Insufficient filling of vacuum tubes as a cause of microhemolysis and elevated serum lactate dehydrogenase levels. Use of a data-mining technique in evaluation of questionable laboratory test results
-
Yoshie Tamechika
Abstract
Experienced physicians noted unexpectedly elevated concentrations of lactate dehydrogenase in some patient samples, but quality control specimens showed no bias. To evaluate this problem, we used a “latent reference individual extraction method”, designed to obtain reference intervals from a laboratory database by excluding individuals who have abnormal results for basic analytes other than the analyte in question, in this case lactate dehydrogenase. The reference interval derived for the suspected year was 264–530U/L, while that of the previous year was 248–495U/L. The only change we found was the introduction of an order entry system, which requests precise sampling volumes rather than complete filling of vacuum tubes. The effect of vacuum persistence was tested using ten freshly drawn blood samples. Compared with complete filling, 1/5 filling resulted in average elevations of lactate dehydrogenase, aspartic aminotransferase, and potassium levels of 8.0%, 3.8%, and 3.4%, respectively (all p<0.01). Microhemolysis was confirmed using a urine stick method. The length of time before centrifugation determined the degree of hemolysis, while vacuum during centrifugation did not affect it. Microhemolysis is the probable cause of the suspected pseudo-elevation noted by the physicians. Data-mining methodology represents a valuable tool for monitoring long-term bias in laboratory results.
References
1. Ichihara K, Matsuda N. [Derivation of latent reference intervals from routine laboratory database: its principle, validity and methodological implications for laboratory informatics] (in Japanese). Rinsho Byori 1996; 44:245–59.Search in Google Scholar
2. Hayashi S, Ichihara K, Kanakura Y, Iwatani Y. A new quality control method based on a moving average of “latent reference values” selected from patients' daily test results. Rinsho Byori 2004; 52:204–11.Search in Google Scholar
3. Ichihara K, Kawai T. Determination of reference interval for 13 plasma proteins based on IFCC international reference preparation (CRM470) and NCCLS proposed guideline (C28-P, 1992): trial to select reference individuals by results of screening tests and application of maximal likelihood method. J Clin Lab Anal 1996; 10:110–7.10.1002/(SICI)1098-2825(1996)10:2<110::AID-JCLA9>3.0.CO;2-GSearch in Google Scholar
4. Itoh Y, Ichihara K, Kanno T, Sugawara T, Ohkubo A, Hirabayashi Y, et al. Serum protein standardization project in Japan: evaluation of an IFCC reference material (RPPHS/CRM470) and establishment of reference intervals. J Clin Lab Anal 1997; 11:39–44.10.1002/(SICI)1098-2825(1997)11:1<39::AID-JCLA7>3.0.CO;2-FSearch in Google Scholar
5. Ichihara K, Itoh Y, Min WK, Yap SF, Lam CW, Kong XT, et al. Diagnostic and epidemiological implications of regional differences in serum concentrations of proteins observed in six Asian cities. Clin Chem Lab Med 2004; 42:800–9.10.1515/CCLM.2004.133Search in Google Scholar
6. Enzymology Commission: Société Française de Biologie Clinique. Recommendations for determining the catalytic concentration of lactate dehydrogenase in human serum at 30°C (document F). Ann Biol Clin 1982;40:160–4.Search in Google Scholar
7. Japanese Society of Clinical Chemistry. [Recommended method for measurement of enzymes in human serum – aspartate aminotransferase (AST) – (1989-08-30)] (in Japanese). Jpn J Clin Chem 1989;18:226–30.Search in Google Scholar
8. Japanese Society of Clinical Chemistry. [Recommended method for measurement of enzymes in human serum – aspartate aminotransferase (AST) – (1989-08-30)] (in Japanese). Jpn J Clin Chem 1989;18:230–49.Search in Google Scholar
9. Japanese Society of Clinical Chemistry. [Recommended method for measurement of enzymes in human serum – alanine aminotransferase (ALT) – (1989-08-30)] (in Japanese). Jpn J Clin Chem 1989;18:250–4.Search in Google Scholar
10. Japanese Society of Clinical Chemistry. [Recommended method for measurement of enzymes in human serum – alanine aminotransferase (ALT) – (1989-08-30)] (in Japanese). Jpn J Clin Chem 1989;18:255–62.Search in Google Scholar
11. Shin H, Yozu R, Maehara T, Matayoshi T, Morita M, Kawai Y, et al. Vacuum assisted cardiopulmonary bypass in minimally invasive cardiac surgery: its feasibility and effects on hemolysis. Artif Organs 2000; 24:450–3.10.1046/j.1525-1594.2000.06587.xSearch in Google Scholar
12. Gregoretti S. Suction-induced hemolysis at various vacuum pressures: implications for intraoperative blood salvage. Transfusion 1996; 36:57–60.10.1046/j.1537-2995.1996.36196190516.xSearch in Google Scholar
13. Copeland BE, Dyer PJ, Pesce AJ. Hemoglobin by first derivative spectrophotometry: extent of hemolysis in plasma and serum collected in vacuum container devices. Ann Clin Lab Sci 1989; 19:383–8.Search in Google Scholar
©2006 by Walter de Gruyter Berlin New York
Articles in the same Issue
- CCLM: Expanding the science worldwide
- Factor V Leiden, prothrombin G20210A substitution and hormone therapy: indications for molecular screening
- Immunochemical quantification of free immunoglobulin light chains from an analytical perspective
- De novo deletion removes a conserved motif in the C-terminus of ABCA4 and results in cone-rod dystrophy
- Molecular detection of squamous cell carcinoma antigen transcripts in peripheral blood of cancer patients
- Influence of human haptoglobin polymorphism on oxidative stress induced by free hemoglobin on red blood cells
- Real-time RT-PCR quantification of PRAME gene expression for monitoring minimal residual disease in acute myeloblastic leukaemia
- Association of high-sensitive C-reactive protein with advanced stage β-cell dysfunction and insulin resistance in patients with type 2 diabetes mellitus
- A longitudinal evaluation of urinary glycosaminoglycan excretion in normoalbuminuric type 1 diabetic patients
- National survey on the execution of the oral glucose tolerance test (OGTT) in a representative cohort of Italian laboratories
- The reduction of cholesteryl linoleate in lipoproteins: an index of clinical severity in β-thalassemia/Hb E
- Alterations in serum glycosaminoglycan profiles in Graves' patients
- Alterations in anti-oxidative defence enzymes in erythrocytes from sporadic amyotrophic lateral sclerosis (SALS) and familial ALS patients
- Sandwich ELISAs for soluble immunoglobulin superfamily receptor translocation-associated 2 (IRTA2)/FcRH5 (CD307) proteins in human sera
- Utilizing ultrafiltration to remove alkaline phosphatase from clinical analyzer water
- Measurement of serum monoclonal components: comparison between densitometry and capillary zone electrophoresis
- Salivary aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase: possible markers in periodontal diseases?
