Clinical Pathology Abstracts, 11/15

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Clinical laboratory quality practices when hemolysis occurs

Even with advances in clinical laboratory testing, hemolyzed specimens continue to cause interference, resulting in a delay in result reporting, additional test ordering, complications in interpreting results, and increases in health care costs. Since most laboratory tests in chemistry involve measuring the light that passes through a specimen, hemolysis may interfere with the absorption of light. This is especially true for spectrophotometric assays. Hemolysis also may interfere with test results by releasing analytes normally found in red blood cells into patients’ serum or plasma. Examples of elevated analytes as a result of specimen hemolysis are potassium and lactate dehydrogenase. The authors used the College of American Pathologists’ Surveys program to query CAP Chemistry Survey participants about their hemolysis practices. They received responses from 24 percent (846 of 3,495) of the participants. Many had written hemolysis policies for potassium (85 percent), lactate dehydrogenase (69 percent), and glucose (55 percent), but fewer had standardized hemolysis reports between their primary and secondary chemistry analyzers for these three analytes. Forty-nine percent of participants took corrective action to reduce hemolysis during the past year and used, on average, 2.4 different approaches. These corrective actions included collecting and distributing data to administration, troubleshooting outliers, retraining phlebotomists, and establishing quality improvement teams. When asked to comment about progress with corrective actions, 70 percent noted slow to no progress and two percent reported giving up on improvement. In summary, hemolysis continues to be a barrier for laboratory testing, and many of the issues point to concerns with techniques during collection of blood samples. Practices for measuring, reporting, and reducing hemolysis rates need to be improved.

Howanitz PJ, Lehman CM, Jones BA, et al. Clinical laboratory practices when hemolysis occurs. Arch Pathol Lab Med. 2015;139:901–906.

Correspondence: Dr. Peter J. Howanitz at peter.howanitz@downstate.edu