The percentages of hemolyzed specimens were similar in the internal medicine and surgery departments (3.1%), intensive care units (3.5%), the emergency department (3.3%), and in the department of organ transplantation (3.4%). Although hemolyzed specimens may reflect the presence of hemolytic anemia, in most cases they are due to preanalytical sources related to incorrect procedures or failure to follow procedures for collection, handling and storage of the samples; some of these are typical of the ED. Paolo Carraro and others, Hemolyzed Specimens: A Reason for Rejection or a Clinical Challenge?, Clinical Chemistry, Volume 46, Issue 2, 1 February 2000, Pages 306307, https://doi.org/10.1093/clinchem/46.2.306. We identified 505 hemolyzed specimens (3.3%); of these, 64% were affected by a small degree (<50 mg/L of hemoglobin) of hemolysis, 31% by an intermediate degree, and 5% by a high degree (>300 mg/L of hemoglobin). No funding was received for this study. Blood specimen rejection rate in clinical laboratory: A systematic review and meta-analysis. But before we master the art of preventing hemolysis, we have to understand how it occurs. Definition Holloway/Getty Images Hemolysis is the breakdown of RBCs. Influence of Selective Extraction/Isolation of Heme/Hemoglobin with Hydrophobic Imidazolium Ionic Liquids on the Precision and Accuracy of Cotinine ELISA Test. During a prolonged hospitalization, a patient requiring many lab tests may develop what condition as a result of multiple blood samples being drawn? The potential adverse effects of haemolysis. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. The body typically performs hemolysis in the spleen. Pakula PD, Halama A, Al-Dous EK, Johnson SJ, Filho SA, Suhre K, Vinardell T. Front Vet Sci. government site. A comprehensive scheme for the systematic investigation of hemolytic anemia. When this happens, it is usually not possible to get a test result. On the other hand, if the first sample is hemolyzed and the subsequent sample is also hemolyzed, the likely cause would be in vivo hemolysis, and a clinical history is required to support this hypothesis. Clinical applications of hemolytic markers in the differential diagnosis and management of hemolytic anemia. Policy. This is nearly five-times higher than other causes such as clotted samples, inadequate procedures for collection, insufficient volume, and incorrect samples.1,5 In vitro hemolysis is the leading cause of specimen rejection for both outpatient and inpatient samples, as well as urgent and routine specimens.6-9, In vivo hemolysis occurs as a result of the premature death of red blood cells (RBCs) within the circulation, which can cause hemolytic anemia when active bone marrow is unable to compensate for the amount of RBC breakdown.10,11 The etiology of premature RBC death varies and can be due to antigen-antibody reactions, chemical reaction, hemolytic anemias, toxins and poisonous substance, mechanical RBC rupture due to artificial heart valves, and medical intervention such as hemodialysis or the use of the heart-lung bypass machine.1,12-15 Usually, less than 2% of all samples with detectable hemolysis are due to in vivo hemolysis.16 Since in vivo hemolysis does not rely on the skills and practice of healthcare providers, preventing its occurrence can be very difficult, and it may not be completely resolved.17 Rejection of suspected in vivo hemolysis samples is considered malpractice. If they suspect hemolytic anemia, they may request the following tests: Treatment options will depend on the cause of hemolysis. 1,45 Visual detect. This can include deformities in the cell structure and metabolism or in the hemoglobin structure. As RBCs age, they begin to lose certain properties and work less efficiently. We do not endorse non-Cleveland Clinic products or services. You can, however, reduce your risk for serious illness by talking to your healthcare provider any time you develop symptoms that may be anemia. A complete blood count (CBC) is one of the preliminary tests they may do. The authors declared no conflicts of interest. Federal government websites often end in .gov or .mil. Hemolysis may also be due to pathological conditions, such as immune reactions, infections, medications, toxins and poisons, and therapeutic procedures. Avoid infections by washing your hands and avoiding people when theyre sick. Diagnosis and management. 