605
Views
1
CrossRef citations to date
0
Altmetric
Invited Reviews

Erroneous potassium results: preanalytical causes, detection, and corrective actions

& ORCID Icon
Pages 442-465 | Received 25 Jan 2023, Accepted 23 Mar 2023, Published online: 12 Apr 2023

References

  • Electrolytes and blood gases. In: Burtis CA, Ashwood ER, eds. Tietz textbook of clinical chemistry. 3rd ed. philadelphia: Elsevier Health Sciences, 1998. 1058–1059.
  • Kapoor AK, Ravi A, Twomey PJ. Investigation of outpatients referred to a chemical pathologist with potential pseudohyperkalaemia. J Clin Pathol. 2009;62(10):920–923.
  • Grzych G, Roland E, Lezier D, et al. Pneumatic tube system transport and false hyperkalemia related to leukocytosis: a retrospective analysis. Ann Biol Clin. 2019;77(3):281–286.
  • Orphanet [Internet]. Paris: INSERM US14; 2015. cited 2022 Dec 22]. Available from: https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=90044.
  • Dimeski G, Barnett RJ. Effects of total plasma protein concentration on plasma sodium, potassium and chloride measurements by an indirect ion selective electrode measuring system. Crit Care Resusc. 2005;7(1):12–15.
  • Hartmann RC, Mellinkoff SM. Relationship of platelets to serum potassium concentration. J Clin Invest. 1955;34:938.
  • Frick PG. Pseudohyperkalemia in thrombocytosis. Schweiz Med Wochenschr. 1960;90:433–435.
  • Myerson RM, Frumin AM. Hyperkalemia associated with the myeloproliferative disorder. Arch Intern Med. 1960;106:479–482.
  • Ingram RH, Jr, Seki M. Pseudohyperkalemia with thrombocytosis. N Engl J Med. 1962;267:895–900.
  • Whitefield JB. Spurious hyperkalaemia and hyponatraemia in a patient with thrombocythaemia. J Clin Path. 1966;19:496–497.
  • Modder B, Meuthen I. Pseudohyperkalemia in the serum in reactive thrombocytosis and thrombocythemia. Dtsch Med Wochenschr. 1986;111(9):329–332.
  • Graber M, Subramani K, Corish D, et al. Thrombocytosis elevates serum potassium. Am J Kidney Dis. 1988;12(2):116–120.
  • Wulkan RW, Michiels JJ. Pseudohyperkalaemia in thrombocythaemia. J Clin Chem Clin Biochem. 1990;28:489–491.
  • Makela K, Kairisto V, Peltola O, et al. Effect of platelet count on serum and plasma potassium: evaluation using database information from two hospitals. Scand J Clin Lab Invest Suppl. 1995;222:95–100.
  • Ong YL, Deore R, El-Agnaf M. Pseudohyperkalaemia is a common finding in myeloproliferative disorders that may lead to inappropriate management of patients. Int J Lab Hematol. 2010;32:e151–157.
  • Thurlow V, Ozevlat H, Jones SA, et al. Establishing a practical blood platelet threshold to avoid reporting spurious potassium results due to thrombocytosis. Ann Clin Biochem. 2005;42(Pt 3):196–199.
  • Roccaforte V, Daves M, Alfreijat A, et al. Spurious elevation of serum potassium concentration measured in samples with thrombocytosis. Diagnosis. 2016;3(2):71–74.
  • Sevastos N, Theodossiades G, Efstathiou S, et al. Pseudohyperkalemia in serum: the phenomenon and its clinical magnitude. J Lab Clin Med. 2006;147:139–144.
  • Nomura M, Nakasuji M, Nakamura M, et al. Pitfall in intraoperative electrolyte management for a patient with pseudohyperkalemia caused by thrombocytosis. Masui. 2009;58:1300–1302.
  • Mannu GS, Bhalerao AF. Case report: unrecognized pseudohyperkalaemia in essential thrombocythaemia. JRSM Open. 2011;2:85.
  • Narayanan S, Guder WG. Preanalytical variables and their influence on the quality of laboratory results. EJIFCC. 2001;13(1):9–12.
