Pseudohyperkalemia in capillary whole-blood samples – an occasional error or a significant problem in a pediatric hospital?

Pseudohyperkalemia in capillary whole-blood samples – an occasional error or a significant... To the Editor,Capillary whole-blood samples are widely collected for acid-base balance evaluation in pediatric individuals. Material can be collected from fingertips, earlobes or heels. Besides typical acid-base parameters such as pH and pCO2, the sample is also referred for electrolytes (potassium and sodium) concentration analysis. Potassium is one of the most frequently tested analytes, since it plays a critical role in human homeostasis. Pre-analytical errors can result in falsely increased potassium concentrations in collected samples. Pseudohyperkalemia is defined as a difference between serum and plasma potassium concentration of more than 0.4 mmol/L [1]. Excessive leakage of potassium from cells during blood collection due to tissue squeezing can falsely elevate its concentration. Pseudohyperkalemia may also result from hemolysis, leukocytosis or blood clotting, since intracellular potassium concentration is ca. 30 times higher than extracellular concentration [2]. The phenomenon is widely known; however, it seems to be often misinterpreted [3]. The main causes of spurious hyperkalemia are presented in Table 1.Table 1:List of causes of pseudohyperkalemia in capillary and venous blood samples.Causes of pseudohyperkalemiaPre-laboratory pre-analytical phase errorVenipuncture Traumatic venipuncture Excessive force of syringe suction Prolonged application of tourniquet Fist clenchingCapillary blood collection Puncture on swollen or previously punctured site Too shallow puncture Excessive massaging or squeezing of surrounding tissues Collecting http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Clinical Chemistry and Laboratory Medicine (CCLM) de Gruyter

Pseudohyperkalemia in capillary whole-blood samples – an occasional error or a significant problem in a pediatric hospital?

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Publisher
De Gruyter
Copyright
©2017 Walter de Gruyter GmbH, Berlin/Boston
ISSN
1437-4331
eISSN
1437-4331
D.O.I.
10.1515/cclm-2016-0735
Publisher site
See Article on Publisher Site

Abstract

To the Editor,Capillary whole-blood samples are widely collected for acid-base balance evaluation in pediatric individuals. Material can be collected from fingertips, earlobes or heels. Besides typical acid-base parameters such as pH and pCO2, the sample is also referred for electrolytes (potassium and sodium) concentration analysis. Potassium is one of the most frequently tested analytes, since it plays a critical role in human homeostasis. Pre-analytical errors can result in falsely increased potassium concentrations in collected samples. Pseudohyperkalemia is defined as a difference between serum and plasma potassium concentration of more than 0.4 mmol/L [1]. Excessive leakage of potassium from cells during blood collection due to tissue squeezing can falsely elevate its concentration. Pseudohyperkalemia may also result from hemolysis, leukocytosis or blood clotting, since intracellular potassium concentration is ca. 30 times higher than extracellular concentration [2]. The phenomenon is widely known; however, it seems to be often misinterpreted [3]. The main causes of spurious hyperkalemia are presented in Table 1.Table 1:List of causes of pseudohyperkalemia in capillary and venous blood samples.Causes of pseudohyperkalemiaPre-laboratory pre-analytical phase errorVenipuncture Traumatic venipuncture Excessive force of syringe suction Prolonged application of tourniquet Fist clenchingCapillary blood collection Puncture on swollen or previously punctured site Too shallow puncture Excessive massaging or squeezing of surrounding tissues Collecting

Journal

Clinical Chemistry and Laboratory Medicine (CCLM)de Gruyter

Published: Jul 26, 2017

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