Inadequate hemolysis of erythrocytes on reagent strips at low pH causes false-negative readings

Patients' urines gave an unexpectedly high percentage of false-negative results for erythrocytes on a reagent strip, even when the test field for ascorbic acid indicated that none of this substance was present to inhibit the test reaction. By adding known amounts of erythrocytes to normal urines, we found that this phenomenon was time-dependent and occurred with three different brands of reagent strips in urines having a pH below 6.0. Hemolysis of erythrocytes was totally inhibited below pH 5.1 after 4 h of incubation with 50 X 10(6) erythrocytes per liter. The inhibition is apparently caused by shrinkage of the erythrocytes, rending them insensitive to the hemolytic agents in the different reagent strips tested.