Poor knowledge and faulty thinking regarding hemolysis and potassium elevation
-
Robert C. Hawkins
Abstract
A questionnaire to assess knowledge of the expected elevation in serum K measurement with different grades of hemolysis was administered to medical technologists working in biochemistry laboratories, hospital physicians and nurses. The questions involved different grades of hemolysis (mild, 1.0, moderate, 2.5 and severe, 5.0g/L) and different final K measurements (2.9, 4.0, 5.2 and 8.2mmol/L). Subjects estimated the K concentration in a non-hemolyzed sample for each scenario. Adjustment values (difference between final hemolyzed K concentration and subject's response) were calculated. For the 132 respondees, the mean correct score was 1.7/12. Mean adjustment values were: mild, 0.43mmol/L (K 2.9), 0.55 (4.0), 0.88 (5.2) and 1.53 (8.2); moderate, 0.85 (2.9), 0.92 (4.0), 1.33 (5.2) and 2.50 (8.2); and severe, 0.93 (2.9), 1.48 (4.0), 1.96 (5.2), 2.96 (8.2). Correct adjustments were: mild, 0.28; moderate, 0.70; and severe, 1.40mmol/L. Healthcare staff overestimated the effect of hemolysis on potassium measurement and used an incorrect proportional adjustment approach to the problem. Such poor knowledge and faulty thinking could lead to diagnostic delays or misdiagnoses. There is potential for such faulty thinking in all areas of laboratory medicine, and laboratories should review their educational responsibilities and reporting practices in light of this.
References
1 Jay DW, Provasek D. Characterization and mathematical correction of hemolysis interference in selected Hitachi 717 assays. Clin Chem 1993; 39: 1804–10. 10.1093/clinchem/39.9.1804Search in Google Scholar
2 Yücel D, Dalva K. Effect of in vitro hemolysis on 25 common biochemical tests. Clin Chem 1992; 38: 575–7. 10.1093/clinchem/38.4.575Search in Google Scholar
3 Jones BA, Calam RR, Howanitz PJ. Chemistry specimen acceptability: a College of American Pathologists Q-Probes study of 453 laboratories. Arch Pathol Lab Med 1997; 121: 19–26. Search in Google Scholar
4 Hawkins R. Discrepancy between visual and spectrophotometric assessment of sample haemolysis. Ann Clin Biochem 2002; 39: 521–2. 10.1258/000456302320314575Search in Google Scholar
5 Caraway W. Chemical and diagnostic specificity of laboratory tests. Am J Clin Pathol 1962; 37: 445–64. 10.1093/ajcp/37.5.445Search in Google Scholar
6 Brydon W, Roberts L. The effect of haemolysis on the determination of plasma constituents. Clin Chim Acta 1972; 41: 435–8. 10.1016/0009-8981(72)90537-2Search in Google Scholar
7 Guder WG, da Fonseca-Wollheim F, Heil W, Schnitt YM, Topfer G, Wisser H, et al. The haemolytic, icteric and lipaemic sample recommendations regarding their recognition and prevention of clinically relevant interferences. J Lab Med 2000; 24: 357–64. Search in Google Scholar
8 Carraro P, Servidio G, Plebani M. Hemolyzed specimens: a reason for rejection or a clinical challenge? Clin Chem 2000; 46: 306–7. 10.1093/clinchem/46.2.306Search in Google Scholar
9 Alter D, Sykes E. Using hemolyzed specimens. Am J Clin Pathol 2000; 114: 820–1. Search in Google Scholar
10 Narayanan S. Using hemolyzed specimens [reply]. Am J Clin Pathol 2000; 114: 820–1. Search in Google Scholar
11 Scott M, Heusel J, LeGruys V, Siggaard-Andersen O. Electrolytes and blood gases. In: Burtis C, Ashwood E, editors. Tietz textbook of clinical chemistry, 3rd ed. Philadelphia: WB Saunders, 1999:1056–92. Search in Google Scholar
12 Hawkins R. Variability in potassium/hemoglobin ratios for hemolysis correction. Clin Chem 2002; 48: 796. 10.1093/clinchem/48.5.796Search in Google Scholar
13 Frank JJ, Bermes EW, Bickel MJ, Watkins BF. Effect of in vitro hemolysis on chemical values for serum. Clin Chem 1978; 24: 1966–70. 10.1093/clinchem/24.11.1966Search in Google Scholar
14 Tversy A, Kahnemann D. Judgement under uncertainty: heuristics and biases. Science 1974; 185: 1124–31. Search in Google Scholar
15 Northcraft G, Neale M. Expert, amateurs and real estate: an anchoring-and-adjustment perspective on property pricing decisions. Org Behav Hum Decision Processes 1987; 39: 228–41. 10.1016/0749-5978(87)90046-XSearch in Google Scholar
16 Caverni J-P, Pris J. The anchoring-adjustment heuristic in an “information rich, real world setting”: knowledge assessment by experts. In: Caverni J-P, Fabre J-M, Gonzalez M, editors. Cognitive biases. New York: North-Holland, 1990. Search in Google Scholar
17 Wilson T, Houston C, Etling K, Brekke N. A new look at anchoring effects: basic anchoring and its antecedents. J Exp Psychol Gen 1996; 4: 387–402. 10.1037/0096-3445.125.4.387Search in Google Scholar