  • Šálek T. Pseudohyperkalemia – potassium released from cells due to clotting and centrifugation - a case report. Biochem Med. 2018;28(1):011002.
  • Dubin I, Schattner A. Reversible iatrogenic paraparesis secondary to masked hypokalaemia in thrombocytosis-associated pseudohyperkalaemia. BMJ Case Rep. 2019;12(3):e228058.
  • Valentine RM, Barkhuizen A, Roberts R, et al. Pseudohyperkalemia-not always benign. J Appl Lab Med. 2019;3(6):1049–1053.
  • Guo Y, Li HC. Pseudohyperkalemia caused by essential thrombocythemia in a patient with chronic renal failure: a case report. World J Clin Cases. 2020;8(21):5432–5438.
  • Lee JW, Kim S, Jang PS, et al. Marked thrombocytosis resulting in pseudohyperkalemia in a neonate with transient abnormal myelopoiesis. Pediatr Blood Cancer. 2021;68(8):e28986.
  • Ahmed R, Isaac AM. Postsplenectomy thrombocytosis and pseudohyperkalemia in trauma: a case report and review of literature. J Trauma. 2009;67: E17–19.
  • Lambertucci JR, Otoni A, Rodrigues VL. Pseudohyperkalemia and pseudohyperphosphatemia after splenectomy in hepatosplenic chistosomiasis mansoni. Rev Soc Bras Med Trop. 2008;41:692.
  • Li G, Wang B, Li D, et al. Markedly increased small-sized megakaryocytes and platelets count in the circulation with pseudo-hyperkalemia following splenectomy. Eur J Med Res. 2022;27(1):155.
  • Fukasawa H, Furuya R, Kato A, et al. Pseudohyperkalemia occurring in a patient with chronic renal failure and polycythemia vera without severe leukocytosis or thrombocytosis. Clin Nephrol. 2002;58(6):451–454.
  • Tsolakidis GF, Fourka S, Anthopoulos G, et al. Pseudohyperkalemia during the onset of clinical illness. Crit Care. 2004;8: S129.
  • Bronson WR, DeVita VT, Carbone PP, et al. Pseudohyperkalemia due to release of potassium from white blood cells during clotting. N Engl J Med. 1966;274(7):369–375.
  • Zaki KS, Majid U, Islam N. Spurious hyperkalaemia: an insight. J Pak Med Assoc. 2011;61:297–299.
  • Kintzel PE, Scott WL. Pseudohyperkalemia in a patient with chronic lymphoblastic leukemia and tumor lysis syndrome. J Oncol Pharm Pract. 2012;18:432–435.
  • Kellerman PS, Thornbery JM. Pseudohyperkalemia due to pneumatic tube transport in a leukemic patient. Am J Kidney Dis. 2005;46:746–748.
  • Dickinson H, Webb NJ, Chaloner C, et al. Pseudohyperkalaemia associated with leukaemic cell lysis during pneumatic tube transport of blood samples. Pediatr Nephrol. 2012;27:1029–1031.
  • Dimeski G, Bird R. Hyperleukocytosis: pseudohyperkalaemia and other biochemical abnormalities in hyperleukocytosis. Clin Chem Lab Med. 2009;47(7):880–881.
  • Guiheneuf R, Vuillaume I, Mangalaboyi J, et al. Pneumatic transport is critical for leukaemic patients with major leukocytosis: what precautions to measure lactate dehydrogenase, potassium and aspartate aminotransferase? Ann Clin Biochem. 2010;47(Pt 1):94–96.
  • Claver-Belver N, Cano-Corres R, Miró-Cañís S, et al. Pseudohyperkalemia due to severe leukocytosis: case presentation. Clin Chem Lab Med. 2016;54(12):e365–e367.
  • De Rosales AR, Siripala DS, Bodana S, et al. Pseudohyperkalemia: look before you treat. Saudi J Kidney Dis Transpl. 2017;28(2):410–414.
  • Alhaj Moustafa M, Malkovska V, Elmahdy S, et al. A challenging case of pseudohyperkalemia in chronic lymphocytic leukemia. J Investig Med High Impact Case Rep. 2017;5(4):2324709617746194.
