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Handling of hemolyzed serum samples in clinical chemistry laboratories: the Nordic hemolysis project

  • Gro Gidske EMAIL logo , Kristin Moberg Aakre , Pål Rustad , Sverre Sandberg , Anna Norling , Jonna Pelanti , Gitte Henriksen , Ingunn Thorsteinsdottir and Gunn B.B. Kristensen
Published/Copyright: July 9, 2019
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 57 Issue 11

Abstract

Background

Some clinical chemistry measurement methods are vulnerable to interference if hemolyzed serum samples are used. The aims of this study were: (1) to obtain updated information about how hemolysis affects clinical chemistry test results on different instrument platforms used in Nordic laboratories, and (2) to obtain data on how test results from hemolyzed samples are reported in Nordic laboratories.

Methods

Four identical samples containing different degrees of hemolysis were prepared and distributed to 145 laboratories in the Nordic countries. The laboratories were asked to measure the concentration of cell-free hemoglobin (Hb), together with 15 clinical chemistry analytes. In addition, the laboratories completed a questionnaire about how hemolyzed samples are handled and reported.

Results

Automated detection of hemolysis in all routine patient samples was used by 63% of laboratories, and 88% had written procedures on how to handle hemolyzed samples. The different instrument platforms measured comparable mean Hb concentrations in the four samples. For most analytes, hemolysis caused a homogenous degree of interference regardless of the instrument platform used, except for alkaline phosphatase (ALP), bilirubin (total) and creatine kinase (CK). The recommended cut-off points for rejection of a result varied substantially between the manufacturers. The laboratories differed in how they reported test results, even when they used the same type of instrument.

Conclusions

Most of the analytes were homogeneously affected by hemolysis, regardless of the instrument used. There is large variation, however, between the laboratories on how they report test results from hemolyzed samples, even when they use the same type of instrument.

Keywords: analytical interference; hemoglobin; hemolysis; laboratory errors; preanalytical phase
Corresponding author: Gro Gidske, MSc, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, P.O. Box 6165, 5892 Bergen, Norway, Phone: +47 55 97 95 00, Fax: +47 55 97 95 10

Acknowledgments

The authors would like to thank Mette Christophersen Tollånes, Noklus, for useful comments. The authors also gratefully acknowledge the financial support provided by the Nordic Society of Clinical Chemistry (NFKK).

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2019-0366).

Received: 2019-04-05
Accepted: 2019-06-06
Published Online: 2019-07-09
Published in Print: 2019-10-25

©2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Identification and management of spurious hemolysis: controversies, concerns and criticisms
  4. Reviews
  5. CYP24A1 and SLC34A1 genetic defects associated with idiopathic infantile hypercalcemia: from genotype to phenotype
  6. Meta-analysis: compared with anti-CCP and rheumatoid factor, could anti-MCV be the next biomarker in the rheumatoid arthritis classification criteria?
  7. Opinion Paper
  8. Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of Italian experts
  9. General Clinical Chemistry and Laboratory Medicine
  10. Using the hemoglobin-binding Staphylococcus aureus protein IsdH to enable plasma analysis of hemolyzed blood samples
  11. Handling of hemolyzed serum samples in clinical chemistry laboratories: the Nordic hemolysis project
  12. Clinical biomarker innovation: when is it worthwhile?
  13. Impact of total automation consolidating first-line laboratory tests on diagnostic blood loss
  14. Diagnostic and prognostic value of the D-dimer test in emergency department patients: secondary analysis of an observational study
  15. Screening of chemical libraries in pursuit of kallikrein-5 specific inhibitors for the treatment of inflammatory dermatoses
  16. Comparison of five automated urine sediment analyzers with manual microscopy for accurate identification of urine sediment
  17. Establishment of an international autoantibody reference standard for human anti-DFS70 antibodies: proof-of-concept study for a novel Megapool strategy by pooling individual specific sera
  18. Only monospecific anti-DFS70 antibodies aid in the exclusion of antinuclear antibody associated rheumatic diseases: an Italian experience
  19. Performance evaluation of an Indoxyl Sulfate Assay Kit “NIPRO”
  20. Variable and inaccurate serum IgG4 levels resulting from lack of standardization in IgG subclass assay calibration
  21. Hematology and Coagulation
  22. Influence of hypertriglyceridemia, hyperbilirubinemia and hemolysis on thrombin generation in human plasma
  23. Reference Values and Biological Variations
  24. Reference intervals for serum total vitamin B12 and holotranscobalamin concentrations and their change points with methylmalonic acid concentration to assess vitamin B12 status during early and mid-pregnancy
  25. Cardiovascular Diseases
  26. Serum concentrations of free fatty acids are associated with 3-month mortality in acute heart failure patients
  27. Letters to the Editor
  28. Management of potassium results in haemolysed plasma samples at the emergency department laboratory
  29. Unexpected analytical interference in isavuconazole UV determination in a child in therapy with lumacaftor/ivacaftor for cystic fibrosis
  30. Total laboratory automation has the potential to be the field of application of artificial intelligence: the cyber-physical system and “Automation 4.0”
  31. 99th percentile upper reference limit of AccuTnI+3 in a Korean reference population: a multicenter study using fresh serum
  32. Roche Troponin T hs-STAT meets all expert opinion analytical laboratory practice recommendations for the use of the differential diagnosis of acute coronary syndrome
  33. A comparison of biotin interference in routine immunoassays on the Roche Cobas 8000, Beckman Coulter DXi and Siemens Advia Centaur XPT immunoassay platforms
  34. The importance of the methodology and sample matrix when interpreting chromogranin A results
  35. The sudden death of the combined first trimester aneuploidy screening, a single centre experience in Belgium
  36. Reply to Luksic et al. Clin Chem Lab Med 2018;56(4):574–581
https://doi.org/10.1515/cclm-2019-0366
Keywords for this article
analytical interference; hemoglobin; hemolysis; laboratory errors; preanalytical phase

