Algorithm for Differential Diagnosis of in Vitro and in Vivo Hemolysis in Anticoagulated Blood Specimens
Journal of Laboratory Medicine and Quality Assurance
;
: 132-140, 2017.
Article
in Korean
| WPRIM
| ID: wpr-100911
ABSTRACT
BACKGROUND:
Hemolytic specimens contain components that interfere with clinical laboratory results. We evaluated previously published hemolysis indices (HI) and developed an algorithm for differentiating between mechanical hemolysis and immune-mediated hemolysis based on complete blood count (CBC).METHODS:
Sixty-three residual EDTA (ethylenediamine tetraacetic acid)-anticoagulated blood specimens were obtained during regular health check-ups, and each specimen was divided into 3 aliquots (A control, B, and C group). Aliquots B and C were mechanically hemolysed by 2 and 5 aspirations, respectively, using a 25-gauge needle before testing; aliquot A was analysed immediately without hemolysis. Additionally, we collected 36 specimens from patients suspected of having immune-mediated hemolysis after thorough reviewing their various laboratory results including direct antiglobulin test. We compared CBC parameters between the groups (A, B, C, D [B+C], and E [immune-mediated hemolysis group]).RESULTS:
Our HI scoring system using the sum of red blood cell ghosts, measured hemoglobin-calculated hemoglobin, mean corpuscular hemoglobin concentration-corpuscular hemoglobin concentration mean, and mean platelet volume rather than mean corpuscular hemoglobin, effectively identified mechanical hemolysis; the results were similar to those of previous studies. Furthermore, the HI score using the sum of mean corpuscular volume, red cell distribution width, hemoglobin distribution width, polymorphonuclear %, and neutrophil % differentiated mechanical hemolysis from immune-mediated hemolysis (cut-off, 9; sensitivity, 91.7%; specificity, 92.9%; area under the receiver operating characteristic curve, 0.965 [95% confidence interval, 0.924–0.988]).CONCLUSIONS:
The newly developed algorithm may provide effective screening for detecting hemolysis and differential diagnosis of mechanical hemolysis and immune-mediated hemolysis based on CBC results.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Aspirations, Psychological
/
Blood Cell Count
/
In Vitro Techniques
/
Coombs Test
/
Mass Screening
/
ROC Curve
/
Sensitivity and Specificity
/
Edetic Acid
/
Diagnosis, Differential
/
Erythrocyte Indices
Type of study:
Diagnostic study
/
Prognostic study
/
Screening study
Limits:
Humans
Language:
Korean
Journal:
Journal of Laboratory Medicine and Quality Assurance
Year:
2017
Type:
Article
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