Abstract
Background: Rejection of hemolysed samples for coagulation test is the standard practice.However, when clinicians deal with extremely sick patients where repeat sampling is difficult toobtain, rejection of the sample is a lost opportunity for the lab physician to assist inpatient care.Proceeding with the test and providing a clinically helpful interpretation of the results will ensure theactive participation of the laboratory physician. Different principles of coagulation testing handle thehemolysed samples differently. It is essential to know the best principle to proceed with thehemolysed sample if need be. This study set out to estimate the predictive values of post-hemolyticsample coagulation test results with various coagulation test principles. Methods: This is aprospective experimental study where the non-hemolysed samples were processed for coagulationtests. Part of the sample was deliberately hemolysed, and the coagulation tests were repeated.Results: Two hundred and forty-eight samples were studied. A median of 11% hemolysis wasachieved experimentally. The mean difference in prothrombin time between pre and post hemolyticsamples with normal PT was 0.9 and with abnormal PT, it was 1.1 seconds. The same for APTT was4.9 and 1.1 seconds, respectively. The majority of the samples showed prolonged coagulation posthemolysis. Positive (PPV) and negative (NPV) predictive values for prothrombin time are 97.3 and73.4%, respectively. Similarly, PPV and NPV for APTT are 97.4 and 47.1%, respectively.Conclusions: Samples with normal values after hemolysis are more likely to be normal.
Highlights
Coagulation testing is one of the frequently requested laboratory tests by the clinicians involved in the care of patients in intensive care units, obstetrics, surgery and those requiring anticoagulant or antithrombotic therapy
Two hundred and forty-eight samples received in the Hematology laboratory for coagulation testing were studied. 59% of the samples were from emergency and ICU wards, and 41% were from the outpatient department. 235 (94%) of the samples were from the adult population, and 15 (6%) were from Pediatrics. 247 (99%) samples were analysed for Prothrombin time (PT) & INR, and 238 (95.2%) were analysed for Activated partial thromboplastin time (APTT)
Our study shows that the coagulation results of hemolysed samples vary significantly compared to non-hemolytic samples and remain inferior to proceed with coagulation tests
Summary
Coagulation testing is one of the frequently requested laboratory tests by the clinicians involved in the care of patients in intensive care units, obstetrics, surgery and those requiring anticoagulant or antithrombotic therapy. Rejection of all hemolysed samples is the standard rule set by the manufacturers of the instruments and the reagents. The clinical and Laboratory Standards Institute recommends that samples with visible hemolysis be used because of possible clotting factor activation and endpoint measurement interference. Rejection of hemolysed samples for coagulation test is the standard practice. Different principles of coagulation testing handle the hemolysed samples differently. This study set out to estimate the predictive values of post-hemolytic sample coagulation test results with various coagulation test principles. Methods: This is a prospective experimental study where the non-hemolysed samples were processed for coagulation tests. Part of the sample was deliberately hemolysed, and the coagulation tests were repeated. Conclusions: Samples with normal values after hemolysis are more likely to be normal
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