Hemolysis溶血した検体が
臨床に与える影響とは？

溶血は分析前エラーの最大の
原因であり、カリウム (K+) の
結果に影響を与える可能性が
あります1,2

  • 救急外来（ED）では、検体のおよそ5件中1件に溶血が見られる1
  • 新生児集中治療室（NICU）では、検体の半数近くに溶血が見られる4
  • in vitro溶血は以下のようなリスクを招く:
    • 不適切な患者管理2,5,6
    • 患者満足度の低下5,7
    • コストの増加5,7,8
    • スタッフ / 治療の時間の非効率化6-8
  1. Lippi G, von Meyer A, Cadamuro J, Simundic A-M.Blood sample quality.Diagnosis.2018;6(1):25–31. doi:10.1515/dx-2018-0018.
  2. O’Hara M, Wheatley EG, Kazmierczak SC.The impact of undetected in vitro hemolysis or sample contamination on patient care and outcomes in point-of-care testing: a retrospective study.J Appl Lab Med.2020;5(2):332-341.doi:10.1093/jalm/jfz020.
  3. Nichols JH, Apple FS.Prevalence of hemolyzed results in acute care settings.J Appl Lab Med.2023;8:431-434. doi:10.1093/jalm/jfac141.
  4. Tóth J, Oláh AV, Petercsák T, Kovács T, Kappelmayer J. Detection of haemolysis, a frequent preanalytical problem in the serum of newborns and adults.2020Mar;31(1):6-14.PMID：32256284; PMCID：PMC7109500.
  5. Phelan MP, Hustey FM, Good DM, Reineks EZ.Seeing red: blood sample hemolysis is associated with prolonged emergency department throughput.J Appl Lab Med.2020;5(4):732–737. doi:10.1093/jalm/jfaa073.
  6. Wilson M, Adelman S, Maitre JB, et al.Accuracy of hemolyzed potassium levels in the emergency department.West J Emerg Med.2020;21(6):272–275. doi:10.5811/westjem.2020.8.46812.
  7. Milutinović D, Andrijević I, Ličina M, Andrijević L. Confidence level in venipuncture and knowledge on causes of in vitro hemolysis among healthcare professionals.Biochem Med.2015;25(3):401–409. doi:10.11613/BM.2015.040.
  8. Phelan MP, Ramos C, Walker LE, et al.The hidden cost of hemolyzed blood samples in the emergency department.J Appl Lab Med.2021;6(6):1607–1610. doi:10.1093/jalm/jfab035.
  9. Lippi G, Salvagno GL, Favaloro EJ, Guidi GC.Survey on the prevalence of hemolytic specimens in an academic hospital according to collection facility: opportunities for quality improvement.Clin Chem Lab Med.2009;47(5):616–618.doi:10.1515/CCLM.2009.132.

溶血は病院全体にみられ、
全検体の10％で発生1する
と言われています

各臨床現場での溶血検体の割合

ICU ＝ 集中治療室、NICU ＝ 新生児集中治療室、OR ＝ 手術室、ED ＝ 救急外来

  1. Nichols JH, Apple FS.Prevalence of hemolyzed results in acute care settings.J Appl Lab Med.2023;8:431-434.doi:10.1093/jalm/jfac141
  2. Lippi G, Salvagno GL, Favaloro EJ, Guidi GC.Survey on the prevalence of hemolytic specimens in an academic hospital according to collection facility: opportunities for quality improvement.Clin Chem Lab Med.2009;47(5):616–618. doi:10.1515/CCLM.2009.132.
  3. Tóth J, Oláh AV, Petercsák T, et al.Detection of haemolysis, a frequent preanalytical problem in the serum of newborns and adults.EJIFCC.2020;31(1):6–14.
  4. Khedr S, Blake V, Erdogan E. Neonatal unit hemolysis rates from an academic medical center:A quality improvement project.Arch Path Lab.2016;140(6):502-503. doi:10.5858/arpa.2015-0252-le

溶血はK+値の上昇を
引き起こします

  • 溶血が起こると赤血球の細胞膜が破れ、K+が周囲の体液に漏出する
  • その結果、K+値が上昇する
  1. Nichols JH, Apple FS.Prevalence of hemolyzed results in acute care settings.J Appl Lab Med.2023;8:431-434.doi:10.1093/jalm/jfac141
  2. Lippi G, Fontana R, Avanzini P, Sandei F, Ippolito L. Influence of spurious hemolysis on blood gas analysis.Clin Chem Lab Med.2013;51(8):1651–1654. doi:10.1515/cclm-2012-0802

全血検査の盲点:溶血によるK+の結果の変化

溶血の存在は、K+の結果の分布を変化させる1

  1. 12 Hawkins R. Measurement of whole-blood potassium—is it clinically safe?Clin Chem.2003;49(12):2105–2106.doi:10.1373/clinchem.2003.027227.

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