In Vitro and In Vivo Hemolysis: An Unresolved Dispute in Laboratory Medicine (Patient Safety Book 4)

Defined as red blood cell break down and the release of hemoglobin and intracellular contents into the plasma, hemolysis can seriously impact patient care as well as the laboratory's reputation through its affect on test results. Therefore, the European Preanalytical Scientific Committee, in collaboration with the International Federation of Clinical Chemistry Working Group on Patient Safety, have designed a questionnaire to collect data on prevalence and management of hemolytic specimens referred to the clinical laboratories for clinical chemistry testing. This book will help identify the areas where hemolysis occurs most frequently, which can, in turn, guide further analysis about why it is occurring. Once these elements are known, practices and procedures can be implemented to dramatically reduce hemolysis and avoid erroneous laboratory results affecting patient care and increasing laboratory costs. * Introduces clinically relevant findings about hemolysis * Indicates possible laboratory errors caused by hemolysis * Covers management of hemolytic specimens In Vitro and In Vivo Hemolysis: An Unresolved Dispute in Laboratory Medicine 4 Contents 6 Preface 8 1 Structure and function of red blood cells 10 2 Red blood cell parameters 12 2.1 Hematocrit 12 2.2 Mean corpuscular volume 12 2.3 Mean corpuscular hemoglobin 12 2.4 Mean corpuscular hemoglobin concentration 13 2.5 Red blood cell distribution width 13 3 Definition of hemolysis 16 4 Prevalence of hemolyzed specimens in clinical laboratories 18 5 In vivo hemolysis 24 5.1 Causes 24 5.2 Clinical presentation 27 5.3 Diagnosis of hemolytic anemia 28 6 In vitro hemolysis 30 6.1 Unsuitable procedures during blood collection 30 6.2 Blood collection with various devices and needles 33 6.2.1 Blood collection by syringe 33 6.2.2 Blood collection from intravenous catheters 34 6.2.3 Blood collection from butterfly devices 36 6.2.4 Blood collection with small-bore needles 37 6.2.5 Blood collection through spring-loaded and manual lance devices 38 6.3 Sample transportation and storage 40 6.4 Centrifugation of the specimen 42 7 How to distinguish in vivo versus in vitro hemolysis 44 8 Effects of in vitro hemolysis on laboratory testing 48 8.1 Interference in clinical chemistry testing 48 8.1.1 Mechanism of interference 52 8.1.2 Interference due to the delta between intracellular and extracellular concentrations of the analytes 53 8.1.3 Spectrophotometric interference 54 8.1.4 Chemical interference 54 8.1.5 Additional considerations regarding interference 55 8.2 Interference in hemostasis testing 56 8.3 Interference in immunoassays and electrophoresis 58 8.4 Interference in ABO type and antibody screen testing 61 9 Spurious hemolysis and veterinary medicine 64 9.1 Blood collection from small animals and pets 64 9.2 Interference of hemolysis in veterinary laboratory medicine 64 10 Detection of hemolyzed specimens 66 11 Management of hemolyzed specimens 72 11.1 Local evaluation of the bias 72 11.1.1 Preparation of the hemolysate 73 11.1.2 Measurement of hemoglobin in biological samples 75 11.1.3 The “reference” serum or plasma specimens 77 11.1.4 Definition of the allowable bias 77 11.2 Surveys and recommendations 78 11.3 General indications for preventing hemolysis during blood collection 78 11.4 Preventing hemolysis from intravenous catheters 80 11.5 Reliable identification of hemolyzed specimens 81 11.6 Management of test results on hemolyzed specimens 82 11.6.1 Data correction for the degree of hemolysis 83 11.6.2 Report results with interpretative comments 85 11.6.3 Suppress test results, warn clinicians, and ask for new specimens 85 12 The challenge of synthetic blood substitutes 90 12.1 Individual studies evaluating the interference of blood substitutes 90 12.2 Detection and quantification of blood substitutes 95 12.3 Final remarks on blood substitutes 97 References 98 Index 110

Defined as red blood cell break down and the release of hemoglobin and intracellular contents into the plasma, hemolysis can seriously impact patient care as well as the laboratory's reputation through its affect on test results. Therefore, the European Preanalytical Scientific Committee, in collaboration with the International Federation of Clinical Chemistry Working Group on Patient Safety, have designed a questionnaire to collect data on prevalence and management of hemolytic specimens referred to the clinical laboratories for clinical chemistry testing. This book will help identify the areas where hemolysis occurs most frequently, which can, in turn, guide further analysis about why it is occurring. Once these elements are known, practices and procedures can be implemented to dramatically reduce hemolysis and avoid erroneous laboratory results affecting patient care and increasing laboratory costs.

Defined as red blood cell break down and the release of hemoglobin and intracellular contents into the plasma, hemolysis can seriously impact patient care as well as the laboratory's reputation through its affect on test results. Therefore, the European Preanalytical Scientific Committee, in collaboration with the International Federation of Clinical Chemistry Working Group on Patient Safety, have designed a questionnaire to collect data on prevalence and management of hemolytic specimens referred to the clinical laboratories for clinical chemistry testing. This book will help identify the areas where hemolysis occurs most frequently, which can, in turn, guide further analysis about why it is occurring. Once these elements are known, practices and procedures can be implemented to dramatically reduce hemolysis and avoid erroneous laboratory results affecting patient care and increasing laboratory costs. Giuseppe Lippi and Gianfranco Cervellin, Azienda Ospedaliero-Universitaria di Parma, Italy;Emmanuel J. Favaloro, Westmead Hospital, Australia; Mario Plebani, Università degli Studi di Padova, Padua, Italy Defined as red blood cell break down and the release of hemoglobin and intracellular contents into the plasma, hemolysis can seriously impact patient care as well as the laboratory's reputation through its affect on test results. Therefore, the European Preanalytical Scientific Committee, in collaboration with the International Federation of Clinical Chemistry Working Group on Patient Safety, have designed a questionnaire to collect data on prevalence and management of hemolytic specimens referred to the clinical laboratories for clinical chemistry testing. This book will help identify the areas where hemolysis occurs most frequently, which can, in turn, guide further analysis about why it is occurring. Once these elements are known, practices and procedures can be implemented to dramatically reduce hemolysis and avoid erroneous laboratory results affecting patient care and increasing laboratory costs. --Book Jacket Defined as red blood cell break down and the release of hemoglobin and intracellular contents into the plasma, haemolysis can seriously impact patient care as well as the laboratory's reputation through its affect on test results. Therefore, the European Preanalytical Scientific Committee, in collaboration with the International Federation of Clinical Chemistry Working Group on Patient Safety, have designed a questionnaire to collect data on prevalence and management of haemolytic specimens referred to the clinical laboratories for clinical chemistry testing. The new book will help identify the areas where haemolysis occurs most frequently, which can, in turn, guide further analysis about why it is occurring. Once these elements are known, practices and procedures can be implemented to dramatically reduce haemolysis and avoid erroneous laboratory results affecting patient care and increasing laboratory costs.