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.
Author(s): Tamechika Y, Iwatani Y, Tohyama K, Ichihara K
Publication: Clin Chem Lab Med, 2006, Vol. 44, Page 657-61
PubMed ID: 16681441 PubMed Review Paper? No
Purpose of Paper
Conclusion of Paper
Studies
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Study Purpose
The purpose of this study was to determine the effects of unfilled vacuum in blood specimen collection tubes on hemolysis, LDH, alanine aminotransferase (ALT), AST, gamma-glutamyl transpeptidase (GGT), sodium (Na), K, and chloride.
Summary of Findings:
Levels of LDH, AST, and K increased by 8.0%, 3.8%, and 3.4%, respectively in serum when sample tubes had unfilled vacuum compared to those with no unfilled vacuum. Unfilled vacuum in collection tubes had no significant effect on ALT, GGT, Na, or chloride. When hemolysis was semi-quantitatively measured by urine stick analysis, 8/10 paired specimens showed a significantly higher hemoglobin concentration in the sample tube containing unfilled vacuum.
Biospecimens
Preservative Types
- None (Fresh)
Diagnoses:
- Normal
Platform:
Analyte Technology Platform Electrolyte/Metal Clinical chemistry/auto analyzer Protein Clinical chemistry/auto analyzer Morphology Colorimetric assay Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Aliquots and Components Aliquot size/volume 6 mL (with a 6 mL draw volume)
2 mL (with a 9 mL draw volume)
Storage Time at room temperature 90 min
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Study Purpose
The purpose of this study was to determine the influence of time prior to centrifugation on LDH and hemolysis when specimens were collected in tubes with unfilled vacuum. In addition, centrifugation with and without the removal of tube caps was examined to determine the influence of unfilled vacuum during centrifugation.
Summary of Findings:
While the presence of a vacuum during centrifugation had no significant influence on LDH or hemolysis, unfilled vacuum in collection tubes prior to centrifugation significantly affected LDH levels and degrees of hemolysis. As the exposure time to the vacuum prior to centrifugation increased, so did the LDH levels and the degree of hemolysis.
Biospecimens
Preservative Types
- None (Fresh)
Diagnoses:
- Normal
Platform:
Analyte Technology Platform Protein Clinical chemistry/auto analyzer Electrolyte/Metal Clinical chemistry/auto analyzer Morphology Colorimetric assay Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Aliquots and Components Aliquot size/volume 2 mL (with a 9 mL draw volume)
Storage Time at room temperature 60 min
120 min
240 min
Biospecimen Aliquots and Components Centrifugation Under vacuum
No vacuum
Centrifugation delays investigated