Effects of hemolysis on routine biochemistry parameters

Ataturk Training and Research Hospital, Department of Biochemistry and Clinical Biochemistry, Izmir, Turkey.
Biochemia Medica (Impact Factor: 2.67). 02/2011; 21(1):79-85. DOI: 10.11613/BM.2011.015
Source: PubMed


Hemolysis is still the most common reason for rejecting samples, while reobtaining a new sample is an important problem. The aim of this study was to investigate the effects of hemolysis in different hemolysis levels for mostly used biochemical parameters to prevent unnecessary rejections.
Sixteen healthy volunteers were enrolled in the study. Four hemolysis levels were constituted according to hemoglobin concentrations and they were divided into five groups: Group I: 0-0.10 g/L, Group II:0.10-0.50 g/L, Group III: 0.51-1.00 g/L, Group IV: 1.01-2.50 g/L, Group V: 2.51-4.50 g/L. Lysis was achieved by mechanical trauma.
Hemolysis interference affected lactate dehydrogenase (LD) and aspartate aminotransferase (AST) almost at undetectable hemolysis by visual inspection (plasma hemoglobin < 0.5 g/L). Clinically meaningful variations of potassium and total bilirubin were observed in moderately hemolyzed samples (hemoglobin > 1 g/L). Alanine aminotransferase (ALT), cholesterol, gamma glutamyltransferase (GGT), and inorganic phosphate (P) concentrations were not interfered up to severely hemolyzed levels (hemoglobin: 2.5-4.5 g/L). Albumin, alkaline phosphatase (ALP), amylase, chloride, HDL-cholesterol, creatine kinase (CK), glucose, magnesium, total protein, triglycerides, unsaturated iron binding capacity (UIBC) and uric acid differences were statistically significant, but remained within the CLIA limits.
To avoid preanalytical visual inspection for hemolysis detection, improper sample rejection, and/or rerun because of hemolysis, it is recommended in this study that, routine determination of plasma or serum free hemoglobin concentrations is important. For the analytes interfered with hemolysis, new samples have to be requested.

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Available from: Serap Çuhadar, Sep 16, 2015
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    • "Inappropriate handling, mechanical or osmotic stress lead to rupture of erythrocyte membranes, resulting in the release of intracellular components into the blood sample. For many clinical routine parameters, haemolysis has been shown to significantly affect the outcome of laboratory measurements and haemolysis may lead to an overestimation of the true concentration in certain analytes [32] [33]. In children, Bellomo et al. have recently shown that haemolysis results in falsely low immunoreactive insulin concentrations. "
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    • "To study the effect of in vitro hemolysis, procedure of Mehmet et al., (2011) was used where four samples were drawn from the healthy volunteers through the needles of 5 mL syringe (1.5 inch, 21 gauge) speedily for 2, 4, 6 and 8 times respectively to lyse the cells by mechanical trauma to obtain slightly, mildly, moderately and severely hemolyzed samples. They were all centrifuged at 1000 x g for 15 minutes and sera were collected. "
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