The Impact of Hemolysis-Index Thresholds on Plasma and Serum Potassium Measurements. 2022

Tiffany Yin, and Adrianna Z Herskovits
Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Modern clinical laboratory analyzers measure a hemolysis index (H-index) because test results can be inaccurate when intracellular contents from erythrocytes leak into serum or plasma. In 2020, Roche Diagnostics decreased the H-index from 90/100 to 20 for potassium, recommending that laboratories avoid using specimens with an H-index >20; however, there are a limited number of studies investigating the impact of this recommendation on patient testing. Out of 113 916 serum or plasma potassium tests performed within a 6-month interval, 72 patients with potentially hemolyzed potassium specimens (H-index >20) and a second non-hemolyzed specimen (H-index ≤20) within 2 h were identified. The clinical impact of decreasing the H-index and the utility of applying a corrective formula for adjusting potassium results were evaluated. The majority of initial test results either had small differences between original and corrected results that would not have affected clinical management or H-indices above the threshold previously recommended by Roche. We estimated the second sample was reported an average of 3 h 23 min after the initial sample was collected, with 95% CI [2 h 37 min to 4 h 8 min], and the median time delay was 2 h 44 min. Our analysis does not show a clear benefit from avoiding the use of potassium specimens above an H-index threshold of 20. Our findings suggest these practices may be detrimental in terms of patient safety due to increased turnaround time for a critical analyte.

UI MeSH Term Description Entries
D007753 Laboratories Facilities equipped to carry out investigative procedures. Laboratory
D011188 Potassium An element in the alkali group of metals with an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte that plays a significant role in the regulation of fluid volume and maintenance of the WATER-ELECTROLYTE BALANCE.
D006403 Hematologic Tests Tests used in the analysis of the hemic system. Blood Tests,Hematologic Test,Hematological Tests,Test, Hematologic,Tests, Hematologic,Blood Test,Hematological Test,Test, Blood,Test, Hematological,Tests, Blood,Tests, Hematological
D006461 Hemolysis The destruction of ERYTHROCYTES by many different causal agents such as antibodies, bacteria, chemicals, temperature, and changes in tonicity. Haemolysis,Extravascular Hemolysis,Intravascular Hemolysis,Extravascular Hemolyses,Haemolyses,Hemolyses, Extravascular,Hemolyses, Intravascular,Hemolysis, Extravascular,Hemolysis, Intravascular,Intravascular Hemolyses
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D064790 Clinical Laboratory Services Organized services provided by MEDICAL LABORATORY PERSONNEL for the purpose of carrying out CLINICAL LABORATORY TECHNIQUES used for the diagnosis, treatment, and prevention of disease. Laboratory Services, Clinical,Clinical Laboratory Service,Laboratory Service, Clinical,Service, Clinical Laboratory,Services, Clinical Laboratory

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