Pseudohyperkalaemia in leukaemic patients: the effect of test tube type and form of transport to the laboratory

Dastych, Milan; Čermáková, Z

doi:10.1177/0004563213497928

Cited by 9 publications

(7 citation statements)

References 6 publications

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“…WBC count errors in PTS may be affected by fragile leukocyte membranes. Dastych et al showed that leukemia causes pseudohyperkalemia and was associated with in vitro cellular lysis [ 8 ]. Other research has considered how the PTS affects leukemic cells physically [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, PTS transportation is also associated with some risks, such as in vitro hemolysis and aberrant results for plasma lactate dehydrogenase (LD) [ 6 , 7 ]. These errors are particularly more likely for leukemic patients with fragile leukocyte membranes [ 8 ]. The PTS effects are associated with transportation speed, acceleration and deceleration, spin times at corners, distance to station, and a lack of cushioning [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Assessing Safety of Pneumatic Tube System (PTS) for Patients with Very Low Hematologic Parameters

et al. 2016

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BackgroundPreventive interventions save lives during the process of chemotherapy for hematologic malignancies, when a hematology laboratory can ensure accurate results. The use of a pneumatic tube system (PTS) is associated with measurement errors and unnecessary transfusions. The aim of this study was to evaluate pre-analytical errors associated with transportation method (PTS versus hand-delivered) and to investigate whether there are unnecessary transfusion events in pancytopenia leukemia patients with very low hematological parameters.Material/MethodsA total of 140 paired blood collections were performed for hemogram and biochemistry assays. Paired EDTA and serum gel blood samples were collected from 58 cases with acute leukemia on different days. For each pair, one sample was hand-delivered by a courier (Group 1) while the other sample was transported through a PTS (Group 2).ResultsThe hand-delivered method showed that some platelet transfusions were unnecessary for different thrombocyte cut-off values. Calculated unnecessary platelet (PLT) transfusion ratios when using PTS (PLT <30×103/μL, 16.3%; PLT <25×103/μL, 16.4%; PLT <20×103/μL, 80.3%; PLT <15×103/μL, 48.6%; and PLT <10×103/μL, 150.0%) were found to be statistically significant (p=0.002, p=0.046, p<0.000, p=0.028, and p<0.000, respectively). In contrast, for RBC transfusion ratios, although the ratios were high in Group 2, we found no significant difference between the two groups; (HGB <8.0 g/dL, 23.3%; HGB <9.0 g/dL, 25.0%, HGB<10.0 g/dL, 19.3%) and (p=0.002, p=0.085, p<0.160, and p=0.235, respectively).ConclusionsAlthough our results cannot be universally applied, physicians should be careful, skeptical, and suspicious of transfusion decisions in hematology clinics and consider potential analytical and pre-analytical errors in cases of severe cytopenia when using PTS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessing Safety of Pneumatic Tube System (PTS) for Patients with Very Low Hematologic Parameters

et al. 2016

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“…Pseudohyperkalemia can be confirmed by determining plasma potassium in vacuum tubes with lithium heparin after centrifugation, and/or by whole blood potassium determination in electrolyte balanced lithium heparin syringe ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Pseudohyperkalemia - Potassium released from cells due to clotting and centrifugation - a case report

Skalický

2017

Biochemia Medica

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Hyperkalemia is a potentially lethal condition. Pseudohyperkalemia should be always excluded before implementing treatment to prevent inappropriate cause of hypokalemia – equally a potentially lethal condition. Here we present a case report of a 62 year female with chronic myeloproliferative disorder, i.e. essential thrombocythemia. The laboratory test results for potassium concentration were 6.3 mmol/L, for platelet count 1305 x109/L and for leukocyte count 39.8 x109/L. This was due to a temporary drug withdrawal after a surgical intervention for gastric bleeding. Potassium concentration in lithium heparin plasma collected in a vacuum tube without gel separator and in whole blood syringe were 4.6 mmol/L and 3.4 mmol/L, respectively. It means that mechanical stress such as centrifugation can contribute to spurious hyperkalemia. Prior to reporting unexpected hyperkalemia result, pseudohyperkalemia should always be considered by the laboratory. Such potassium results require investigation in case it is pseudohyperkalemia, which may be due to thrombocytosis and leukocytosis. In cases where thrombocytosis or leukocytosis exists, an interpretative comment indicating these conditions inserted with the results of the potassium concentration can increase awareness for more accurate patient care decisions.

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“…3,4 Cell membrane damage and lysis can also be influenced by the type of sample and the choice of phlebotomy site and/or method. 1 However, susceptibility to PTS-induced cell lysis varies significantly from one individual to another. 2 The results of the present study suggest that PTS interference with LD assays can be reduced through gentle aspiration of the blood into the tube and (to a lesser extent) use of adequate cushioning.…”

Section: Introductionmentioning

confidence: 99%

“…However, PTS transportation of blood specimens is known to be associated with aberrant assay results for plasma lactate dehydrogenase (LD), due to the mechanical disruption of blood cells. This bias is particularly problematical for leukaemic patients with fragile leukocyte membranes 1 but is not absent in subjects with normal blood cells. 2 The PTS’s effects increase with transportation speed, rapid acceleration and deceleration when changing in direction, transportation distance and a lack of cushioning.…”

Section: Introductionmentioning

confidence: 99%

Gentle blood aspiration and tube cushioning reduce pneumatic tube system interference in lactate dehydrogenase assays

et al. 2015

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Background: Use of a hospital pneumatic tube system may be associated with measurement errors. Methods: A venous blood sample was collected from 79 patients into a pair of lithium heparin tubes; one tube was sent to the laboratory by porter and the other was sent via the pneumatic tube system. Plasma lactate dehydrogenase concentrations were then assayed. Results: Lactate dehydrogenase concentrations were overestimated (median bias: 18.8%) when evacuated vacuum lithium heparin tubes were sent by pneumatic tube system. This bias was reduced by bubble-wrapping the standard lithium heparin tube or using Monovette lithium heparin tubes in aspiration mode (median bias: þ8.7% and À0.3%, respectively). Conclusions: Cushioning and aspiration-mode sampling may limit pneumatic tube system-associated overestimation of lactate dehydrogenase concentrations.

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Pseudohyperkalaemia in leukaemic patients: the effect of test tube type and form of transport to the laboratory

Cited by 9 publications

References 6 publications

Assessing Safety of Pneumatic Tube System (PTS) for Patients with Very Low Hematologic Parameters

Assessing Safety of Pneumatic Tube System (PTS) for Patients with Very Low Hematologic Parameters

Pseudohyperkalemia - Potassium released from cells due to clotting and centrifugation - a case report

Gentle blood aspiration and tube cushioning reduce pneumatic tube system interference in lactate dehydrogenase assays

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