2021;00:1-7). In cases of hyperbilirubinemia, levels will exceed 1.5 mg/dL and plasma will become affected. We do not endorse non-Cleveland Clinic products or services. Comparison of visual vs. automated detection of lipemic, icteric and hemolyzed specimens: can we rely on a human eye? Oxford University Press is a department of the University of Oxford. The most common form of AIHA in children is due to warm-reactive antibodies. Unreliable visual estimation of the incidence and amount of turbidity, hemolysis, and icterus in serum from hospitalized patients. The average life span of a healthy RBC is roughly 4 months. Lactate dehydrogenase as a biomarker of hemolysis-associated nitric oxide resistance, priapism, leg ulceration, pulmonary hypertension, and death in patients with sickle cell disease. As a library, NLM provides access to scientific literature. Your red blood cells are an essential part of your blood. Hemolytic specimen is still a major concern to laboratory specialists worldwide. Over a 30-day observation period, we evaluated 27 540 blood specimens from 15 323 sample requests for clinical chemistry, coagulation, and toxicological tests. Further investigations in combination with clinical history, physical examination, and peripheral blood smear are essential for the differentiation of in vivo or in vitro hemolysis.12,18, In vitro hemolysis is a result of pre-analytical causes associated with sample collection, jarring transportation methods, extreme temperature, sample handling, delayed processing, and prolonged storage.19-21 Hemolysis resulting from phlebotomy may be caused by incorrect needle size, improper tube mixing, incorrect filling of tubes, excessive suction, prolonged tourniquet, and difficult collection. All rights reserved. Hence, in this form of hemolysis, the potassium values are correct. (https://pubmed.ncbi.nlm.nih.gov/32777816/#:~:text=In%20this%20study%2C%20we%20provide,process%20of%20phagocytosing%20intact%20erythrocytes.). Hemolytic Anemia: Evaluation and Differential Diagnosis | AAFP Hemolysis may be due to specimen collection, processing, or transport. Complications due to hemolytic anemia can include: Arrhythmia, cardiomyopathy, heart failure, and iron deficiency are other possible complications. Hemolysis or haemolysis ( / himlss / ), [1] also known by several other names, is the rupturing ( lysis) of red blood cells (erythrocytes) and the release of their contents ( cytoplasm) into surrounding fluid (e.g. Pretlow L, Gandy T, Leibach EK, Russell B, Kraj B. Lippi G, Bonelli P, Graiani V, Caleffi C, Cervellin G. Clin Biochem. Having too few red blood cells because of hemolysis causes a condition called hemolytic anemia. Due care must be taken since this practice might introduce bias and depending on the multiplier used may cause inaccurate or false results.22 It would also be of paramount importance to discuss and educate clinicians of the method applied so that the result would not be mistakenly interpreted or ignored by the respective clinicians.22, The management of hemolyzed samples remains an unsettled dilemma given the available options. eCollection 2023 Jan. Flieger J, Tatarczak-Michalewska M, Flieger W, Baj J, Buszewicz G, Teresiski G, Maciejewski R, Wawrzykowski J, Przygodzka D, Lutsyk V, Paziski W. Int J Mol Sci. Hemolysis: Types, Causes & Symptoms - Cleveland Clinic Cadamuro J, Simundic A-M, Ajzner E, Sandberg S. A pragmatic approach to sample acceptance and rejection. Plebani M, Carraro P. Mistakes in a stat laboratory: types and frequency. This can be accomplished by transporting samples to the laboratory without mechanical agitation (for example, avoiding pneumatic tube transport), taking blood in a lithium heparin container, and immediate separation of plasma from cells. Clinical laboratories must improve the preanalytical phase, a phase highly susceptible to mistakes (1). National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention. a. transcription time b. error reduction time c. turnaround time d. reporting time c. turnaround time The phlebotomist has the greatest impact on which phase of laboratory testing? Free Flashcards about MCC Phlebotomy exam - StudyStack Haemolysis as an influence and interference factor in clinical chemistry. Using a small-gauge needle and a large vacuum tube During a prolonged hospitalization, a patient requiring many lab tests may develop what condition as a result of multiple blood samples being drawn? Yet another cause was hemolysis caused by forcing blood from a syringe into a tube, which was confirmed by observing a difference in the degree of hemolysis in the different tubes filled with blood from the same syringe. This site needs JavaScript to work properly. However, the diagnostic value of haptoglobin is restricted by impaired liver function test with the decrease of haptoglobin synthesis.36 The presence of concomitant infection or chronic hemolysis should be ruled out given haptoglobin is also an acute phase reactant, and the diagnostic reliability of haptoglobin has been questioned as a marker of hemolysis. Cases suspected of in vivo hemolysis should include certain