Correction factors for estimating potassium concentrations in samples with in vitro hemolysis: A detriment to patient safety

Context. - Correction factors have been proposed for estimating true potassium concentrations in blood samples with evidence of in vitro hemolysis. Objective. - We used 2 different models of true (ie, nonsimulated) in vitro hemolysis to evaluate the clinical utility of correction factors for estimating potassium concentrations in samples with evidence of in vitro hemolysis. Design. - Potassium correction factors were derived using 2 different models. In model 1, potassium and plasma hemoglobin were measured with the Hitachi 747 analyzer in 132 paired blood samples, with each pair consisting of 1 sample with evidence of hemolysis and 1 without, collected during the same phlebotomy procedure. The change in measured potassium concentration was plotted versus the change in plasma hemoglobin concentration for each pair of samples. In model 2, the potassium levels of 142 784 blood samples and the corresponding hemolytic index values were measured with the Beckman LX20 analyzer. Potassium concentrations at the 10th, 25th, 50th, 75th, and 90th percentiles were calculated for each hemolysis index category. Results. - From our 2 models, we derived correction factors expressing an increase in potassium concentration of 0.51 and 0.40 mEq/L for every increase in plasma hemoglobin concentration of 0.1 g/dL. These correction factors are much higher than those reported in studies that simulated in vitro hemolysis by freeze-thaw lysis or osmotic disruption of whole blood. Conclusions. - Use of correction factors for estimating the true potassium concentration in samples with evidence of in vitro hemolysis is not recommended. Derivation of correction factors by using samples with nonsimulated in vitro hemolysis suggests that the actual increase in potassium in hemolyzed samples is much higher than that reported in previous studies that produced hemolysis with artificial means.