Methods for Hemolysis Interference Study in Laboratory Medicine - A Critical Review

Abstract

Hemolysis represents an important source of error associated with the pre-analytical phase. Improving the protocols for detection, measurement, management of the parameters affected by the interference, and differentiation between hemolysis in vivo and in vitro, would favor a personalized management of hemolysis by increasing patient safety. For this, it is essential to agree on the definition of "hemolysis". From this definition, a critical point is to establish cut-offs of hemolysis management for each analyte studied in the clinical laboratory. Thus, in this review, the main methods described in the literature developed for obtaining a hemolysate are grouped, that simulate in controlled laboratory protocols what happens with a hemolyzed sample of a patient. These methods are grouped into 3 categories according to their basis of lysing cells: freezing-thawing, osmotic shock and shear stress. In addition to development and improvement of methods for the study of hemolysis, it is necessary to carry out comparative studies to determine which one offers the best capabilities. Harmonization of the methods will allow to include them in working guidelines. All these strategies will allow to move from managing hemolysis on whole-sample basis to customize it analyte by analyte.

Keywords: hemolysis; phlebotomy; preanalytical phase; reproducibility of results.