- Reticulocyte count, mean reticulocyte volume, immature reticulocyte fraction, and mean sphered cell volume in elite athletes: reference values and comparison with the general population
- Serum homocysteine levels and paraoxonase 1 activity in preschool aged children in Greece
- The effects of adrenocorticotrophic hormone and cortisol on homocysteine and vitamin B concentrations
- Plasma, salivary and urinary cotinine in non-smoker Italian women exposed and unexposed to environmental tobacco smoking (SEASD study)
- Cut-off values for total serum immunoglobulin E between non-atopic and atopic children in north-west Croatia
- Thyroglobulin assay during thyroxine treatment in low-risk differentiated thyroid cancer management: comparison with recombinant human thyrotropin-stimulated assay and imaging procedures
- Evaluation of serum levels of p53 in hepatocellular carcinoma in Egypt
- Insufficient filling of vacuum tubes as a cause of microhemolysis and elevated serum lactate dehydrogenase levels. Use of a data-mining technique in evaluation of questionable laboratory test results
- Evaluation of three different specimen types (serum, plasma lithium heparin and serum gel separator) for analysis of certain analytes: clinical significance of differences in results and efficiency in use
- Comparative evaluation of a new immunoradiometric assay for corticotropin
- Mast cells in atherosclerosis as a source of the cytokine RANKL
- Falsely increased total serum protein due to dextran interference
Articles in the same Issue
- CCLM: Expanding the science worldwide
- Factor V Leiden, prothrombin G20210A substitution and hormone therapy: indications for molecular screening
- Immunochemical quantification of free immunoglobulin light chains from an analytical perspective
- De novo deletion removes a conserved motif in the C-terminus of ABCA4 and results in cone-rod dystrophy
- Molecular detection of squamous cell carcinoma antigen transcripts in peripheral blood of cancer patients
- Influence of human haptoglobin polymorphism on oxidative stress induced by free hemoglobin on red blood cells
- Real-time RT-PCR quantification of PRAME gene expression for monitoring minimal residual disease in acute myeloblastic leukaemia
- Association of high-sensitive C-reactive protein with advanced stage β-cell dysfunction and insulin resistance in patients with type 2 diabetes mellitus
- A longitudinal evaluation of urinary glycosaminoglycan excretion in normoalbuminuric type 1 diabetic patients
- National survey on the execution of the oral glucose tolerance test (OGTT) in a representative cohort of Italian laboratories
- The reduction of cholesteryl linoleate in lipoproteins: an index of clinical severity in β-thalassemia/Hb E
- Alterations in serum glycosaminoglycan profiles in Graves' patients
- Alterations in anti-oxidative defence enzymes in erythrocytes from sporadic amyotrophic lateral sclerosis (SALS) and familial ALS patients
- Sandwich ELISAs for soluble immunoglobulin superfamily receptor translocation-associated 2 (IRTA2)/FcRH5 (CD307) proteins in human sera
- Utilizing ultrafiltration to remove alkaline phosphatase from clinical analyzer water
- Measurement of serum monoclonal components: comparison between densitometry and capillary zone electrophoresis
- Salivary aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase: possible markers in periodontal diseases?
- Reticulocyte count, mean reticulocyte volume, immature reticulocyte fraction, and mean sphered cell volume in elite athletes: reference values and comparison with the general population
- Serum homocysteine levels and paraoxonase 1 activity in preschool aged children in Greece
- The effects of adrenocorticotrophic hormone and cortisol on homocysteine and vitamin B concentrations
- Plasma, salivary and urinary cotinine in non-smoker Italian women exposed and unexposed to environmental tobacco smoking (SEASD study)
- Cut-off values for total serum immunoglobulin E between non-atopic and atopic children in north-west Croatia
- Thyroglobulin assay during thyroxine treatment in low-risk differentiated thyroid cancer management: comparison with recombinant human thyrotropin-stimulated assay and imaging procedures
- Evaluation of serum levels of p53 in hepatocellular carcinoma in Egypt
- Insufficient filling of vacuum tubes as a cause of microhemolysis and elevated serum lactate dehydrogenase levels. Use of a data-mining technique in evaluation of questionable laboratory test results
- Evaluation of three different specimen types (serum, plasma lithium heparin and serum gel separator) for analysis of certain analytes: clinical significance of differences in results and efficiency in use
- Comparative evaluation of a new immunoradiometric assay for corticotropin
- Mast cells in atherosclerosis as a source of the cytokine RANKL
- Falsely increased total serum protein due to dextran interference