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Identification and management of spurious hemolysis: controversies, concerns and criticisms
  4. Reviews
  5. CYP24A1 and SLC34A1 genetic defects associated with idiopathic infantile hypercalcemia: from genotype to phenotype
  6. Meta-analysis: compared with anti-CCP and rheumatoid factor, could anti-MCV be the next biomarker in the rheumatoid arthritis classification criteria?
  7. Opinion Paper
  8. Collection, transport and storage procedures for blood culture specimens in adult patients: recommendations from a board of Italian experts
  9. General Clinical Chemistry and Laboratory Medicine
  10. Using the hemoglobin-binding Staphylococcus aureus protein IsdH to enable plasma analysis of hemolyzed blood samples
  11. Handling of hemolyzed serum samples in clinical chemistry laboratories: the Nordic hemolysis project
  12. Clinical biomarker innovation: when is it worthwhile?
  13. Impact of total automation consolidating first-line laboratory tests on diagnostic blood loss
  14. Diagnostic and prognostic value of the D-dimer test in emergency department patients: secondary analysis of an observational study
  15. Screening of chemical libraries in pursuit of kallikrein-5 specific inhibitors for the treatment of inflammatory dermatoses
  16. Comparison of five automated urine sediment analyzers with manual microscopy for accurate identification of urine sediment
  17. Establishment of an international autoantibody reference standard for human anti-DFS70 antibodies: proof-of-concept study for a novel Megapool strategy by pooling individual specific sera
  18. Only monospecific anti-DFS70 antibodies aid in the exclusion of antinuclear antibody associated rheumatic diseases: an Italian experience
  19. Performance evaluation of an Indoxyl Sulfate Assay Kit “NIPRO”
  20. Variable and inaccurate serum IgG4 levels resulting from lack of standardization in IgG subclass assay calibration
  21. Hematology and Coagulation
  22. Influence of hypertriglyceridemia, hyperbilirubinemia and hemolysis on thrombin generation in human plasma
  23. Reference Values and Biological Variations
  24. Reference intervals for serum total vitamin B12 and holotranscobalamin concentrations and their change points with methylmalonic acid concentration to assess vitamin B12 status during early and mid-pregnancy
  25. Cardiovascular Diseases
  26. Serum concentrations of free fatty acids are associated with 3-month mortality in acute heart failure patients
  27. Letters to the Editor
  28. Management of potassium results in haemolysed plasma samples at the emergency department laboratory
  29. Unexpected analytical interference in isavuconazole UV determination in a child in therapy with lumacaftor/ivacaftor for cystic fibrosis
  30. Total laboratory automation has the potential to be the field of application of artificial intelligence: the cyber-physical system and “Automation 4.0”
  31. 99th percentile upper reference limit of AccuTnI+3 in a Korean reference population: a multicenter study using fresh serum
  32. Roche Troponin T hs-STAT meets all expert opinion analytical laboratory practice recommendations for the use of the differential diagnosis of acute coronary syndrome
  33. A comparison of biotin interference in routine immunoassays on the Roche Cobas 8000, Beckman Coulter DXi and Siemens Advia Centaur XPT immunoassay platforms
  34. The importance of the methodology and sample matrix when interpreting chromogranin A results
  35. The sudden death of the combined first trimester aneuploidy screening, a single centre experience in Belgium
  36. Reply to Luksic et al. Clin Chem Lab Med 2018;56(4):574–581
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