analytes such as potassium, which provides clinicians with vital information and identification of clinical situations that require urgent intervention. Kato GJ, McGowan V, Machado RF, Little JA, Taylor J, VI, Morris CR, et al. In vitro and in vivo hemolysis: an unresolved dispute in laboratory medicine. In most cases it was possible to relate the presence of hemolysis to a specific cause because of the cooperation of phlebotomists and nurses, and only 26 (5.1%) cases remained unresolved (Table 1 ). Therefore, serologic testing is not recommended for a serum . Department of Chemical Pathology, School of Medical Sciences, Universiti Sains, Kelantan, Malaysia. Phlebotomy: Chapter 12 Self Study Flashcards | Quizlet 8600 Rockville Pike % Hemolyzed Specimens from July 2009 to December 2009 Specimens Collected By ECC Staff, Hospitalwide Staff & Phlebotomy Staff 0.2 10.4 4.9 2.4 0.3 0.6 1 . As RBCs begin to lose functionality, they accumulate signals that initiate erythrocyte turnover. In vitro hemolysis generates analytical and biological interferences.11,24-27 The impact of in vitro hemolysis on measured potassium concentrations is well documented. An emerging challenge for clinical laboratories is to differentiate between in vivo and in vitro hemolysis. The site is secure. Sometimes, people have mild hemolytic anemia symptoms that go away after treatment. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information. This refers to a protein that may be present on the surface of RBCs. Unit 4 Chapters 11, 12, 14 Flashcards | Chegg.com Remove the tourniquet and needle A phlebotomy technician is teaching a patient about collecting a sputum specimen at home. Hemolyzed specimens cause increased lab turnaround time and patient dissatisfaction due to re-collection. 144. The term hemolysis designates the pathological process of breakdown of red blood cells in blood, which is typically accompanied by varying degrees of red tinge in serum or plasma once the whole blood specimen has been centrifuged. Errors in clinical laboratories or errors in laboratory medicine? Other times, hemolytic anemia happens as a reaction to certain infections and medications. Baek S-W, Lee M-W, Ryu H-W, Lee K-S, Song I-C, Lee H-J, et al. Mycoplasma pneumonia, lymphoma, leukemia, lupus and rheumatoid arthritis are just a few conditions that can cause your immune system to attack your red blood cells. Baldwin Caitlyn, Pandey Jyotsna, Olarewaju Olubunmi. Centrifuge samples for serum separation within 4 hours of sample collection. A healthcare provider will perform a blood draw to check for problems related to hemolysis. Last reviewed by a Cleveland Clinic medical professional on 08/15/2022. Hemolysis: Symptoms, Outlook, Treatment, and More - Healthgrades Red blood cells, also known as erythrocytes, contain hemoglobin molecules which are released during hemolysis. (d) A consensus between the medical laboratory and clinicians should be reached to assure the correct use of and improvement in these guidelines. People may develop hemolytic anemia by inheriting genetic conditions that cause anemia, certain infections and certain medications. Typically, the body will destroy old or damaged RBCs in the spleen or in other parts of the body through a process known as hemolysis. Quality gap: hemolyzed blood samples. Chemistry specimen acceptability: a College of American Pathologists Q-Probes study of 453 laboratories. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Disclaimer. Identification of the haemoglobin scavenger receptor. Careers. Some medications may cause your immune system to attack your red blood cells, destroying them prematurely. official website and that any information you provide is encrypted Causes, consequences and management of sample hemolysis in the - PubMed This refers to a group of conditions that present with symptoms similar to those of other types of anemia, due to hemolysis occurring too fast or too often. They may perform any of the following tests to determine if your blood cell count is low because of hemolysis. Satisfactory skills and a relevant and good level of knowledge and experience are essential to collect a quality specimen that produces anticipated and accurate results. Talk to your healthcare provider whenever youre concerned about changes in your body that dont go away. Sometimes, problems related to a cells structure or components shorten its lifespan. In vivo hemolysis occurs as a result of the premature death of red blood cells (RBCs) within the circulation, which can cause hemolytic anemia when active bone marrow is unable to compensate for the amount of RBC breakdown. Plebani M, Lippi G, Cervellin G, Favaloro EJ. MeSH In this article, we discuss hemolysis in detail, including its potential causes