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Rejection of hemolyzed samples can jeopardize patient safety

INTRODUCTION: In vitro hemolysis is the primary cause of sample/test rejection by the laboratory. CASE REPORT: A 10-year-old, admitted with an asthma attack in the emergency-room, medicated with albuterol sulphate (intravenous bronchodilator that could induce hypokalemia), needed laboratory test mon...

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Autores principales: Barbato, Lorenzo, Campelo, Marise Danielle, Pigozzo, Sara, Realdon, Nicola, Gandini, Anna, Barbazza, Roberto, Coêlho, Mayara Ladeira, Bovo, Chiara, Marini, Paola, Lima-Oliveira, Gabriel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Communications and Publications Division (CPD) of the IFCC 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7109497/
https://www.ncbi.nlm.nih.gov/pubmed/32256285
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author Barbato, Lorenzo
Campelo, Marise Danielle
Pigozzo, Sara
Realdon, Nicola
Gandini, Anna
Barbazza, Roberto
Coêlho, Mayara Ladeira
Bovo, Chiara
Marini, Paola
Lima-Oliveira, Gabriel
author_facet Barbato, Lorenzo
Campelo, Marise Danielle
Pigozzo, Sara
Realdon, Nicola
Gandini, Anna
Barbazza, Roberto
Coêlho, Mayara Ladeira
Bovo, Chiara
Marini, Paola
Lima-Oliveira, Gabriel
author_sort Barbato, Lorenzo
collection PubMed
description INTRODUCTION: In vitro hemolysis is the primary cause of sample/test rejection by the laboratory. CASE REPORT: A 10-year-old, admitted with an asthma attack in the emergency-room, medicated with albuterol sulphate (intravenous bronchodilator that could induce hypokalemia), needed laboratory test monitoring. The physician prescribed the technical-nurse to perform blood sampling for: complete blood count, electrolytes, glucose, and blood gas analysis–within 30min after therapy. Samples were delivered to laboratory with a note “I had difficult to locate an appropriate access to perform the blood collection”. LABORATORY RESULTS: Glucose: 4.77 mmol/L. Complete blood count revealed discreet eosinophilia 0.13x10(9)/L, and thrombocytopenia 18x10(9)/L. However, platelet clumps were observed in peripheral blood smear. Blood gas analysis was unreported, laboratory informed that sample had micro clots. Electrolytes: laboratory did not report the results; sample hemolyzed. 0.9 g/L of free hemoglobin is the cut-off defined by the laboratory; the sample presented 2.3 g/L of free hemoglobin. 3.9 mmol/L of potassium was the unreported result vs 2.1 mmol/L in the new sample. Briefly, the laboratory technician was trained to hide potassium results on hemolyzed sample due to the potential overestimation. Even if the hemolyzed sample presented a potassium value close to the lower reference range value (3.5-5.1 mmol/L), reporting the potassium result could allow the physician starting proper therapy to revert the hypokalemia by albuterol sulfate. CONCLUSION: The laboratory should be aware of the clinical patient conditions and of the related physician needs, before hiding results. Therefore, both the laboratory and the clinic personnel should communicate in order to guarantee the patient safety.
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spelling pubmed-71094972020-04-01 Rejection of hemolyzed samples can jeopardize patient safety Barbato, Lorenzo Campelo, Marise Danielle Pigozzo, Sara Realdon, Nicola Gandini, Anna Barbazza, Roberto Coêlho, Mayara Ladeira Bovo, Chiara Marini, Paola Lima-Oliveira, Gabriel EJIFCC Case Report INTRODUCTION: In vitro hemolysis is the primary cause of sample/test rejection by the laboratory. CASE REPORT: A 10-year-old, admitted with an asthma attack in the emergency-room, medicated with albuterol sulphate (intravenous bronchodilator that could induce hypokalemia), needed laboratory test monitoring. The physician prescribed the technical-nurse to perform blood sampling for: complete blood count, electrolytes, glucose, and blood gas analysis–within 30min after therapy. Samples were delivered to laboratory with a note “I had difficult to locate an appropriate access to perform the blood collection”. LABORATORY RESULTS: Glucose: 4.77 mmol/L. Complete blood count revealed discreet eosinophilia 0.13x10(9)/L, and thrombocytopenia 18x10(9)/L. However, platelet clumps were observed in peripheral blood smear. Blood gas analysis was unreported, laboratory informed that sample had micro clots. Electrolytes: laboratory did not report the results; sample hemolyzed. 0.9 g/L of free hemoglobin is the cut-off defined by the laboratory; the sample presented 2.3 g/L of free hemoglobin. 3.9 mmol/L of potassium was the unreported result vs 2.1 mmol/L in the new sample. Briefly, the laboratory technician was trained to hide potassium results on hemolyzed sample due to the potential overestimation. Even if the hemolyzed sample presented a potassium value close to the lower reference range value (3.5-5.1 mmol/L), reporting the potassium result could allow the physician starting proper therapy to revert the hypokalemia by albuterol sulfate. CONCLUSION: The laboratory should be aware of the clinical patient conditions and of the related physician needs, before hiding results. Therefore, both the laboratory and the clinic personnel should communicate in order to guarantee the patient safety. The Communications and Publications Division (CPD) of the IFCC 2020-03-20 /pmc/articles/PMC7109497/ /pubmed/32256285 Text en Copyright © 2020 International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Barbato, Lorenzo
Campelo, Marise Danielle
Pigozzo, Sara
Realdon, Nicola
Gandini, Anna
Barbazza, Roberto
Coêlho, Mayara Ladeira
Bovo, Chiara
Marini, Paola
Lima-Oliveira, Gabriel
Rejection of hemolyzed samples can jeopardize patient safety
title Rejection of hemolyzed samples can jeopardize patient safety
title_full Rejection of hemolyzed samples can jeopardize patient safety
title_fullStr Rejection of hemolyzed samples can jeopardize patient safety
title_full_unstemmed Rejection of hemolyzed samples can jeopardize patient safety
title_short Rejection of hemolyzed samples can jeopardize patient safety
title_sort rejection of hemolyzed samples can jeopardize patient safety
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7109497/
https://www.ncbi.nlm.nih.gov/pubmed/32256285
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