (within 0.5 mmol/l of VL result) although capillary samples were more accurate than the VBG results (p<0.001). FP, EP and VBG sodium all met acceptability criteria (>95% within 4 mmol/l of VL result). Participants found capillary tests less painful (p<0.001) and preferred FP testing method to serial venous blood tests (p=0.002). Conclusion:Capillary and VBG samples can be used to guide acutely unwell diabetic patient treatment (with capillary testing preferred by patients) but caution is required as there is deviation from laboratory results, for potassium particularly.Ethical approval was provided by NRES West Midlands (14/WM/1057).

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Is suboptimal phlebotomy technique impacting on potassium results for primary care?

Cited by 26 publications

References 6 publications

Increased serum potassium affects renal outcomes: a post hoc analysis of the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial

Increased serum potassium affects renal outcomes: a post hoc analysis of the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial

Gene Expression Profiles from Peripheral Blood Mononuclear Cells Are Sensitive to Short Processing Delays

The Benefits and Limitations of Point of Care Testing for Patients with Diabetes Who are Acutely Unwell

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