Handling Hemolytic Blood Samples from High-Risk Clinical Areas: A Call to Action

Area of Science:

• Clinical Chemistry
• Preanalytical Errors
• Laboratory Medicine

Background:

• Hemolysis detection is vital for accurate lab results, particularly in emergency and intensive care units.
• Despite known causes and prevention, hemolysis remains a frequent preanalytical error.
• Point-of-care analyzers increasingly incorporate direct hemolysis detection technology.

Framework:

• Summarizes the medical significance of in vitro hemolysis from clinical and laboratory perspectives.
• Differentiates in vivo and in vitro hemolysis causes, noting their indistinguishability in routine analysis.
• Reviews hemolysis detection methods and perspectives in American and European clinical laboratories.

Implementation:

• In vivo hemolysis stems from genetic factors, hemoglobinopathies, and mechanical support.
• In vitro hemolysis has numerous causes, with ED and ICU patients being highly susceptible.
• Mandatory implementation of hemolysis index testing is not universal, despite recommendations.

Implications:

• Highlights the risk of erroneous potassium results and subsequent patient harm.
• Emphasizes the need for education on hemolysis prevention and detection.
• Recommends standardized reporting, monitoring, and laboratory practices for hemolysis testing.