NIH, National Cancer Institute, Division of Cancer Treatment and Diagnosis (DCTD) NIH - National Institutes of Health National Cancer Institute DCTD - Division of Cancer Treatment and Diagnosis

Effect of Hemolysis on Routine Blood Gas and Whole Blood Analytes.

Author(s): Agana BA, Overton B, Florendo K, Knezevic CE

Publication: J Appl Lab Med, 2024, Vol. , Page

PubMed ID: 39688384 PubMed Review Paper? No

Purpose of Paper

This paper investigated the effects of hemolysis on the analysis of 13 blood gas analytes in whole blood by comparing levels in aliquots of remnant blood specimens with and without the induction of hemolysis and in a specimen analyzed before aliquoting.

Conclusion of Paper

The visual and H-index categorization of hemolysis agreed in 78 of 85 specimens, with only a one category difference found for the remaining 7 specimens. Levels of sodium, ionized calcium, glucose, and methemoglobin were consistently lower in the hemolyzed portion than the non-hemolyzed portion (passed through a syringe without a needle) or the original analysis, but the other nine analytes  were consistently higher in the hemolyzed portion. When specimens were stratified as slightly (H-index Delta <100 compared to non-hemolyzed), moderately (H-index delta of 100-500 compared to non-hemolyzed) or severely hemolyzed (H-index delta >500 compared to non-hemolyzed), bias increased concomitantly with the degree of hemolysis for sodium (−0.56%, −1.10%, and −3.96%, respectively), potassium (6.02%, 24%, and 108%, respectively), calcium (−2.99%, −5.65%, and −15.5%, respectively), and methemoglobin (−2.99%, −5.65%, and −15.5%, respectively). In contrast, the observed biases in hemolyzed aliquots for total hemoglobin, oxyhemoglobin, carboxyhemoglobin, pH, oxygen saturation, glucose, creatinine, and lactate did not increase with increasing levels of hemolysis. When compared to original values, aliquots passed through the syringe without a needle (non-hemolyzed portion) had decreased glucose and increased lactate, which are attributable to the increased processing time.

Studies

  1. Study Purpose

    This study investigated the effects of hemolysis on the analysis of 13 blood gas analytes in whole blood by comparing levels in aliquots of remnant blood specimens with and without the induction of hemolysis and in a specimen analyzed before aliquoting. After an initial analysis, 85 remnant whole blood specimens (diagnosis not specified) were split into two aliquots, which were aspirated and dispensed through a syringe ≥ one time with (hemolysis induction) or without (control) a 30-gauge needle. pH, potassium, sodium, chloride, ionized calcium, glucose, lactate, creatinine, hemoglobin, oxyhemoglobin, carboxyhemoglobin, methemoglobin, and oxygen saturation were quantified using a Radiometer ABL800. Following initial analysis in whole blood, the blood was centrifuged (details not provided), and hemolysis was assessed using a Roche cobas 8000 instrument as well as manually as slight, moderate, or severe based on color by two medical technologists.

    Summary of Findings:

    The visual and H-index categorization of hemolysis agreed in 78 of 85 specimens, with only a one category difference found for the remaining 7 specimens. Levels of sodium, ionized calcium, glucose, and methemoglobin were consistently lower in the hemolyzed portion than the non-hemolyzed portion (mean bias of -1.79, -7.85, -0.97 and -10.14, respectively) or the original analysis (mean bias of -1.03, -10.54, -4.71 and -11.43, respectively) but all other analytes were consistently higher in the hemolyzed portion. When specimens were stratified as slightly (H-index Delta <100 compared to non-hemolyzed), moderately (H-index delta of 100-500 compared to non-hemolyzed) or severely hemolyzed (H-index delta >500 compared to non-hemolyzed), bias increased concomitantly for sodium (−0.56%, −1.10%, and −3.96%, respectively), potassium (6.02%, 24%, and 108%, respectively), calcium (−2.99%, −5.65%, and −15.5%, respectively), and methemoglobin (−2.99%, −5.65%, and −15.5%, respectively). In contrast, the observed biases in hemolyzed aliquots for total hemoglobin, oxyhemoglobin, carboxyhemoglobin, pH, oxygen saturation, glucose, creatinine, and lactate did not increase with increasing levels of hemolysis. When compared to original values, aliquots passed through the syringe without a needle (non-hemolyzed portion) had decreased glucose and increased lactate, which are attributable to the increased processing time.

    Biospecimens
    Preservative Types
    • None (Fresh)
    Diagnoses:
    • Not specified
    Platform:
    AnalyteTechnology Platform
    Carbohydrate Clinical chemistry/auto analyzer
    Electrolyte/Metal Clinical chemistry/auto analyzer
    Gas Clinical chemistry/auto analyzer
    Protein Clinical chemistry/auto analyzer
    Protein Macroscopic observation
    Small molecule Clinical chemistry/auto analyzer
    Pre-analytical Factors:
    ClassificationPre-analytical FactorValue(s)
    Clinical chemistry/auto analyzer Specific Technology platform Visual inspection
    Autoanalyzer
    Biospecimen Aliquots and Components Hemolysis A range of hemolysis scores investigated
    Not induced
    Fine needle aspiration-induced

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