Barbato Lorenzo, Campelo Marise Danielle, Pigozzo Sara, Realdon Nicola, Gandini Anna, Barbazza Roberto, Coêlho Mayara Ladeira, Bovo Chiara, Marini Paola, Lima-Oliveira Gabriel
Pharmacy, University Hospital of Verona, Italy.
Clinical Laboratory Bioanalise, Teresina, Piaui, Brazil.
EJIFCC. 2020 Mar 20;31(1):15-20. eCollection 2020 Mar.
hemolysis is the primary cause of sample/test rejection by the laboratory.
A 10-year-old, admitted with an asthma attack in the emergency-room, medicated with albuterol sulphate (intravenous bronchodilator that could induce hypokalemia), needed laboratory test monitoring. The physician prescribed the technical-nurse to perform blood sampling for: complete blood count, electrolytes, glucose, and blood gas analysis-within 30min after therapy. Samples were delivered to laboratory with a note "I had difficult to locate an appropriate access to perform the blood collection".
Glucose: 4.77 mmol/L. Complete blood count revealed discreet eosinophilia 0.13x10/L, and thrombocytopenia 18x10/L. However, platelet clumps were observed in peripheral blood smear. Blood gas analysis was unreported, laboratory informed that sample had micro clots.Electrolytes: laboratory did not report the results; 0.9 g/L of free hemoglobin is the cut-off defined by the laboratory; the sample presented 2.3 g/L of free hemoglobin. 3.9 mmol/L of potassium was the unreported result vs 2.1 mmol/L in the new sample.Briefly, the laboratory technician was trained to hide potassium results on hemolyzed sample due to the potential overestimation. Even if the hemolyzed sample presented a potassium value close to the lower reference range value (3.5-5.1 mmol/L), reporting the potassium result could allow the physician starting proper therapy to revert the hypokalemia by albuterol sulfate.
The laboratory should be aware of the clinical patient conditions and of the related physician needs, before hiding results. Therefore, both the laboratory and the clinic personnel should communicate in order to guarantee the patient safety.
溶血是实验室拒收样本/检测的主要原因。
一名10岁儿童因哮喘发作在急诊室就诊，使用硫酸沙丁胺醇（一种可导致低钾血症的静脉支气管扩张剂）进行治疗，需要实验室检测监测。医生指示技术护士在治疗后30分钟内采集血液样本进行：全血细胞计数、电解质、葡萄糖和血气分析。样本送到实验室时附有一张纸条，上面写着“我很难找到合适的采血部位”。
葡萄糖：4.77 mmol/L。全血细胞计数显示轻度嗜酸性粒细胞增多0.13×10⁹/L，血小板减少18×10⁹/L。然而，在外周血涂片上观察到血小板聚集。血气分析未报告结果，实验室告知样本中有微凝块。电解质：实验室未报告结果；实验室定义的游离血红蛋白临界值为0.9 g/L；该样本游离血红蛋白含量为2.3 g/L。未报告的钾结果为3.9 mmol/L，而新样本中的钾结果为2.1 mmol/L。简而言之，由于可能存在高估情况，实验室技术人员接受过培训，对溶血样本隐藏钾结果。即使溶血样本的钾值接近参考范围下限值（3.5 - 5.1 mmol/L），报告钾结果也可使医生开始适当治疗以纠正硫酸沙丁胺醇引起的低钾血症。
在隐藏结果之前，实验室应了解患者的临床情况及相关医生的需求。因此，实验室和临床人员应进行沟通以确保患者安全。
