Evaluation and management of leukolysis-mediated pseudohyperkalemia in paediatric leukemic samples.

IF 3.8 3区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY
Lourens Jan Peter Nonkes, Valérie de Haas, Hans Kemperman, Albert Huisman, Ruben Eduardus Antonius Musson, Wouter Marcel Tiel Groenestege
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引用次数: 1

Abstract

Introduction: Leukolysis-related pseudohyperkalemia due to preanalytical procedures may lead to erroneous (or absence of) treatment based on an invalid lab test result. We aimed to obtain a leukocyte threshold above which leukolysis-related pseudohyperkalemia becomes clinical relevant. Secondly, temporal dynamics of treatment-induced leukocyte decrease were studied to allow tailored implementation of laboratory information system (LIS) decision rules based on the leukocyte threshold to avoid leukolysis-related pseudohyperkalemia.

Materials and methods: Potassium results of AU5811 routine chemistry (Beckman Coulter, Brea, California, USA) and iStat point of care (POC) (Abbott Diagnostics, Chicago, Illinois, USA) analysers were compared, the latter method being insensitive to leukolysis caused by pre-analytical procedures. Potassium results were combined with leukocyte counts obtained using a Cell-Dyn Sapphire haematology analyser (Abbott Diagnostics, Santa Clara, California, USA), resulting in 132 unique data triplets. Regression analysis was performed to establish a leukocyte threshold. The Reference Change Value (√2 x Z x √(CVa 2 + CVi 2)) was used to calculate maximum allowable difference between routine analyser and POC potassium results (deltamax + 0.58 mmol/L). Temporal analysis on the treatment-induced leukocyte decrease was performed by plotting leukocyte counts in time for all patients above the threshold leukocyte count (N = 41).

Results: Established leukocyte threshold was 63 x109/L. Temporal analysis showed leukocyte counts below the threshold within 8 days of treatment for all patients.

Conclusions: Based on performed analyses we were able to implement LIS decision rules to reduce pseudohyperkalemia due to preanalytical procedures. This implementation can contribute to a reduction in erroneous (or absence of) treatments in the clinic.

Abstract Image

Abstract Image

评估和处理白血病患儿白血病溶解介导的假性高钾血症。
导读:分析前程序导致的与白血病相关的假性高钾血症可能导致基于无效实验室检测结果的错误(或缺乏)治疗。我们的目的是获得一个白细胞阈值,超过这个阈值,白细胞溶解相关的假性高钾血症就具有临床相关性。其次,研究了治疗诱导的白细胞减少的时间动态,以便根据白细胞阈值定制实验室信息系统(LIS)决策规则,以避免白细胞溶解相关的假性高钾血症。材料和方法:比较AU5811常规化学(Beckman Coulter, Brea, California, USA)和iStat护理点(POC) (Abbott Diagnostics, Chicago, Illinois, USA)分析仪的钾检测结果,后者对前分析程序引起的白细胞溶解不敏感。钾结果与使用Cell-Dyn Sapphire血液学分析仪(Abbott Diagnostics, Santa Clara, California, USA)获得的白细胞计数相结合,产生132个独特的三胞胎数据。采用回归分析建立白细胞阈值。参考变化值(√2 × Z ×√(CVa 2 + CVi 2))用于计算常规分析仪与POC钾结果(deltamax + 0.58 mmol/L)之间的最大允许差值。通过及时绘制白细胞计数高于阈值的所有患者(N = 41)的白细胞计数,对治疗诱导的白细胞减少进行时间分析。结果:建立的白细胞阈值为63 × 109/L。时间分析显示,所有患者在治疗8天内白细胞计数均低于阈值。结论:根据所进行的分析,我们能够实施LIS决策规则,以减少由于分析前程序引起的假性高钾血症。这种实现有助于减少临床错误(或缺乏)治疗。
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来源期刊
Biochemia Medica
Biochemia Medica 医学-医学实验技术
CiteScore
5.50
自引率
3.00%
发文量
70
审稿时长
>12 weeks
期刊介绍: Biochemia Medica is the official peer-reviewed journal of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Journal provides a wide coverage of research in all aspects of clinical chemistry and laboratory medicine. Following categories fit into the scope of the Journal: general clinical chemistry, haematology and haemostasis, molecular diagnostics and endocrinology. Development, validation and verification of analytical techniques and methods applicable to clinical chemistry and laboratory medicine are welcome as well as studies dealing with laboratory organization, automation and quality control. Journal publishes on a regular basis educative preanalytical case reports (Preanalytical mysteries), articles dealing with applied biostatistics (Lessons in biostatistics) and research integrity (Research integrity corner).
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