  • Neupane SP, Sharma P, Dangal MM. Pseudohyperkalemia: hyperkalemia cocktail or alternative diagnosis. Case Rep Med. 2018;2018:9060892.
  • Merritt M, Kline H, Garimella S, et al. Pseudohyperkalemia in a patient with T-cell acute lymphoblastic leukemia and hyperleukocytosis. J Pediatr Intensive Care. 2018;7(3):166–168.
  • Le RD, Geary SP. A case of hyperkalemia versus pseudohyperkalemia in chronic lymphocytic leukemia. Clin Pract Cases Emerg Med. 2020;4(2):208–210.
  • Ghersin Z, Fernandes ND, Winkler A, et al. Pseudohyperkalemia and pseudohyponatremia in two children with T-cell acute lymphoblastic leukemia. J Pediatr. 2021;232:294–298.
  • Shrestha B, Rijal SS, Pokhrel A, et al. Pseudohyperkalemia associated with leukemia. Cureus. 2022;14(4):e23978.
  • Theparee T, Benirschke RC, Lee HK. Variable potassium concentrations: which is right and which is wrong? Lab Med. 2017; 48(2):183–187.
  • Jafar MS, Thalambedu N, Kolandra L, et al. False, reversed but not true: a curious case of hyperkalemia. Cureus. 2020;12(8):e10066.
  • Bnaya A, Ruchlemer R, Itzkowitz E, et al. Incidence, risk factors, and recognition of pseudohyperkalemia in patients with chronic lymphocytic leukemia. Int J Hematol. 2021;114(1):102–108.
  • Ranjitkar P, Greene DN, Baird GS, et al. Establishing evidence-based thresholds and laboratory practices to reduce inappropriate treatment of pseudohyperkalemia. Clin Biochem. 2017;50(12):663–669.
  • Peter Nonkes LJ, de Haas V, Kemperman H, et al. Evaluation and management of leukolysis-mediated pseudohyperkalemia in paediatric leukemic samples. Biochem Med. 2022;32(1):010904.
  • Dastych M, Cermáková Z. Pseudohyperkalaemia in leukaemic patients: the effect of test tube type and form of transport to the laboratory. Ann Clin Biochem. 2014;51:110–113.
  • Huang N, Bufalino S, Czerlanis C. Pneumatic tube-induced reverse pseudohyperkalemia in a patient with chronic lymphocytic leukemia. Fed Pract. 2016;33(5):60S–62S.
  • Mansoor S, Holtzman NG, Emadi A. Reverse pseudohyperkalemia: an important clinical entity in chronic lymphocytic leukemia. Case Rep Hematol. 2015;2015:930379.
  • Wills MR, Fraser ID. Spurious hyperkalaemia. J Clin Pathol. 1964;17(6):649–650.
  • Bellevue R, Dosik H, Spergel G, et al. Pseudohyperkalemia and extreme leukocytosis. J Lab Clin Med. 1975;85:660–664.
  • Polak R, Huisman A, Sikma MA, et al. Spurious hypokalaemia and hypophosphataemia due to extreme hyperleukocytosis in a patient with a haematological malignancy. Ann Clin Biochem. 2010;47:179–181.
  • Ruddy KJ, Wu D, Brown JR. Pseudohyperkalemia in chronic lymphocytic leukemia. J Clin Oncol. 2008;26(16):2781–2782.
  • Asirvatham JR, Moses V, Bjornson L. Errors in potassium measurement: a laboratory perspective for the clinician. N Am J Med Sci. 2013;5:255–259.
  • Cao J, Karger AB. Critically elevated potassium in a 55-year-old female with chronic lymphocytic leukemia. Lab Med. 2018; 49(3):280–283.
  • Singh PJ, Zawada ET, Santella RN. A case of 'reverse’ pseudohyperkalemia. Miner Electrolyte Metab. 1997;23(1):58–61.
  • Abraham B, Fakhar I, Tikaria A, et al. Reverse pseudohyperkalemia in a leukemic patient. Clin Chem. 2008;54:449–451.
  • Garwicz D, Karlman M. Early recognition of reverse pseudohyperkalemia in heparin plasma samples during leukemic hyperleukocytosis can prevent iatrogenic hypokalemia. Clin Biochem. 2012;45:1700–1702.
