Section Navigation. Facebook Twitter LinkedIn Syndicate. Minus Related Pages. Create a Hemolysis Reference Palette Print the palette from a color printer. Laminate the palette. Place palette s around the laboratory for easy access: Glue a magnet on the back, or Punch a hole at the top and hang from a hook. Hemolysis either in vivo or in vitro is traditionally detected by visual inspection of the specimen after centrifugation and comparing it with the hemolytic chart, which shows the color of samples with increasing concentrations of free hemoglobin.
They provide quantitative measurement with high repeatability, thereby standardizing the identification process of hemolyzed specimens. Reasons accounted include unease of increased specimen rejection rate, lack of standardize units of measure, differences in instrument-specific cutoff, negative impact on throughput, poor harmonization of analytical techniques, organization and laboratory economics, and lack of a reliable quality control systems.
Many of these concerns, however, have been addressed and evidence now supports automated HI in enlightening quality and patient safety. These laboratories should have standard operating procedures on how to detect, analyze and report hemolysis, and possible results interference for both in vivo and in vitro hemolysis. Cases suspected of in vivo hemolysis should include certain analytes such as potassium, which provides clinicians with vital information and identification of clinical situations that require urgent intervention.
There is an ongoing debate as to whether laboratories should or should not report results from samples affected by hemolysis. In the absence of sufficient relevant and specific clinical data and guidelines, there is understandably substantial heterogeneity among the laboratories, statewide, nationwide, and globally in the way they handle and manage hemolyzed specimens.
This practice has consequences since repeating sample collection is not always possible and rejecting the sample means subjecting patients to another invasive test and may delay diagnosis.
Rejecting the sample may cause other potential harm to the patient should it lead to an incorrect clinical decision, treatment option, or patient monitoring following the lack of laboratory results.
By not reporting the result, the laboratory is suggesting to the clinical team that the potassium concentration analytically unmeasurable, and this is appropriate for in vitro hemolysis.
But the result may be of clinical use in cases of in vivo hemolysis whereby the availability of potassium result, which had perhaps mounted acutely in a relatively short time, could have led to earlier dialysis treatment. However, the lack of standardization with this option has led to reporting inconsistencies that seriously affect the true significance of the measured value following the wide variation of the attached remarks.
The addition of a brief comment to the laboratory report with very little evidence-based data support cast doubts on the interpretation of test results and its benefit to patient care. Due care must be taken since this practice might introduce bias and depending on the multiplier used may cause inaccurate or false results. The management of hemolyzed samples remains an unsettled dilemma given the available options. Many opinions reject hemolyzed samples and favor rapidly informing clinicians about the need to redraw the samples as the best option clinically and analytically for safe practice.
The laboratory specialist in return would then be able to guide clinicians on the most appropriate use of test results, for example, the use of potassium analyte results in lieu of the possible in vivo hemolysis, which would be crucial to the management of patients as opposed to in cases of in vitro hemolyzed samples.
This can be accomplished by transporting samples to the laboratory without mechanical agitation for example, avoiding pneumatic tube transport , taking blood in a lithium heparin container, and immediate separation of plasma from cells. In the laboratory, HI report generated automatically through laboratory information system can save human resources and reduces turnaround time. Hemolytic specimen is still a major concern to laboratory specialists worldwide. Satisfactory skills and a relevant and good level of knowledge and experience are essential to collect a quality specimen that produces anticipated and accurate results.
There is a need to have or develop an effective laboratory guideline with emphasis on standardizations of procedures for identification of hemolyzed clinical specimens, measurement, and immediate communication of laboratory results, which can provide clinicians with essential information for immediate or subsequent management of patients.
The automated platforms are considered the most appropriate solution for continuous, standardized and effective detection, and management of hemolyzed specimens. It is perceived as a more objective option when deciding to reject hemolyzed specimens and requesting recollection. Automated HI may also reduce laboratory expenditure of performing unnecessary blood tests, shorten the turnaround time to run the test, and avoid inaccurate test results that can affect patient care.
The authors declared no conflicts of interest. No funding was received for this study. National Center for Biotechnology Information , U. Journal List Oman Med J v. Oman Med J. Author information Article notes Copyright and License information Disclaimer. E-mail: ym. Received Dec 27; Accepted Apr This article has been cited by other articles in PMC. Abstract Pre-analytical quality in clinical chemistry testing is as important as analytical and post-analytical quality.
Keywords: Hemolysis, Detection, Rejection, Management. In vitro hemolysis In vitro hemolysis is a result of pre-analytical causes associated with sample collection, jarring transportation methods, extreme temperature, sample handling, delayed processing, and prolonged storage.
Challenges in identifying of in vivo and in vitro hemolysis An emerging challenge for clinical laboratories is to differentiate between in vivo and in vitro hemolysis. Reject or not to reject? Conclusion Hemolytic specimen is still a major concern to laboratory specialists worldwide. Disclosure The authors declared no conflicts of interest. References 1. Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories.
Clin Chem Lab Med ; 46 6 Detection of haemolysis and reporting of potassium results in samples from neonates. Ann Clin Biochem May; 46 Pt 3 Influence of hemolysis on routine clinical chemistry testing. Clin Chem Lab Med ; 44 3 Plebani M.
Errors in clinical laboratories or errors in laboratory medicine? Clin Chem Lab Med ; 44 6 Goyal T, Schmotzer CL. Validation of hemolysis index thresholds optimizes detection of clinically significant hemolysis. Am J Clin Pathol Apr; 4 Lippi G, Guidi GC.
Risk management in the preanalytical phase of laboratory testing. Clin Chem Lab Med ; 45 6 Chemistry specimen acceptability: a College of American Pathologists Q-Probes study of laboratories.
Arch Pathol Lab Med Jan; 1 Errors in laboratory medicine. Clin Chem May; 48 5 Carraro P, Plebani M. Errors in a stat laboratory: types and frequencies 10 years later. Jul; 53 7 Hashimoto C. Autoimmune hemolytic anemia. Clin Rev Allergy Immunol ; 16 3 Hemolyzed specimens: a major challenge for emergency departments and clinical laboratories.
Crit Rev Clin Lab Sci When blood is collected using a gas syringe or a test tube, a small amount of blood is dispensed into the disposable test. This separates whole blood to plasma or serum.
The disposable test with the sample is then placed onto a reader Helge H10 reader to see whether the blood sample is haemolysed. The user can define which values of a haemolytic index between 0 and should be considered positive for haemolysis. The cut off is adjustable using software settings in the system.
Helge is a point-of-care technology that can test blood samples for haemolysis without the need for centrifugation. This could avoid potential errors caused by haemolysed blood samples. The company notes that there is currently no point-of-care technology that can detect haemolysis in blood gas analysis. It claims that Helge can provide fast test results that improve patient care. Haemolysis happens when red blood cells burst and release the blood cell content into the plasma.
Haemolysis may happen inside or outside the body. Haemolysis inside the body is a result of a number of medical conditions, such as genetic disorders or autoimmune disorders. Outside the body, haemolysis is triggered by improper or mishandled procedures during sampling collection and transportation. For example, when collecting a blood sample, squeezing a finger too hard can cause haemolysis.
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