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Pediatric hemolysis in emergency departments: Prevalence, risk factors, and clinical implications

Nicholas Mielke1, Ray Lee2, Amit Bahl3

  • 1Creighton University School of Medicine, Omaha, Nebraska, United States of America.

Plos One
|March 21, 2024
PubMed

Insights

Hemolyzed laboratory samples are common in pediatric emergency departments, affecting 14% of encounters. Peripheral intravenous catheters (PIVCs) placed in the hand or wrist increase hemolysis risk and PIVC failure in infants.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Pathology
  • Laboratory Science

Background:

  • Hemolysis, the breakdown of red blood cells, is a common issue in laboratory sample collection.
  • Data on the prevalence and risk factors of hemolyzed samples in pediatric emergency departments (EDs) is limited.
  • Understanding hemolysis is crucial for accurate diagnostic testing in children.

Purpose of the Study:

  • To determine the prevalence of hemolyzed laboratory samples in a pediatric ED setting.
  • To identify risk factors associated with sample hemolysis.
  • To evaluate the clinical implications of hemolysis, including its impact on peripheral intravenous catheter (PIVC) failure.

Main Methods:

  • A multi-site observational cohort study was conducted in Metro Detroit, Michigan.
  • Included were pediatric patients (<18 years) undergoing PIVC placement and laboratory testing.
  • Hemolysis presence, risk factors, and PIVC failure were primary and secondary outcomes.

Main Results:

  • Out of 10,462 encounters, 14.0% had hemolyzed samples.
  • Infants (0-1 year) had the highest hemolysis rate (20.1%).
  • PIVCs in the hand/wrist were linked to increased hemolysis in toddlers/children and higher failure rates in infants.

Conclusions:

  • Hemolysis is a frequent complication in pediatric EDs, occurring at rates similar to adults.
  • Hand/wrist PIVC placement is associated with a higher risk of hemolysis and PIVC failure.
  • Consider alternative PIVC sites and further research into pediatric hemolysis implications is recommended.
Abstract

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