18 Block R, Harper D. Overconfidence in estimation: testing the anchoring-and-adjustment hypothesis. Org Behav Hum Decision Processes 1991; 49: 188–207. 10.1016/0749-5978(91)90048-XSearch in Google Scholar
19 Chapman G, Johnson E. The limits of anchoring. J Behav Decision Making 1994; 7: 223–42. 10.1002/bdm.3960070402Search in Google Scholar
20 Grice H. Logic and conversation. In: Cole P, Morgan J, editors. Syntax and semantics, vol. 3 Speech Acts. New York: Academic Press, 1975:41–58. Search in Google Scholar
21 Strack F, Mussweiler T. Explaining the enigmatic anchoring effect: mechanisms of selective accessibility. J Pers Soc Psychol 1997; 73: 437–46. 10.1037/0022-3514.73.3.437Search in Google Scholar
22 Smith A, Beckett G, Walker S, Rae P. Lecture notes on clinical biochemistry 6th ed. Oxford: Blackwell Science, 1988. Search in Google Scholar
23 Gaw A, Cowan R, O'Reilly D, Stewart M, Shepherd J. Clinical biochemistry, 2nd ed. Edinburgh: Churchill Livingstone, 1999. Search in Google Scholar
24 Walmsley R, Watkinson L, Cain H. Cases in chemical pathology: a diagnostic approach, 4th ed. Singapore: World Scientific, 1999. 10.1142/4191Search in Google Scholar
25 Van Niekerk LM, Martin F. Tasmanian nurses' knowledge of pain management. Int J Nurs Stud 2001; 38: 141–52. 10.1016/S0020-7489(00)00053-5Search in Google Scholar
26 El Deirawi KM, Zuraikat N. Registered nurses' actual and perceived knowledge of diabetes mellitus. J Vasc Nurs 2001; 19: 95–100. 10.1067/mvn.2001.118311Search in Google Scholar
27 Coyne ML, Reinert B, Cater K, Dubuisson W, Smith JF, Parker MM, et al. Nurses' knowledge of pain assessment, pharmacologic and nonpharmacologic interventions. Clin Nurs Res 1999; 8: 153–65. 10.1177/10547739922158214Search in Google Scholar
28 Santiano N, Daffurn K, Lee A. The basic knowledge assessment tool: is it useful? Aust Crit Care 1994; 7: 18–23. 10.1016/S1036-7314(94)70698-6Search in Google Scholar
29 Hamilton J, Edgar L. A survey examining nurses' knowledge of pain control. J Pain Sympt Manage 1992; 7: 18–26. 10.1016/0885-3924(92)90103-OSearch in Google Scholar
30 Morgan SL, Weinsier RL, Boker JR, Brooks CM. Nutrition education for medical students: evaluation of the relative contribution of freshman courses in biochemistry and nutrition to performance on a standardized examination in nutrition. Nutrition 1989; 5: 31–6. Search in Google Scholar
31 Crogan NL, Evans BC. Nutrition assessment: experience is not a predictor of knowledge. J Contin Educ Nurs 2001; 32: 219–22. 10.3928/0022-0124-20010901-08Search in Google Scholar PubMed
32 Crogan NL, Shultz JA, Massey LK. Nutrition knowledge of nurses in long-term care facilities. J Contin Educ Nurs 2001; 32: 171–6. 10.3928/0022-0124-20010701-08Search in Google Scholar PubMed
33 Brown ST, Bowman JM, Eason FR. Assessment of nurses' attitudes and knowledge regarding pain management. J Contin Educ Nurs 1999; 30: 132–9. 10.3928/0022-0124-19990501-10Search in Google Scholar PubMed
34 Rose MA, Larrimore KL. Knowledge and awareness concerning chemical and biological terrorism: continuing education implications. J Contin Educ Nurs 2002; 33: 253–8. 10.3928/0022-0124-20021101-05Search in Google Scholar PubMed
35 WHO. Use of anticoagulants in diagnostic laboratory investigations. WHO/DIL/LAB/99.1 Rev 2. Geneva: World Health Organisation, 2002. Search in Google Scholar
36 Todd P, Benbasat I. An experimental investigation of the impact of computer based decision aids on decision making strategies. Inf Syst Res 1991; 2: 87–115. 10.1287/isre.2.2.87Search in Google Scholar
©2005 by Walter de Gruyter Berlin New York
Articles in the same Issue
- Quality control for SELDI analysis
- Immunobead multiplex RT-PCR detection of carcinoembryonic genes expressing cells in the blood of colorectal cancer patients
- Optimization and evaluation of surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) with reversed-phase protein arrays for protein profiling
- Simultaneous determination of HIV antibodies, hepatitis C antibodies, and hepatitis B antigens in dried blood spots –a feasibility study using a multi-analyte immunoassay
- Hematopoietic cytokines in the sera of patients with pancreatic cancer
- Modulation of translation factor's gene expression by histone deacetylase inhibitors in breast cancer cells
- Whole genome amplification of buccal cell DNA: genotyping concordance before and after multiple displacement amplification
- Y-Chromosome short tandem repeat (STR) haplotypes in a Campania population sample
- TaqMan assays for genotyping of single nucleotide polymorphisms present at a disease susceptibility locus on chromosome 6
