Influence of hemolysis on routine clinical chemistry testing
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Giuseppe Lippi
Abstract
Background: Preanalytical factors are the main source of variation in clinical chemistry testing and among the major determinants of preanalytical variability, sample hemolysis can exert a strong influence on result reliability. Hemolytic samples are a rather common and unfavorable occurrence in laboratory practice, as they are often considered unsuitable for routine testing due to biological and analytical interference. However, definitive indications on the analytical and clinical management of hemolyzed specimens are currently lacking. Therefore, the present investigation evaluated the influence of in vitro blood cell lysis on routine clinical chemistry testing.
Methods: Nine aliquots, prepared by serial dilutions of homologous hemolyzed samples collected from 12 different subjects and containing a final concentration of serum hemoglobin ranging from 0 to 20.6g/L, were tested for the most common clinical chemistry analytes. Lysis was achieved by subjecting whole blood to an overnight freeze-thaw cycle.
Results: Hemolysis interference appeared to be approximately linearly dependent on the final concentration of blood-cell lysate in the specimen. This generated a consistent trend towards overestimation of alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, creatine kinase (CK), iron, lactate dehydrogenase (LDH), lipase, magnesium, phosphorus, potassium and urea, whereas mean values of albumin, alkaline phosphatase (ALP), chloride, γ-glutamyltransferase (GGT), glucose and sodium were substantially decreased. Clinically meaningful variations of AST, chloride, LDH, potassium and sodium were observed in specimens displaying mild or almost undetectable hemolysis by visual inspection (serum hemoglobin <0.6g/L). The rather heterogeneous and unpredictable response to hemolysis observed for several parameters prevented the adoption of reliable statistic corrective measures for results on the basis of the degree of hemolysis.
Conclusion: If hemolysis and blood cell lysis result from an in vitro cause, we suggest that the most convenient corrective solution might be quantification of free hemoglobin, alerting the clinicians and sample recollection.
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Articles in the same Issue
- Recent advances in physiological calcium homeostasis
- Associations of apolipoprotein E exon 4 and lipoprotein lipase S447X polymorphisms with acute ischemic stroke and myocardial infarction
- Association of angiotensin II type 1 receptor gene polymorphism with carotid atherosclerosis
- Comparison of the TaqMan and LightCycler systems in pharmacogenetic testing: evaluation of CYP2C9*2/*3 polymorphisms
- Urinary cystatin C as a specific marker of tubular dysfunction
- Time-resolved fluorimetric immunoassay of calprotectin: technical and clinical aspects in diagnosis of inflammatory bowel diseases
- Direct and fast determination of antiretroviral drugs by automated online solid-phase extraction-liquid chromatography-tandem mass spectrometry in human plasma
- Markers of oxidative stress in children with Down syndrome
- Influence of hemolysis on routine clinical chemistry testing
- C-Reactive protein and neopterin levels in healthy non-obese adults
- Comparison of the lipid profile and lipoprotein(a) between sedentary and highly trained subjects
- Clinical outcome estimates based on treatment target limits of laboratory tests: proposal for a plot visualizing effects and differences of medical target setting exemplified by glycemic control in diabetes
- Metrological traceability of values for catalytic concentration of enzymes assigned to a calibration material
- Evaluation of a new Sebia kit for analysis of hemoglobin fractions and variants on the Capillarys® system
- Recommendation for measuring and reporting chloride by ISEs in undiluted serum, plasma or blood: International Federation of Clinical Chemistry and Laboratory Medicine (IFCC): IFCC Scientific Division, Committee on Point of Care Testing and Working Group on Selective Electrodes
- Diluent Multiassay for the MODULAR ANALYTICS E170 does not improve TSH dilutions compared to Diluent Universal