  • Meng QH, Krahn J. Reverse pseudohyperkalemia in heparin plasma samples from a patient with chronic lymphocytic leukemia. Clin Biochem. 2011;44:728–730.
  • Moreno G, Gunsolus IL. Reverse pseudohyperkalemia and pseudohyponatremia in a patient with B-cell non-Hodgkin lymphoma. Clin Biochem. 2020;78:63–65.
  • Onuigbo MA, Ross A. Pseudohyperkalemia and the need for imperative caution with the newly introduced potent potassium binders: two cases. Cureus. 2021; 13(8):e17179.
  • Stewart GW, Corrall RJ, Fyffe JA, et al. Familial pseudohyperkalaemia. A New Syndrome. Lancet. 1979;2:175–177.
  • Meenaghan M, Follett GF, Brophy PJ. Temperature sensitivity of potassium flux into red blood cells in the familial pseudohyperkalaemia syndrome. Biochim Biophys Acta. 1985;821(1):72–78.
  • Lukens MV, de Mare A, Kerbert-Dreteler MJ, et al. Leaky cell syndrome: a rare cause of pseudohyperkalaemia. Ann Clin Biochem. 2012;49(Pt 1):97–100.
  • Andolfo I, Alper SL, Delaunay J, et al. Missense mutations in the ABCB6 transporter cause dominant familial pseudohyperkalemia. Am J Hematol. 2013;88(1):66–72.
  • Dalal BI, Brigden ML. Factitious biochemical measurements resulting from 390 hematological conditions. Am J Clin Pathol. 2009;131:195–204.
  • Andolfo I, Russo R, Manna F, et al. Functional characterization of novel ABCB6 mutations and their clinical implications in familial pseudohyperkalemia. Haematologica. 2016;101(8):909–917.
  • Meli A, McAndrew M, Frary A, et al. Familial pseudohyperkalemia induces significantly higher levels of extracellular potassium in early storage of red cell concentrates without affecting other standard measures of quality: a case control and allele frequency study. Transfusion. 2021;61(8):2439–2449.
  • Chow E, Fox N, Gama R. Effect of low serum total protein on sodium and potassium measurement by ion-selective electrodes in critically ill patients. Br J Biomed Sci. 2008;65(3):128–131.
  • Chopra P, Datta SK. Discrepancies in electrolyte measurements by direct and indirect ion selective electrodes due to interferences by proteins and lipids. J Lab Physicians. 2020;12(2):84–91.
  • Gohel M, Makadia JS, Chakrabarti C. Effect of hypoproteinemia on electrolyte measurement by direct and indirect ion selective electrode methods. J Lab Physicians. 2021;13(2):144–147.
  • Goyal B, Datta SK, Mir AA, et al. Increasing glucose concentrations interfere with estimation of electrolytes by indirect ion selective electrode method. Indian J Clin Biochem. 2016;31(2):224–230.
  • Allardet-Servent J, Lebsir M, Dubroca C, et al. Point-of-care versus central laboratory measurements of hemoglobin, hematocrit, glucose, bicarbonate and electrolytes: a prospective observational study in critically ill patients. PLOS One. 2017;12(1):e0169593.
  • Tietz fundamentals of clinical chemistry. Burtis CA, Ashwood ER, eds. 4th ed. Philadelphia, PA: W.B. Saunders Company; 1996. 499.
  • Lum G, Gambino SR. A comparison of serum versus heparinised plasma for routine chemical tests. Am J Clin Pathol. 1974;61(1):108–113.
  • Doumas BT, Hause LL, Simuncak DM, et al. Differences between values for plasma and serum in tests performed in the Ektachem 700 XR analyzer, and evaluation of plasma separator tubes (PST). Clin Chem. 1989;35:151–153.
  • Hartland AJ, Neary RH. Serum potassium is unreliable as an estimate of in vivo plasma potassium. Clin Chem. 1999;45(7):1091–1092.
  • Hawkins R. Measurement of whole-blood potassium–is it clinically safe? Clin Chem. 2003;49(12):2105–2106.
  • Salvagno GL, Demonte D, Lippi G. A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis. Biochem Med. 2019;29(1):011003.
