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Influence of spurious hemolysis on blood gas analysis

  • Giuseppe Lippi EMAIL logo , Rossana Fontana , Paola Avanzini , Franca Sandei and Luigi Ippolito
Published/Copyright: January 5, 2013
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 51 Issue 8

Abstract

Background: Although the prevalence of hemolyzed samples referred for blood gas analysis is as high as 4%, no studies have assessed the bias introduced by spurious erythrocyte breakdown, nor it is known which parameters are mostly influenced and to what extent. This study was hence planned to assess the influence of spurious hemolysis on venous blood gas analysis.

Methods: Venous blood was collected from nine healthy volunteers in sodium heparin tubes and divided in two aliquots of 3 mL. The former aliquot was mechanically hemolyzed by aspiration with 0.5 mL insulin syringe equipped with 30 gauge needle. One milliliter of all aliquots was tested for hemoglobin, pH, oxygen partial pressure (pO2), partial pressure of carbon dioxide (pCO2), bicarbonate (HCO3–), oxygen tension at 50% hemoglobin saturation (p50), oxygen saturation (sO2), actual base excess (ABE), carboxyhemoglobin (COHb), methemoglobin (metHb), ionized calcium (Ca2+) and potassium, on ABL800 flex. The remaining 2 mL of blood were centrifuged, plasma separated and tested for hemolysis index.

Results: The concentration of cell-free hemoglobin increased from <0.5 g/L to 8.9±1.5 g/L in hemolyzed aliquots. In hemolyzed blood, significant decreases were found for pH (−0.2%), pO2 (−4.9%), sO2 (−4.9%), COHb (−11%) and Ca2+ (−7.0%), whereas significant increases were observed for pCO2 (+4.1%), HCO3– (+1.4%) and potassium (+152%). Clinically meaningful bias was found for pO2, pCO2, Ca2+ and potassium.

Conclusions: Spurious hemolysis is likely to introduce meaningful biases in blood gas analysis, hence manufacturers of blood gas analyzers should develop instrumentation capable of identifying interfering substances in whole blood. The presence of spurious hemolysis should also be suspected whenever test results do not reflect the clinics.

Keywords: blood gas analysis; hemolysis; interference; preanalytical variability
Corresponding author: Prof. Giuseppe Lippi, Laboratory of Clinical Chemistry and Haematology, Department of Pathology and Laboratory Medicine, Academic Hospital of Parma, 43126 Parma, Italy, Phone: +39 0521 703050, +39 0521 703054

References

1. Plebani M, Lippi G. Closing the brain-to-brain loop in laboratory testing. Clin Chem Lab Med 2011;49:1131–3.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000292538800006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

2. Lippi G, Guidi GC, Mattiuzzi C, Plebani M. Preanalytical variability: the dark side of the moon in laboratory testing. Clin Chem Lab Med 2006;44:358–65.10.1515/CCLM.2006.073Search in Google Scholar PubMed

3. Lippi G, Chance JJ, Church S, Dazzi P, Fontana R, Giavarina D, et al. Preanalytical quality improvement: from dream to reality. Clin Chem Lab Med 2011;49:1113–26.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000292538800004&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

4. Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, et al. Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories. Clin Chem Lab Med 2008;46:764–72.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000257542800003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

5. Lippi G, Plebani M, Di Somma S, Cervellin G. Hemolyzed specimens: a major challenge for emergency departments and clinical laboratories. Crit Rev Clin Lab Sci 2011;48: 143–53.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000294492400003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.3109/10408363.2011.600228Search in Google Scholar PubMed

6. Salvagno GL, Lippi G, Gelati M, Guidi GC. Hemolysis, lipaemia and icterus in specimens for arterial blood gas analysis. Clin Biochem 2012;45:372–3.10.1016/j.clinbiochem.2011.12.005http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000302844500021&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

7. Lippi G, Ippolito L, Fontana R. Prevalence of hemolytic specimens referred for arterial blood gas analysis. Clin Chem Lab Med 2011;49:931–2.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000289465700028&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

8. Clinical and Laboratory Standards Institute. Blood gas and pH analysis and related measurements; Approved Guideline, 2nd ed. CLSI document C46-A2. Wayne, PA: Clinical and Laboratory Standards Institute, 2009.Search in Google Scholar

9. Lippi G, Musa R, Avanzini P, Aloe R, Pipitone S, Sandei F. Influence of in vitro hemolysis on hematological testing on Advia 2120. Int J Lab Hematol 2012;34:179–84.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000300695600010&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111/j.1751-553X.2011.01378.xSearch in Google Scholar PubMed

10. Stadlbauer V, Wallner S, Stojakovic T, Smolle KH. Comparison of 3 different multianalyte point-of-care devices during clinical routine on a medical intensive care unit. J Crit Care 2011;26:433.e1–11.10.1016/j.jcrc.2010.09.003Search in Google Scholar PubMed

11. Lippi G, Luca Salvagno G, Blanckaert N, Giavarina D, Green S, Kitchen S, et al. Multicenter evaluation of the hemolysis index in automated clinical chemistry systems. Clin Chem Lab Med 2009;47:934–9.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000268507800006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

