Current Methods of Haemolysis Detection and Reporting as a Source of Risk to Patient Safety: a Narrative Review

Euan J McCaughey; Elia Vecellio; Rebecca Lake; Ling Li; Leslie Burnett; Douglas Chesher; Stephen Braye; Mark Mackay; Stephanie Gay; Tony C Badrick; Johanna I Westbrook; Andrew Georgiou

Current Methods of Haemolysis Detection and Reporting as a Source of Risk to Patient Safety: a Narrative Review

Clin Biochem Rev. 2016 Dec;37(4):143-151.

Authors

Affiliations

¹ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia.
² Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia;; South Eastern Area Laboratory Services, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
³ South Eastern Area Laboratory Services, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW, 2031, Australia;; Pathology North, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;; Northern Clinical School, Sydney Medical School, University of Sydney, NSW, 2006, Australia.
⁴ Pathology North, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;; Northern Clinical School, Sydney Medical School, University of Sydney, NSW, 2006, Australia.
⁵ Pathology North, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;; Pathology North, NSW Health Pathology, Newcastle, NSW, 2300, Australia.
⁶ Pathology North, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;; Royal College of Pathologists Australasia Quality Assurance Program, St Leonards, NSW, 2065, Australia.
⁷ Royal College of Pathologists Australasia Quality Assurance Program, St Leonards, NSW, 2065, Australia.

PMID: 28167844
PMCID: PMC5242478

Abstract

Aim: Haemolysis has a major impact on patient safety as the need for a replacement specimen increases the risk of injury and infection, delays test results and extends the duration of hospital stays. Consistency of haemolysis detection and reporting can facilitate the generation of benchmark data used to develop quality practices to monitor and reduce this leading cause of pre-analytical laboratory error. This review aims to investigate current methods of haemolysis detection and reporting.

Method: Due to known heterogeneity and immaturity of the research field, a scoping search was conducted using PUBMED, Embase, Medline and CINAHL. Articles published between 2000 and 2014 that reported haemolysis rates in specimens from the general population were included.

Results: Of the 50 studies that met the inclusion criteria, 20 detected haemolysis using the Haemolysis Index (HI), 19 by visual inspection and 13 by undefined methods. There was large intra-study variation in the plasma free haemoglobin level used to establish haemolysis (HI: mean±SD 846±795 mg/L, range 150-3000 mg/L; Visual: 850±436 mg/L, 500-3000 mg/L). Sixteen studies reported the analyte of interest, with only three studies reporting a haemoglobin level at which the specimen would be rejected.

Conclusion: Despite haemolysis being a frequent and costly problem with a negative impact on patient care, there is poor consistency in haemolysis detection and reporting between studies. Improved consistency would facilitate the generation of benchmark data used to create quality practices to monitor and reduce this leading cause of pre-analytical laboratory error.

Publication types

Review