Reducing hemolysis in blood samples

Vigorous shaking during mixing or transport might lead to a hemolyzed blood gas sample [1]

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During the preanalytical phase of blood gas analysis, hemolysis in blood samples might occur if you mix too vigorously. [1]

An example of a hemolyzed blood sample:

Figure 1, Degree of hemolysis. Modified illustration from Wennecke. Useful tips to avoid preanalytical errors in blood gas testing: electrolytes. 2003 [1]

Outcome of hemolysis in blood samples

Vigorous mixing might lead to hemolysis in blood gas samples. In a hemolyzed sample erythrocytes rupture and components from inside the cell(s) are released into the plasma. One of these components is potassium (K⁺). [1]

Reduce the risk of hemolysis in blood gas samples

Manual mixing:

Figure 2, Mixing of the arterial blood sample [5]

A suggested technique is to mix the sample by inverting and rolling the syringe between your palms.

However, you can also use the automatic mixing feature in your blood gas analyzer to obtain a homogenous sample without causing hemolysis. [3]

Hemolysis mixing in blood samples with automatic mixing

You need to mix a sample sufficiently in order to obtain a homogeneous sample to get accurate results. However, the technique of manual mixing is applied inconsistently. [3 - 4]

Additionally, hemolysis in blood gas samples can occur through vigorous mixing prior to analysis. [2]

Automatic mixing on a blood gas analyzer is preferable to non-standardized manual mixing. This is because the automatic mixing helps ensure sufficient mixing and a homogenous sample. [3 - 4]

Dry electrolyte balanced heparin in combination with automatic mixing in our safePICO syringes help reduce the risk of blood sample clotting.

Prior to analysis, sufficient mixing is crucial to obtain a homogeneous sample. The safePICO syringe and automatic mixing on a blood gas analyzer helps you produce a homogeneous sample, without causing hemolysis. [3]

The safePICO syringe is designed to reduce the risk of other preanalytical errors. In addition to hemolysis during mixing, safePICO can help to remove air bubbles safely from the sample and to reduce the risk of needlestick injuries, a clotted blood sample, or patient-sample mix-up.

References

1. Wennecke G. Useful tips to avoid preanalytical errors in blood gas testing: electrolytes. www.acutecaretesting.org Oct 2003.
2. Lippi G, Fontana R, Avanzani P et al. Influence of spurious hemolysis on blood gas analysis. Clin Chem Lab Med 2013; 51: 1651-4.
3. Grenache D et al. Integrated and automatic mixing of whole blood: An evaluation of a novel blood gas analyzer. Science Direct 2006; 375, 1-2; 153 – 157
4. Benoit M et al. Evaluation and advantages of an automatic magnetic mixing of syringes integrated with a whole blood gas analyzer. Scandinavian Journal of Clinical & Laboratory Investigation 2009; 69, 5: 628-32.
5. Dukic L et al. Blood gas testing and related measurements: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochemia Medica 2016; 26, 3: 318-36.