  • Ciepiela O, Raniszewska A, Manda-Handzlik A, et al. Pseudohyperkalemia in capillary whole-blood samples – an occasional error or a significant problem in a pediatric hospital? Clin Chem Lab Med. 2017;55(8):e159–e162.
  • 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.
  • Nigro M, Valli G, Marchionne ML, et al. Is there a risk of misinterpretation of potassium concentration from undetectable hemolysis using a POCT blood gas analyzer in the emergency department? Medicina. 2022;59(1):66.
  • Laessig RH, Hassemer DJ, Paskey TA, et al. The effects of 0.1 and 1.0 per cent erythrocytes and hemolysis on serum chemistry values. Am J Clin Pathol. 1976;66(4):639–644.
  • Verresen L, Lins RL, Neels H, et al. Effects of needle size and storage temperature on measurements of serum potassium. Clin. Chem. 1986;32:698–699b.
  • Burns ER, Yoshikawa N. Hemolysis in serum samples drawn by emergency department personnel versus laboratory phlebotomists. Lab Med. 2002;33:378–380.
  • Lippi G, Salvagno GL, Montagnana M, et al. Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing. Clin Chem Lab Med. 2006;44(8):1009–1014.
  • Kennedy C, Angermuller S, King R, et al. A comparison of hemolysis rates using intravenous catheters versus venipuncture tubes for obtaining blood samples. J Emerg Nurs. 1996;22:566–569.
  • Grant MS. The effect of blood drawing techniques and equipment on the hemolysis of ED laboratory blood samples. J Emerg Nurs. 2003;29:116–121.
  • Dugan L, Leech L, Speroni KG, et al. Factors affecting hemolysis rates in blood samples drawn from newly placed IV sites in the emergency department. J Emerg Nurs. 2005;31:338–345.
  • Carraro P, Servidio G, Plebani M. Hemolyzed specimens: a reason for rejection or a clinical challenge? Clin. Clin Chem. 2000;46(2):306–307.
  • Young DS. Conveying the importance of the preanalytical phase. Clin Chem Lab Med. 2003;41:884–887.
  • Stankovic AK, Smith S. Elevated serum potassium values: the role of preanalytic variables. Am J Clin Pathol. 2004;121Suppl: S105–S12.
  • Sulaiman RA, Twomey PJ, Gama R. Mitigation and detection of spurious potassium and sodium results. Clin Chim Acta. 2011;412(1–2):1–6.
  • Saleem S, Mani V, Chadwick MA, et al. A prospective study of causes of hemolysis during venepuncture: tourniquet time should be kept to a minimum. Ann Clin Biochem. 2009;46:244–246.
  • Lima-Oliveira G, Lippi G, Salvagno GL, et al. New ways to deal with known preanalytical issues: use of transilluminator instead of tourniquet for easing vein access and eliminating stasis on clinical biochemistry. Biochem Med. 2011;21:152–159.
  • Cui M, Jing R, Wang H. Changes of serum lactate dehydrogenase and potassium levels produced by a pneumatic tube system. Lab Med. 2009;40:728–731.
  • Kara H, Bayir A, Ak A, et al. Hemolysis associated with pneumatic tube system transport for blood samples. Pak J Med Sci. 2014;30(1):50–58.
  • Tiwari AK, Pandey P, Dixit S, et al. Speed of sample transportation by a pneumatic tube system can influence the degree of hemolysis. Clin Chem Lab Med. 2012;50(3):471–474.
  • Huyghe T, Buntin F, Bruyninck R, et al. Studies on the use of BD vacutainer® SST II™ and RST™ in general practice: investigation of artefactual hyperkalaemia. Ann Clin Biochem. 2014;51:30–37.
  • Salvagno GL, Danese E, Lima-Oliveira G, et al. Avoidance to wipe alcohol before venipuncture is not a source of spurious hemolysis. Biochem Med. 2013;23(2):201–205.
  • Simundic AM, Baird G, Cadamuro J, et al. Managing hemolyzed samples in clinical laboratories. Crit Rev Clin Lab Sci. 2020;57(1):1–21.
  • Lippi G, Blanckaert N, Bonini P, et al. Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories. Clin Chem Lab Med. 2008;46(6):764–772.
