Buño Antonio, Oliver Paloma
Clinical Laboratory Department, Hospital Universitario La Paz, Madrid, Spain.
Adv Lab Med. 2021 Dec 30;3(2):142-152. doi: 10.1515/almed-2021-0079. eCollection 2022 Jun.
Point-of-care-testing (POCT) facilitates rapid availability of results that allows prompt clinical decision making. These results must be reliable and the whole process must not compromise its quality. Blood gas analyzers are one of the most used methods for POCT tests in Emergency Departments (ED) and in critical patients. Whole blood is the preferred sample, and we must be aware that hemolysis can occur. These devices cannot detect the presence of hemolysis in the sample, and because of the characteristics of the sample, we cannot visually detect it either. Hemolysis can alter the result of different parameters, including potassium with abnormal high results or masking low levels (hypokalemia) when reporting normal concentrations. Severe hyperkalemia is associated with the risk of potentially fatal cardiac arrhythmia and demands emergency clinical intervention. Hemolysis can be considered the most frequent cause of pseudohyperkalemia (spurious hyperkalemia) or pseudonormokalemia and can be accompanied by a wrong diagnosis and an ensuing inappropriate clinical decision making. A complete review of the potential causes of falsely elevated potassium concentrations in blood is presented in this article. POCT programs properly led and organized by the clinical laboratory can help to prevent errors and their impact on patient care.
即时检验（POCT）有助于快速获得结果，从而实现迅速的临床决策。这些结果必须可靠，并且整个过程绝不能损害其质量。血气分析仪是急诊科（ED）和重症患者POCT检测中最常用的方法之一。全血是首选样本，我们必须意识到可能会发生溶血。这些设备无法检测样本中是否存在溶血，而且由于样本的特性，我们也无法通过肉眼检测到溶血。溶血会改变不同参数的结果，包括钾离子，导致结果异常升高，或者在报告正常浓度时掩盖低钾水平（低钾血症）。严重高钾血症与潜在致命性心律失常的风险相关，需要紧急临床干预。溶血可被视为假性高钾血症（假性高钾血症）或假性正常血钾血症最常见的原因，可能会导致错误诊断以及随之而来的不恰当临床决策。本文全面综述了血液中钾浓度假性升高的潜在原因。由临床实验室妥善领导和组织的POCT项目有助于预防错误及其对患者护理的影响。
