Handling Hemolytic Blood Samples from High-Risk Clinical Areas: A Call to Action.

Background: Spectrophotometric testing to detect sample hemolysis is available from central laboratory chemistry analyzers. While the cause and preventative measures are known, hemolysis continues to be a common preanalytical error, especially for specimens collected from the emergency department (ED) and intensive care units (ICUs) where point-of-care analyzers are commonly used for whole blood electrolyte testing. Recently, these analyzers have employed technology to detect hemolysis directly on whole blood samples.

Methods: Experienced laboratorians and physicians from the clinical laboratory, ED, adult and neonatal ICUs provide a summary of the medical importance of in vitro hemolysis. Causes for in vivo hemolysis are summarized as it is indistinguishable from in vitro hemolysis from routine laboratory analysis. The detection of hemolysis by clinical laboratories is discussed from the American and European perspectives.

Results: In vivo hemolysis can occur due to genetic abnormalities, hemoglobinopathies that cause red cell lysis, and mechanical circulatory support. There are many causes of in vitro hemolysis. Patients in the ED and ICU are particularly vulnerable to erroneous laboratory data such as potassium. Incorrectly treated patients can lead to significant medical consequences. Within the clinical laboratory, there are recommendations made by accrediting bodies, but none are mandatory, and the implementation of the hemolysis index testing is not universal.

Conclusions: Recommendations have been authored regarding the need for education for prevention, performance of hemolysis detection testing, defining levels of hemolysis reporting, periodic monitoring of hemolysis detection performance, and laboratory reporting practices for high and normal potassium test results.