Tests Affected by Hemolyzed, Lipemic and Icteric Samples And Their Mechanism

When a substance or process falsely alters the test results, it may lead to inappropriate further tests, incorrect diagnosis and treatments with potentially unfavourable outcomes for the patient. Interferences from hemolysis, lipemia and icterus are most frequently noted which alter the assay results.
Hemolysed-Lipemic-Icteric-Samples

Hemolysis

Hemolysis is the most common reason for sample rejaction by laboratories. Hemolysis is defined as the rupture of red blood cells with the release of hemoglobin and the intracellular components into the plasma. The release of hemoglobin causes the serum or plasma to appear pale red to cherry red in color.

Causes of Hemolysis:

Hemolysis may be intravascular or extravascular. Intravascular hemolysis is very rare and is usually the result of blood transfusion reaction or hemolytic anemia. Extravascular hemolysis is quite common and occurs during improper phlebotomy techniques, handelling, transport and storage of specimens.

Mechanism of Interferences

  1. Leakage of constituents of red blood cells into plasma or serum.
  2. Spectrophotometric/colorimetric interference by hemoglobin.
  3. Participation of the hemoglobin in the reaction through augmentation or inhibition.
  4. Dilution of serum or plasma components.

Common biochemical tests affected by hemolysed sample

IncreasedDecreased
Potassium (K+)Troponin T
Lactate Dehydrogenase (LDH)Haptoglobin
SGOT/ASTBilirubin
SGPT/ALTAmylase
Creatine Kinase (CK)Bicarbonate (HCO3)
Iron
Phosphate (PO4)
Total Protein
Albumin
Magnesium (Mg++)
Calcium (Ca++)
Alkaline Phosphatase (ALP)

Lipemia

Lipemia is the presence of excess lipids or fats in the bloodstream. This phenomenon causes the plasma or serum to appear turbid or ‘milky’.

Causes of Lipemia

Lipemia is the increased concentration of triglyceride-rich lipoproteins in blood resulting in the cloudy/turbid appearance of serum or plasma. As lipoproteins vary in sizes, not all contribute equally to turbidity. The largest particles, chylomicrons have the greatest potential in causing turbidity of the sample.

Mechanism of Interferences

  1. Light scattering effects may increase absorbances during end point reactions and non-blanked reactions for some analytes.
  2. Volume displacement effect greatly decreases the value of some analytes particularly electrolytes; Na+,K+.
  3. Hemolysis of RBCs is enhanced in the presence of lipemia.
  4. Non homogeneity of the sample.
  5. Physical and chemical interferences.

Common biochemical tests affected by lipemic sample

IncreasedDecreased
Bile AcidsSodium (Na+)
Direct BilirubinPotassium (K+)
TIBCChloride (Cl)
Magnesium (Mg++)Bicarbonate (HCO3)
Lactate Dehydrogenase (LDH)

Icterus

Icterus or hyperbilirubenemia is the presence of high levels of bilirubin. Icteric serum or plasma ranges in color from dark to bright yellow, rather than normal straw color.

Causes of Icterus

Icterus occurs because of the increased bilirubin production or inappropriate excretion. eg: hemolytic anemia, liver diseases, biliary tract obstruction etc.

Mechanism of Interferences

  1. Ability to react chemicals in other reagents resulting in decreased analyte values.
  2. Spectral interferences during color measurement.

Common biochemical tests affected by icteric sample

IncreasedDecreased
Magnesium (Mg++)Cholesterol
Triglyceride
Creatinine
Bile Acids
Lipase
Total Protein
Uric Acid
GGT
Tests Affected by Hemolyzed, Lipemic and Icteric Samples And Their Mechanism
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11 Responses to Tests Affected by Hemolyzed, Lipemic and Icteric Samples And Their Mechanism

  1. Sudharsan July 24, 2016 at 1:41 pm #

    Nice and useful tips, we have studied but….

  2. jose fajanilan September 4, 2016 at 9:01 am #

    thank you for your nice updates on hemolysis,i will always use this tool in my lab. work in clinical chemistry examinations to ensure accuracy of results and effective treatment by the physicians for their patients.

  3. jose fajanilan September 4, 2016 at 9:06 am #

    i was clarified because of your knowledge about hemolysis,thank you.

  4. kamal October 1, 2016 at 3:22 pm #

    if i want to process lipemic sample in semi autoanlyzer than what procedure i will take to improve sample and true report.

  5. fatma najem October 24, 2016 at 11:58 am #

    Thanks for nice update ,the effect of lipemic, heamolysis, and icteric different ( decrease or increase) are significant I mean there is any accepted range of different . how we correct the interference?

  6. Daniel November 4, 2016 at 7:13 am #

    Dear Dhurba! Many thanks for your updates, it was very useful but could you give us the source for all of post in next time? Thank you.

  7. DHANUSHKA March 27, 2017 at 1:22 pm #

    IS THAT CORRECT CALCIUM LEVEL INCREASE IN HEMOLYSED SAMPLES??

  8. Jacob Mathew,m t May 3, 2017 at 12:07 pm #

    Highly informative

  9. Gangadhar Kalli September 17, 2017 at 9:29 am #

    Great information
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  10. Abdullah o. Alamoudi September 30, 2017 at 11:32 am #

    Thanks

  11. Leigh October 12, 2017 at 10:09 am #

    If the Lipaemic, Icteric and Haemolysis are absent is that good.

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