  • Lippi G, Plebani M, Di Somma S, et al. Hemolyzed specimens: a major challenge for emergency departments and clinical laboratories. Crit Rev Cl Lab Sci. 2011;48(3):143–153.
  • Luksic AH, Nikolac Gabaj N, Miler M, et al. Visual assessment of hemolysis affects patient safety. Clin Chem Lab Med. 2018;56(4):574–581.
  • Lippi G, Cadamuro J. Visual assessment of sample quality: quo usque tandem? Clin Chem Lab Med. 2018;56(4):513–515.
  • Hutchinson RG, Barksdale B, Watson RL. The effects of exercise on serum potassium levels. Chest. 1992;101:398–400.
  • Atanasovska T, Petersen AC, Rouffet DM, et al. Plasma K+ dynamics and implications during and following intense rowing exercise. J Appl Physiol. 2014;117:60–68.
  • Lam HS, Chan MH, Ng PC, et al. Are your hands clean enough for point-of-care electrolyte analysis? Pathology. 2005;37(4):299–304.
  • Van Steirtegham AC, Young DS. Povidone-iodine (“betadine”) disinfectant as a source of error. Clin Chem. 1977;23:1512.
  • Baer DM, Ernst DJ, Willeford SI, et al. Investigating elevated potassium values. MLO Med Lab Obs. 2006;38:24–26,30-1.
  • Koch TR, Cook JD. Cook JD benzalkonium interference with test methods for potassium and sodium. Clin Chem. 1990;36(5):807–808.
  • Gaylord MS, Pittman PA, Bartness J. Release of benzalkonium chloride from a heparin-bonded umbilical catheter with resultant factitious hypernatremia and hyperkalemia. Pediatrics. 1991;87:631–635.
  • Johnston JB, Messina M. Erroneous laboratory values obtained from Central catheters. J Intraven Nurs. 1991;14(1):13–15.
  • Carraro P, Zago T, Plebani M. Exploring the initial steps of the testing process: frequency and nature of pre-preanalytic errors. Clin. Chem. 2012;58:638–642.
  • Ong YY, Boykin SF, Barnett RN. You can draw blood from the "IV arm" below the intravenous needle if you put a tourniquet in between. Am J Clin Pathol. 1979;72:101–102.
  • Read DC, Viera H, Arkin C. Effect of drawing blood specimens proximal to an in-place but discontinued intravenous solution. Can blood be drawn above the site of a shut-off i.v.? Am J Clin Pathol. 1988;90:702–706.
  • CLSI. Procedures for the collection of diagnostic blood specimens by venipuncture; approved standard—6th Edition. CLSI document H3-A6. Wayne, PA: CLSI; 2007.
  • Cornes MP, Ford C, Gama R. Spurious hyperkalaemia due to EDTA contamination: common and not always easy to identify. A Clin Biochem. 2008;45:601–603.
  • Sharratt CL, Gilbert CJ, Cornes MC, et al. EDTA sample contamination is common and often undetected, putting patients at unnecessary risk of harm. Int J Clin Pract. 2009;63:1259–1262.
  • White G. Serum ethylenediaminetetraacetic acid concentrations in routine samples submitted for biochemical analysis. Ann Clin Biochem. 2010;47:485–486.
  • Chadwick K, Whitehead SJ, Ford C, et al. kEDTA sample contamination: a reappraisal. J Appl Lab Med. 2019;3(6):925–935.
  • Cadamuro J, Felder TK, Oberkofler H, et al. Relevance of EDTA carryover during blood collection. Clin Chem Lab Med. 2015;53(8):1271–1278.
  • Majid A, Heaney DC, Padmanabhan N, et al. The order of draw of blood specimens into additive containing tubes not affect potassium and calcium measurements. J Clin Pathol. 1996;49(12):1019–1020.
  • Sulaiman RA, Cornes MP, Whitehead SJ, et al. Effect of order of draw of blood samples during phlebotomy on routine biochemistry results. J Clin Pathol. 2011;64(11):1019–1020.
