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A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis

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 valu...

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Autores principales: Salvagno, Gian Luca, Demonte, Davide, Lippi, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Croatian Society of Medical Biochemistry and Laboratory Medicine 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366946/
https://www.ncbi.nlm.nih.gov/pubmed/30799980
http://dx.doi.org/10.11613/BM.2019.011003
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author Salvagno, Gian Luca
Demonte, Davide
Lippi, Giuseppe
author_facet Salvagno, Gian Luca
Demonte, Davide
Lippi, Giuseppe
author_sort Salvagno, Gian Luca
collection PubMed
description 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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spelling pubmed-63669462019-02-22 A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis Salvagno, Gian Luca Demonte, Davide Lippi, Giuseppe Biochem Med (Zagreb) Preanalytical Mysteries 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. Croatian Society of Medical Biochemistry and Laboratory Medicine 2019-02-15 2019-02-15 /pmc/articles/PMC6366946/ /pubmed/30799980 http://dx.doi.org/10.11613/BM.2019.011003 Text en ©Croatian Society of Medical Biochemistry and Laboratory Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Preanalytical Mysteries
Salvagno, Gian Luca
Demonte, Davide
Lippi, Giuseppe
A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis
title A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis
title_full A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis
title_fullStr A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis
title_full_unstemmed A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis
title_short A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis
title_sort paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis
topic Preanalytical Mysteries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366946/
https://www.ncbi.nlm.nih.gov/pubmed/30799980
http://dx.doi.org/10.11613/BM.2019.011003
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