Background Hemolysis is a major pre-analytical concern for most laboratory analytes. Detection of hemolysis and mitigation efforts are especially important for analytes, such as potassium, with high intracellular concentrations. Routine serum and plasma chemistry tests are performed on analyzers with the capacity to detect and measure the degree of hemolysis. However, for whole blood chemistries and blood gas measurements, the instruments utilized lack this capacity. The aim of this study was to evaluate the effect of hemolysis on whole blood and blood gas analytes and to compare visual assessments of hemolysis to measured hemolysis indices (H-index). Methods Remnant whole blood samples were split into two portions and each portion was aspirated and dispensed through a syringe one or more times. For the mock portion, only the syringe was used, while the hemolyzed portion had a needle affixed to the end of the syringe. The needle provided shear stress on the red blood cells to induce hemolysis, while the mock procedure was used to assess the impact of aspirating/dispensing on the sample in the absence of hemolysis. Each portion was then analyzed on a Radiometer ABL800 series instrument, spun down, and the H-index of the plasma portion was measured on a Roche cobas 8000 instrument. Medical technologists recorded their visual assessment of the specimens, with two technologists agreeing to the categorization of the specimen as either slightly, moderately, or severely hemolyzed. Degree of hemolysis was categorized by the delta (hemolyzed - mock) of the measured H-index: slight hemolysis was defined as an H-index delta of <100, moderate as 100-500 and severe as >500. Results The effect of hemolysis, with H-indices ranging from 2 to 3861, on 13 routine blood gas analytes was studied for 85 whole blood specimens. Hemolysis had little effect on metabolites, as percent bias was within ±3% at all levels of hemolysis for glucose, creatinine, and lactate. Similarly, most cooximetry components were minimally affected, with total hemoglobin, oxyhemoglobin, carboxyhemoglobin, and oxygen saturation within ±5% bias at all levels of hemolysis. Methemoglobin had a larger overall negative bias, with slight, moderate, and severe hemolysis levels yielding percent biases of -6.6, -12.3, and -13.3%, respectively. As expected, potassium displayed a significant positive bias with increasing hemolysis, with a generally linear trend. At moderate levels of hemolysis, the average potassium bias was 24.0% and at severe levels, over 100%. Sodium and ionized calcium also displayed overall linear trends but with a negative bias. At slight, moderate, and severe levels of hemolysis, sodium had a -0.56, -1.10, and -3.96% bias, and ionized calcium had a -2.99, -5.65, and -15.5% bias respectively. Conclusions Hemolysis can falsely increase or decrease a range of blood gas analytes and lead to misinterpretation of results and adversely affect clinical decision-making. Therefore, equipping current blood gas analyzers with hemolysis detection capabilities is crucial to enable laboratories to mitigate this effect and ensure accurate results for patient care.

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A-345 溶血对常规血气分析的影响


背景 溶血是大多数实验室分析物分析前的一个主要问题。溶血检测和缓解措施对于细胞内浓度较高的分析物（例如钾）尤其重要。常规血清和血浆化学测试是在能够检测和测量溶血程度的分析仪上进行的。然而，对于全血化学和血气测量，所使用的仪器缺乏这种能力。本研究的目的是评估溶血对全血和血气分析物的影响，并将溶血的视觉评估与测量的溶血指数（H 指数）进行比较。方法 将剩余的全血样本分成两部分，并通过注射器对每部分进行一次或多次抽吸和分配。对于模拟部分，仅使用注射器，而溶血部分则在注射器末端固定有针头。针头对红细胞提供剪切应力以诱导溶血，而模拟程序用于评估在没有溶血的情况下吸取/分配对样品的影响。然后在Radiometer ABL800系列仪器上分析每个部分，离心，并在Roche cobas 8000仪器上测量血浆部分的H指数。医疗技术人员记录了他们对标本的视觉评估，两名技术人员同意将标本分类为轻度、中度或严重溶血。溶血程度按测量的 H 指数的增量（溶血 - 模拟）进行分类：轻微溶血定义为 H 指数增量为 <100，中度溶血定义为 100-500，重度溶血定义为 >500。 结果 研究了 H 指数范围为 2 至 3861 的溶血对 85 个全血样本的 13 种常规血气分析物的影响。溶血对代谢物影响不大，因为葡萄糖、肌酐和乳酸的所有溶血水平的百分比偏差均在 ±3% 以内。同样，大多数血氧饱和度测定组件受到的影响最小，在所有溶血水平下，总血红蛋白、氧合血红蛋白、碳氧血红蛋白和氧饱和度偏差均在±5%以内。高铁血红蛋白具有较大的总体负偏差，轻度、中度和重度溶血水平产生的偏差百分比分别为-6.6、-12.3 和-13.3%。正如预期的那样，随着溶血的增加，钾表现出显着的正偏差，总体呈线性趋势。在中度溶血时，平均钾偏差为 24.0%，在严重溶血时，平均钾偏差超过 100%。钠和离子钙也显示出总体线性趋势，但存在负偏差。在轻度、中度和重度溶血水平下，钠的偏差分别为-0.56、-1.10和-3.96%，离子钙的偏差分别为-2.99、-5.65和-15.5%。结论 溶血会错误地增加或减少一系列血气分析物，导致结果的误解并对临床决策产生不利影响。因此，为当前的血气分析仪配备溶血检测功能对于实验室减轻这种影响并确保患者护理结果准确至关重要。