  • Cornes MR, Sulaiman RA, Whitehead SJ, et al. Incorrect order of draw of blood samples does not cause potassium EDTA sample contamination. Br J Biomed Sci. 2012;69(3):136–138.
  • Don BR, Sebastian A, Cheitlin M, et al. Pseudohyperkalemia caused by fist clenching during phlebotomy. N Engl J Med. 1990;322(18):1290–1292.
  • Bailey IR, Thurlow VR. Is suboptimal phlebotomy technique impacting on potassium results for primary care. Ann Clin Biochem. 2008;45(Pt 3):266–269.
  • Gambino R, Sanfilippo M, Lazcano L. Pseudohyperkalaemia from finger flexion during venepuncture masks true hypokalaemia. Ann Clin Biochem. 2009;46:177.
  • Loh TP, Sethi SK. A multidisciplinary approach to reducing spurious hyperkalemia in hospital outpatient clinics. J Clin Nurs. 2015;24(19-20):2900–2906.
  • Statland BE, Bokelund H, Winkel P. Factors contributing to intra-individual variations of serum constituents: effects of posture and tourniquet application on variation of serum constituents in healthy subjects. Clin Chem. 1974;20:1513–1519.
  • Van Elslande J, Dominicus T, Toelen J, et al. A case of severe pseudohyperkalaemia due to muscle contraction. Biochem Med. 2020;30(2):021004.
  • Rade A, Đuras A, Kocijan I, et al. Simple thrombin-based method for eliminating fibrinogen interference in serum protein electrophoresis of haemodialysed patients. Biochem Med (Zagreb). 2020;30(2):020705.
  • Dimeski G, Masci PP, Trabi M, et al. Evaluation of the Becton-Dickinson rapid serum tube: does it provide a suitable alternative to lithium heparin plasma tubes? Clin Chem Lab Med. 2010;48(5):651–657.
  • Cervellin G, Aloe R, Lippi G. A case of factitious hyponatremia hypokalemia due to the presence of fibrin gel in serum. Diagnosis. 2015;2(1):73–74.
  • Simundic AM, Bolenius K, Cadamuro J, et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med. 2018;56(12):2015–2038.
  • Boo AYY, Koh YLE, Hu PL, et al. Prevalence and factors associated with false hyperkalaemia in Asians in primary care: a cross-sectional study (the unlysed hyperkalaemia- the unseen burden (UHUB) study). BMJ Open. 2020;10(9):e033755.
  • Wei R, Légaré W, McShane AJ. Autoverification-based algorithms to detect preanalytical errors: two examples. Clin Biochem. 2022;3; DOI:10.1016/j.clinbiochem.2022.06.010
  • CLSI. Procedures for the handling and processing of blood specimens; approved guideline. 4th Edition. CLSI document H18-A4. Wayne, PA: CLSI; 2010.
  • Oddoze C, Lombard E, Portugal H. Stability study of 81 analytes in human whole blood, in serum and in plasma. Clin Biochem. 2012;45:464–469.
  • Zhang DJ, Elswick RK, Miller WG, et al. Effect of serum-clot contact time on clinical chemistry laboratory results. Clin. Chem. 1998;44:1325–1333.
  • Smellie WS. Spurious hyperkalaemia. BMJ. 2007;334(7595):693–695.
  • Oliver TK, Jr, Young GA, Bates GD, et al. Facititial hyperkalemia due to icing before analysis. Pediatrics. 1966;38(5):900–902.
  • Goodman JR, Vincent J, Rosen I. Serum and potassium changes in blood clots. Am J Clin Pathol. 1954;24(1):111–113.
  • Rehak NN, Chiang BT. Storage of whole blood: effect of temperature on the measured concentration of analytes in serum. Clin Chem. 1988;34(10):2111–2114.
  • Trull AK, Jackson C, Walsh S, et al. The perennial problem with potassium. Ann Clin Biochem. 2004;41(Pt 1):47–52.
  • Dupuy AM, Cristol JP, Vincent B, et al. Stability of routine biochemical analytes in whole blood and plasma/serum: focus on potassium stability from lithium heparin. Clin Chem Lab Med. 2018;56(3):413–421.
