Annals of Laboratory Medicine

Korean Society for Laboratory Medicine (대한진단검사의학회)
권호 표지
DOI QR코드

DOI QR Code

Development of a Novel Quality Improvement Indicator Based on the Hemolysis Index

  • Lee, Eun Jin (Department of Laboratory Medicine, Hallym University College of Medicine) ;
  • Kim, Miyoung (Department of Laboratory Medicine, Hallym University College of Medicine) ;
  • Kim, Han-Sung (Department of Laboratory Medicine, Hallym University College of Medicine) ;
  • Park, Min-Jeong (Department of Laboratory Medicine, Hallym University College of Medicine) ;
  • Lee, Young Kyung (Department of Laboratory Medicine, Hallym University College of Medicine) ;
  • Kang, Hee Jung (Department of Laboratory Medicine, Hallym University College of Medicine)
  • Received : 2016.01.04
  • Accepted : 2016.07.05
  • Published : 2016.11.01
⟨ Previous Next ⟩

Abstract

Hemolysis frequently causes preanalytical errors in laboratory measurements. We aimed to develop a quality improvement indicator for evaluating the extent of inappropriate procedures causing hemolysis in clinical samples collected in medical care units. We defined the threshold value of the hemolysis index (H index) causing significant interference with analyte measurement and analyzed the H index values of clinical samples in relation to the threshold. The H index threshold value causing a 10% bias in the measurement of lactate dehydrogenase was found to be 25. The monthly mean H index and monthly frequency of samples with an H index >25 were significantly different among the types of ward (P=0.001, respectively), and significantly decreased after replacement of a laboratory centrifuge lacking temperature control ($20.6{\pm}0.58$ vs $23.30{\pm}1.08$, P=0.01; $23.4{\pm}1.69%$ vs $32.6{\pm}1.78%$, P=0.01). The monthly mean H index and the monthly frequency of samples with an H index above a threshold value may be useful quality improvement indicators for detection of inappropriate procedures in the acquisition and handling of blood samples in medical care units.

Keywords

Acknowledgement

Supported by : Laboratory Medicine Foundation

References

  1. Blank DW, Kroll MH, Ruddel ME, Elin RJ. Hemoglobin interference from in vivo hemolysis. Clin Chem 1985;31:1566-9.
  2. Van Lente F, Marchand A, Galen RS. Evaluation of a nephelometric assay for haptoglobin and its clinical usefulness. Clin Chem 1979;25: 2007-10.
  3. Witte DL, Brown LF, Feld RD. Effects of bilirubin on detection of hydrogen peroxide by use of peroxidase. Clin Chem 1978;24:1778-82.
  4. Spain MA and Wu AH. Bilirubin interference with determination of uric acid, cholesterol, and triglycerides in commercial peroxidase-coupled assays, and the effect of ferrocyanide. Clin Chem 1986;32:518-21.
  5. Kroll MH. Evaluating interference caused by lipemia. Clin Chem 2004;50:1968-9. https://doi.org/10.1373/clinchem.2004.038075
  6. Bornhorst JA, Roberts RF, Roberts WL. Assay-specific differences in lipemic interference in native and intralipid-supplemented samples. Clin Chem 2004;50:2197-201. https://doi.org/10.1373/clinchem.2004.040154
  7. Aw TC and Kiechle FL. Pseudohyponatremia. Am J Emerg Med 1985;3: 236-9. https://doi.org/10.1016/0735-6757(85)90096-8
  8. Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, et al. Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories. Clin Chem Lab Med 2008;46:764-72.
  9. Shin DH, Kim J, Uh Y, Lee SI, Seo DM, Kim KS, et al. Development of an integrated reporting system for verifying hemolysis, icterus, and lipemia in clinical chemistry results. Ann Lab Med 2014;34:307-12. https://doi.org/10.3343/alm.2014.34.4.307
  10. Clinical Laboratory and Standards Institute. Hemolysis, icterus, and lipemia/turbidity indices as indicators of interference in clinical laboratory analysis; approved guideline, C56-A. Wayne, PA: Clinical Laboratory and Standards Institute, 2012.
  11. Roche Diagnostics. Serum indices: Reduction of clinical errors in laboratory medicine. http://www.rochediagnostics.cz/download/program/Serum%20Indices_maly.pdf. (Updated on July 2012).
  12. Shahangian S and Snyder SR. Laboratory medicine quality indicators: a review of the literature. Am J Clin Pathol 2009;131:418-31. https://doi.org/10.1309/AJCPJF8JI4ZLDQUE

Cited by

  1. In vitro assessment of quality of citrate‐phosphate‐dextrose‐adenine‐1 preserved feline blood collected by a commercial closed system vol.32, pp.3, 2016, https://doi.org/10.1111/jvim.15056