and treatment options. A person will receive RHIg as an injection at 28 weeks of pregnancy to prevent the production of antibodies, and within 72 hours of delivering the baby with Rh-positive blood to prevent the production of antibodies that could affect a future pregnancy. Other cardiac devices used to treat cardiac shock, including intra-aortic balloon pumps and Impella devices. Results of an interlaboratory study. Samples diluted 1:20 may show lipid interference; this may be removed by increasing the dilutions up to 1:400. Some suggestions that may help you to manage anemia include: Hemolytic anemia happens when something is destroying your red blood cells. If tests are performed within 48 hours of collection, transfer serum to a sample tube (cryovial) and store at 4C. Omar E, Allen JC, Jamil AKBM, Iskandar MFKB, Norbu K, Tsang C, Yin J, Ganti S, Siew Kim O, Hock MOE. Hassan KS, Al-Riyami AZ, Al-Huneini M, Al-Farsi K, Al-Khabori M. Methemoglobinemia in an elderly patient with glucose-6-phosphate dehydrogenase deficiency: a case report. In other cases, symptoms can be more severe. Red blood cells normally live for about 120 days. Reporting a critical lab value on the wrong patient b. Collection technique is most often the cause of hemolysis. Get useful, helpful and relevant health + wellness information, 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK558904/). Grafmeyer D, Bondon M, Manchon M, Levillain P. The influence of bilirubin, haemolysis and turbidity on 20 analytical tests performed on automatic analysers. Hemolysis has the potential to render all test results unreliable causing avoidable delays in patient care. The hemolyzed specimen: causes, effects, and reduction. The most prevalent pre-analytical interference and a major source of error producing unreliable laboratory test results is hemolysis of blood samples. C. hemolysis . official website and that any information you provide is encrypted J Forensic Sci. A person exhibiting early signs of anemia should consult a doctor for a prompt diagnosis and treatment. Serum samples that match colors with 100 mg/dL or darker should not be processed by serology testing. Red blood cell population dynamics. Symptoms depend on how low your red blood cell supply is. Prevent Mosquito and Tick Bites, Vector-Borne Diseases Social Media Toolkit, U.S. Department of Health & Human Services, Print the palette from a color printer. Practice Exam (NCCT) Flashcards | Chegg.com blood plasma ). Hemolyzed specimens: a major challenge for emergency - PubMed Conditions involving red blood cell structural defects involve: Autoimmune hemolytic anemia (AIHA) is a rare disorder where your immune system attacks your red blood cells. The effect of sample hemolysis on blood ethanol analysis using headspace gas chromatography. Hemolytic anemia symptoms may look and feel like less serious conditions. Bonini P, Plebani M, Ceriotti F, Rubboli F. Errors in a stat laboratory: types and frequencies 10 years later. Structural irregularities in a red blood cell can cause it to get destroyed too soon. Serum samples containing more than 100 mg/dL of hemoglobin can cause non-specific binding in serologic tests. If your count isnt too low, you may not notice symptoms. Once a whole blood specimen is hemolyzed, the hemoglobin molecules within the red blood cells are released causing the serum or plasma to have pink to red color. In vitro hemolysis may be due to the blood withdrawal technique or sample handling whereas in vivo hemolysis can originate from acquired, hereditary, or iatrogenic conditions and is not technique dependent. Possible symptoms may include: Symptoms of severe hemolytic anemia may include: Hemolytic disease of the newborn, which health experts also call erythroblastosis fetalis, is a blood condition in which a rhesus (Rh) factor incompatibility occurs during pregnancy. Ideguchi H, Ishikawa A, Futata Y, Yamada Y, Ono Y, Sugisaki S, et al. PMC Jones BA, Calam RR, Howanitz PJ. PDF CRITERIA FOR SPECIMEN REJECTION The following are criteria with which But the result may be of clinical use in cases of in vivo hemolysis whereby the availability of potassium result, which had perhaps mounted acutely in a relatively short time, could have led to earlier dialysis treatment.28 The other option would be to perform the test and analysis but to report the result with a remark on the clinical interpretation of the values. Neonatal intensive care unit quality initiative: identifying preanalytical variables contributing to specimen hemolysis and measuring the impact of evidence-based practice interventions. When the cells in the blood do not function as they should, it is possible a person has a blood disorder. Kara H, Bayir A, Ak A, Degirmenci S, Akinci M, Agacayak A, et al.