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Practical recommendations for managing hemolyzed samples in clinical chemistry testing.

Giuseppe Lippi1, Janne Cadamuro2, Alexander von Meyer3

  • 1Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37100 - Verona, Italy.

Clinical Chemistry and Laboratory Medicine
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Summary

Managing hemolyzed samples in clinical chemistry requires a pragmatic approach. Automatic hemolysis index (H-index) measurement guides result release, balancing data quality with clinical urgency.

Keywords:
hemolysisinterferencequalitysafety

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Area of Science:

  • Clinical Chemistry
  • Laboratory Medicine
  • Preanalytical Variables

Background:

  • Hemolysis is a common preanalytical issue affecting clinical chemistry tests.
  • Accurate management of hemolyzed samples is crucial for reliable patient diagnosis and treatment.
  • Current visual inspection methods for hemolysis are subjective and less reliable than automated assessments.

Purpose of the Study:

  • To propose a pragmatic strategy for managing clinical chemistry test results from hemolyzed adult/older child samples.
  • To balance the need for quality laboratory data with the clinical urgency of result release.
  • To provide clear guidelines based on the hemolysis index (H-index) for result reporting.

Main Methods:

  • Automated measurement of the hemolysis index (H-index) in serum or plasma.
  • Establishing decision criteria based on H-index values and their association with analytical and clinical bias.
  • Defining thresholds for releasing results, releasing with comments, or suppressing results based on H-index and analyte variation relative to the reference change value (RCV).

Main Results:

  • Automated H-index measurement is recommended over visual inspection.
  • Results with minimal analytical bias can be released.
  • Results with moderate bias (within RCV) can be released with cautionary comments.
  • Results with significant bias (exceeding RCV) or gross hemolysis (≥10 g/L cell-free hemoglobin) should be suppressed with advisories for sample recollection.

Conclusions:

  • A tiered approach using the H-index provides a systematic method for managing hemolyzed samples.
  • Corrective formulas for hemolysis are discouraged due to inaccuracy and imprecision.
  • This strategy optimizes the release of quality laboratory data while addressing clinical urgency.