Cases & Commentaries
In the emergency department, an older man with multiple medical conditions was found to have evidence of acute kidney injury and an elevated serum potassium level. However, the blood sample was hemolyzed, which can alter the reading. Although the patient was admitted and a repeat potassium level was ordered, the physician did not institute treatment for hyperkalemia. Almost immediately after the laboratory called with a panic result indicating a dangerously high potassium level, the patient went into cardiac arrest. Christopher M. Lehman, MD, of the University of Utah, reviews common causes of hemolysis and describes best practices for decreasing hemolysis rates.
TableTable. Evidence-based Practices for Reducing Specimen Hemolysis Rates.
|Straight needle venipuncture rather than collection from an intravenous catheter|
|Use of ≤ 21 gauge needle (lower gauges are larger)|
|Use of partial vacuum tubes|
|If an IV is used, draw from antecubital sites|