Postgraduate School of Emergency Medicine, Sapienza University of Rome, 00185 Rome, Italy.
Emergency Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy.
Medicina (Kaunas). 2022 Dec 28;59(1):66. doi: 10.3390/medicina59010066.
Background and Objectives: Hemolysis is reported to be present in up to 10% of blood gas specimens in the central lab; however, few data on the incidence of hemolysis using a point-of-care testing (POCT) blood gas analysis are available in the setting of the emergency department. The aims of this study were: (1) to analyze the prevalence of hemolysis in blood gas samples collected in the ED using a POCT device; and (2) to evaluate the impact of hemolysis on blood sample results and its clinical consequences. Materials and Methods: We collected 525 consecutive POCT arterial blood gas samples using syringes with electrolyte-balanced heparin within 3 different EDs in the metropolitan area of Rome. Immediately after the collection, the blood samples were checked for the presence of hemolysis with a POCT instrument (i.e., HEMCHECK, H-10 ®). The samples were then subsequently processed for blood gasses, and an electrolytes analysis by a second operator blinded for the hemolysis results. A venous blood sample was simultaneously collected, analyzed for it’s potassium value, and used as a reference. Results: Of the samples, 472 were considered for the statistics, while 53 were excluded due to the high percentage of hemolysis due to operator fault in carrying out the measurement. The final mean hemolysis per operator was 12% (±13% SD), and the total final hemolysis was 14.4%.Potassium (K+) was significantly higher in the hemolyzed group compared with the non-hemolyzed sample (4.60 ± 0.11 vs. 3.99 ± 0.03 mEq/L; p < 0.001), and there were differences between arterial potassium versus venous potassium (D(a-v) K+, 0.29 ± 0.06 vs.−0.19 ± 0.02 mEq/L, p < 0.01). A Bland−Altman analysis confirmed that hemolysis significantly overestimated blood potassium level. Conclusion: Almost 12% of POCT blood gas analysis samples performed in the ED could be hemolyzed, and the presence of this hemolysis is not routinely detected. This could cause an error in the interpretation of the results, leading to the consideration of potassium concentrations being below the lower limit within the normal limits and also leading to the diagnosis of false hyperkalemia, which would have potential clinical consequences in therapeutic decision-making in the ED. The routine use of a POCT hemolysis detector could help prevent any misdiagnoses.
据报道，中心实验室中多达 10%的血气标本存在溶血；然而，在急诊科使用即时检验（POCT）血气分析时，关于溶血发生率的数据很少。本研究的目的是：（1）分析使用 POCT 设备在急诊科采集的血气样本中溶血的发生率；（2）评估溶血对血液样本结果及其临床后果的影响。
我们在罗马大都市区的 3 个不同急诊科使用装有电解质平衡肝素的注射器连续采集了 525 例连续的 POCT 动脉血气样本。采集后立即使用 POCT 仪器（即 HEMCHECK，H-10®）检查血液样本是否存在溶血。然后，由第二位操作人员对血液样本进行血气分析和电解质分析，该操作人员对溶血结果不知情。同时采集静脉血样，分析其钾值，并作为参考。
对 472 例样本进行了统计分析，而 53 例样本因操作人员在进行测量时操作失误导致溶血百分比过高而被排除在外。最终每位操作人员的平均溶血率为 12%（±13%SD），总溶血率为 14.4%。与非溶血样本相比，溶血组的钾（K+）值明显升高（4.60 ± 0.11 vs. 3.99 ± 0.03 mEq/L；p < 0.001），动脉钾与静脉钾之间存在差异（D(a-v)K+，0.29 ± 0.06 vs. -0.19 ± 0.02 mEq/L，p < 0.01）。Bland-Altman 分析证实溶血显著高估了血钾水平。
急诊科进行的 POCT 血气分析样本中，近 12%可能发生溶血，但这种溶血通常未被检测到。这可能导致对结果的解释出现错误，导致考虑钾浓度在正常范围内低于下限，并导致假性高钾血症的诊断，这可能在急诊科的治疗决策中产生潜在的临床后果。常规使用 POCT 溶血检测仪有助于防止任何误诊。