  • Monneret D, Godmer A, Le Guen R, et al. Stability of routine biochemical analytes in whole blood and plasma from lithium heparin gel tubes during 6-hr storage. J Clin Lab Anal. 2016;30(5):602–609.
  • Henriksen LO, Faber NR, Moller MF, et al. Stability of 35 biochemical and immunological routine tests after 10 hours storage and transport of human whole blood at 21 degrees C. Scand J Clin Lab Invest. 2014;74(7):603–610.
  • Leino A, Koivula MK. Stability of chemical and immunochemical analytes in uncentrifuged plasma samples. Ann Clin Biochem. 2009;46(Pt 2):159–161.
  • Stahl M, Brandslund I. Controlled storage conditions prolong stability of biochemical components in whole blood. Clin Chem Lab Med. 2005;43(2):210–215.
  • Boyanton BL, Jr., Blick KE. Stability studies of twenty-four analytes in human plasma and serum. Clin Chem. 2002;48(12):2242–2247.
  • Sinclair D, Briston P, Young R, et al. Seasonal pseudohyperkalaemia. J Clin Pathol. 2003;56:385–388.
  • Turner HE, Peake RW, Allison JJ. Seasonal pseudohyperkalaemia: no longer an issue? Ann Clin Biochem. 2012;49(Pt 1):94–96.
  • Rampul A, Nowrungsah D, Madurai S, et al. Big data analysis reveals the existence of seasonal pseudohyperkalaemia even in temperate climates. Clin Chim Acta. 2019;497:110–113.
  • Masters PW, Lawson N, Marenah CB, et al. High ambient temperature: a spurious cause of hypokalaemia. BMJ. 1996;312:1652–1653.
  • Lin FC, Cohen R, Losada R, et al. Cellular sedimentation and barrier formation under centrifugal force in blood collection tubes. Lab Med. 2001;32:588–592.
  • Honig A, Oppermann H, Budweg C, et al. Demonstration of temperature dependence of Na(+)-K+ pump activity of human blood cells. Am J Physiol. 1994;266(6 Pt 3):S10–S5.
  • Ayala-Lopez N, Conklin SE, Tenney BJ, et al. Comparative evaluation of blood collection tubes for clinical chemistry analysis. Clin Chim Acta. 2021;520:118–125.
  • Padoan A, Zaninotto M, Piva E, et al. Quality of plasma samples and BD vacutainer barricor tubes: effects of centrifugation. Clin Chim Acta. 2018;483:271–274.
  • Fournier JE, Northrup V, Clark C, et al. Evaluation of BD vacutainer® barricor™ blood collection tubes for routine chemistry testing on a roche cobas® 8000 platform. Clin Biochem. 2018;58:94–99.
  • Gawria G, Tillmar L, Landberg E. A comparison of stability of chemical analytes in plasma from the BD vacutainer® barricor™ tube with mechanical separator versus tubes containing gel separator. J Clin Lab Anal. 2020;34(2):e23060.
  • Hira K, Shimbo T, Fukui T. High serum potassium concentrations after recentrifugation of stored blood specimens. N Engl J Med. 2000;343(2):153–154.
  • Hira K, Ohtani Y, Rahman M, et al. Pseudohyperkalaemia caused by recentrifugation of blood samples after storage in gel separator tubes. Ann Clin Biochem. 2001;38(Pt 4):386–390.
  • BD summary of data on file VS7173. Comparison of BD Vacutainer® SST™ II Advance Tubes with BD Vacutainer® Serum Glass Tubes for Routine Chemistry Analytes2004.
  • Brandhorst G, Engelmayer J, Gotze S, et al. Pre-analytical effects of different lithium heparin plasma separation tubes in the routine clinical chemistry laboratory. Clin Chem Lab Med. 2011;49:1473–1477.
  • BD summary of data on file VS7172. Comparison of BD Vacutainer® PSTTM II Plus tubes with BD Vacutainer® Lithium heparin glass tubes for routine chemistry Analytes2004.
  • BD summary of data on file VS7174. Comparison of BD Vacutainer® Lithium heparin plus tubes with BD Vacutainer® Lithium heparin glass tubes for routine chemistry analytes2004.
  • Joseph TP. Interferences from wood applicator sticks used in serum. Clin Chem. 1982;28:544.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.