- The secretion of ibuprofen metabolites interferes with the capillary chromatography of urinary homovanillic acid and 4-hydroxy-3-methoxymandelic acid in neuroblastoma diagnosis
- Selective measurement of HCHO in urine using direct liquid-phase fluorimetric analysis
- A spectrophotometric micromethod for determining erythrocyte protoporphyrin-IX in whole blood or erythrocytes
- Simultaneous analysis of MDR1 C3435T, G2677T/A, and C1236T genotypes by multiplexed mutagenically separated PCR
- Measurement of reticulocyte and red blood cell indices in patients with iron deficiency anemia and β-thalassemia minor
- Chitotriosidase activity in colostrum from African and Caucasian women
- Integration between point-of-care cardiac markers in an emergency/cardiology department and the central laboratory: methodological and preliminary clinical evaluation
- Controlled storage conditions prolong stability of biochemical components in whole blood
- Poor knowledge and faulty thinking regarding hemolysis and potassium elevation
- Delayed effects of short-term transdermal application of 7-oxo-dehydroepiandrosterone on its metabolites, some hormonal steroids and relevant proteohormones in healthy male volunteers
- Evaluation of a novel semi-automated HPLC procedure for whole blood cyclosporin A confirms equivalence to adjusted monoclonal values from Abbott TDx
- Evaluation of the Bio-Rad VARIANT™ II HbA 2/HbA 1C Dual Program for measurement of hemoglobin concentrations and detection of variants
- Interferences in coagulation tests – evaluation of the 570-nm method on the Dade Behring BCS analyser
- No evidence for involvement of the human inducible nitric oxide synthase gene in susceptibility to coronary artery disease
- National survey on the use of measurement of cholinesterase activity in serum
Articles in the same Issue
- Quality control for SELDI analysis
- Immunobead multiplex RT-PCR detection of carcinoembryonic genes expressing cells in the blood of colorectal cancer patients
- Optimization and evaluation of surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) with reversed-phase protein arrays for protein profiling
- Simultaneous determination of HIV antibodies, hepatitis C antibodies, and hepatitis B antigens in dried blood spots –a feasibility study using a multi-analyte immunoassay
- Hematopoietic cytokines in the sera of patients with pancreatic cancer
- Modulation of translation factor's gene expression by histone deacetylase inhibitors in breast cancer cells
- Whole genome amplification of buccal cell DNA: genotyping concordance before and after multiple displacement amplification
- Y-Chromosome short tandem repeat (STR) haplotypes in a Campania population sample
- TaqMan assays for genotyping of single nucleotide polymorphisms present at a disease susceptibility locus on chromosome 6
- The secretion of ibuprofen metabolites interferes with the capillary chromatography of urinary homovanillic acid and 4-hydroxy-3-methoxymandelic acid in neuroblastoma diagnosis
- Selective measurement of HCHO in urine using direct liquid-phase fluorimetric analysis
- A spectrophotometric micromethod for determining erythrocyte protoporphyrin-IX in whole blood or erythrocytes
- Simultaneous analysis of MDR1 C3435T, G2677T/A, and C1236T genotypes by multiplexed mutagenically separated PCR
- Measurement of reticulocyte and red blood cell indices in patients with iron deficiency anemia and β-thalassemia minor
- Chitotriosidase activity in colostrum from African and Caucasian women
- Integration between point-of-care cardiac markers in an emergency/cardiology department and the central laboratory: methodological and preliminary clinical evaluation
- Controlled storage conditions prolong stability of biochemical components in whole blood
- Poor knowledge and faulty thinking regarding hemolysis and potassium elevation
- Delayed effects of short-term transdermal application of 7-oxo-dehydroepiandrosterone on its metabolites, some hormonal steroids and relevant proteohormones in healthy male volunteers
- Evaluation of a novel semi-automated HPLC procedure for whole blood cyclosporin A confirms equivalence to adjusted monoclonal values from Abbott TDx
- Evaluation of the Bio-Rad VARIANT™ II HbA 2/HbA 1C Dual Program for measurement of hemoglobin concentrations and detection of variants
- Interferences in coagulation tests – evaluation of the 570-nm method on the Dade Behring BCS analyser
- No evidence for involvement of the human inducible nitric oxide synthase gene in susceptibility to coronary artery disease
- National survey on the use of measurement of cholinesterase activity in serum