12. Ricos C, Alvarez V, Cava F, Garcia-Lario JV, Hernandez A, Jimenez CV, et al. Current databases on biologic variation: pros, cons and progress. Scand J Clin Lab Invest 1999;59: 491–500.10.1080/00365519950185229Search in Google Scholar PubMed

13. Cembrowski GS, Tran DV, Higgins TN. The use of serial patient blood gas, electrolyte and glucose results to derive biologic variation: a new tool to assess the acceptability of intensive care unit testing. Clin Chem Lab Med 2010;48:1447–54.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000283186200015&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

14. Buckley BM, Rawson KM, Russell LT. The effect of hemolysis on ionized calcium measurement. In: Burritt MF, O’Connell KM, editors. Methodology and clinical applications of ion-selective electrodes. Proceedings of the International Symposium on the Measurements of Blood Electrolytes, Danvers, MA. Rochester, MN: Davies Printing Co., 1988:141–6.Search in Google Scholar

15. Clinical and Laboratory Standards Institute. Ionized calcium determinations: precollection variables, specimen choice, collection, and handling. Approved Guideline, 2nd ed. CLSI document C31-A2. Wayne, PA: Clinical and Laboratory Standards Institute, 2001.Search in Google Scholar

16. Plebani M, Lippi G. Hemolysis index: quality indicator or criterion for sample rejection? Clin Chem Lab Med 2009;47:899–902.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000268507800001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

17. Lippi G, Plebani M, Favaloro EJ. Interference in coagulation testing: focus on spurious hemolysis, icterus and lipaemia. Semin Thromb Hemost 2012 Dec 10. [Epub ahead of print]. DOI: 10.1055/s-0032-1328972.10.1055/s-0032-1328972http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000316614100005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

18. Lippi G, Mattiuzzi C, Guidi GC. Laboratory quality improvement by implementation of phlebotomy guidelines. MLO Med Lab Obs 2006;38:6–7.Search in Google Scholar PubMed

Received: 2012-11-24
Accepted: 2012-12-06
Published Online: 2013-01-05
Published in Print: 2013-08-01

©2013 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/cclm-2012-0802
Keywords for this article
blood gas analysis; hemolysis; interference; preanalytical variability

Articles in the same Issue

  1. Letters to the Editors
  2. Clinical utility of serum tumor markers and cytokines in cervical cancer and neoplasia
  3. Establishing reference intervals for LDL subfractions in a Korean population using the Lipoprint LDL system
  4. Measurement imprecision of common urinary biochemical analytes on the Roche Cobas 6000 system
  5. A comparison between turbidimetric inhibition immunoassay and capillary electrophoresis in glycated hemoglobin (HbA1c) measurement
  6. Commutability: a peculiar property of calibration and control materials. Definition and evaluation
  7. Diagnostic sensitivity of a panel of tests to detect monoclonal protein in Korean multiple myeloma patients
  8. Commutability of proficiency testing (PT): status of the matrix-related bias in general clinical chemistry
  9. Masthead
  10. Masthead
  11. Editorial
  12. Why specifications for allowable glucose meter errors should include 100% of the data
  13. Reviews
  14. ABO blood group: old dogma, new perspectives
  15. Trace elements and bone health
  16. Mini Review
  17. The role of transcription factors in laboratory medicine
  18. Opinion Papers
  19. Nobelitis: a common disease among Nobel laureates?
  20. The syndrome of the “obsessive-compulsory scientist”: a new mental disorder?
  21. Can current analytical quality performance of UK clinical laboratories support evidence-based guidelines for diabetes and ischaemic heart disease? – A pilot study and a proposal
  22. Guidelines and Recommendations
  23. Survey of national guidelines, education and training on phlebotomy in 28 European countries: an original report by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PA)
  24. General Clinical Chemistry and Laboratory Medicine
  25. Red cell indices: differentiation between β-thalassemia trait and iron deficiency anemia and application to sickle cell disease and sickle cell thalassemia
  26. Problems in determining thalassemia carrier status in a program for prevention and control of severe thalassemia syndromes: a lesson from Thailand
  27. An enzyme linked immunosorbent assay (ELISA) for the determination of the human haptoglobin phenotype
  28. Blood loss from laboratory diagnostic tests in children
  29. Hematocrit correction does not improve glucose monitor accuracy in the assessment of neonatal hypoglycemia
  30. Evaluation of a mobile clinical pathology laboratory developed for the home care of pediatric patients following transplantation of peripheral blood precursor cells
  31. Folic acid supplementation does not reduce intracellular homocysteine, and may disturb intracellular one-carbon metabolism
  32. Influence of spurious hemolysis on blood gas analysis
  33. Serum procalcitonin predicts development of acute kidney injury in patients with suspected infection
  34. Reference Values and Biological Variations
  35. Nationwide multicenter study aimed at the establishment of common reference intervals for standardized clinical laboratory tests in Japan
  36. Cancer Diagnostics
  37. Application of BRAF, NRAS, KRAS mutations as markers for the detection of papillary thyroid cancer from FNAB specimens by pyrosequencing analysis
  38. Comparative evaluation of the My5-FU™ immunoassay and LC-MS/MS in monitoring the 5-fluorouracil plasma levels in cancer patients
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