Reducing haemolysis in blood samples

Vigorous mixing can lead to a haemolysed blood gas sample [1]

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During the preanalytical phase of blood gas analysis, haemolysis in blood samples might occur if you mix too vigorously. [1]

An example of a haemolysed blood sample:

Figure 1, Degree of haemolysis. Modified illustration from Wennecke. Useful tips to avoid preanalytical errors in blood gas testing: electrolytes. 2003 [1]

Vigorous mixing might lead to hemolysis in blood gas samples. In a hemolyzed sample erythrocytes rupture and components from inside the cell(s) are released into the plasma. One of these components is potassium (K⁺). [1]

Reduce the risk of haemolysis in blood gas samples

Manual mixing:

Figure 2, Mixing of the arterial blood sample [5]

A suggested technique is to mix the sample by inverting and rolling the syringe between your palms.

However, you can also use the automated mixing feature in your blood gas analyser to obtain a homogenous sample without causing haemolysis. [3]

Automated mixing

You need to mix a sample sufficiently in order to obtain a homogeneous sample to get accurate results. However, the technique of manual mixing is applied inconsistently. [3 - 4]

Additionally, haemolysis in blood gas samples can occur through vigorous mixing prior to analysis. [2]

Automated mixing on a blood gas analyser is preferable to non-standardized manual mixing. This is because the automated mixing helps ensure sufficient mixing and a homogenous sample. [3 - 4]

Dry electrolyte balanced heparin in combination with automated mixing in our safePICO syringes help reduce the risk of blood sample clotting

Prior to analysis, sufficient mixing is crucial to obtain a homogeneous sample. The safePICO syringe and automated mixing on a blood gas analyser helps you produce a homogeneous sample, without causing haemolysis. [3]

The safePICO syringe is designed to reduce the risk of other preanalytical errors. In addition to hemolysis during mixing, safePICO can help to remove air bubble in the sample safely, to reduce risk of needlestick injuries, a clotted blood sample or patient-sample mix-up.

References

1. Wennecke G. Useful tips to avoid preanalytical errors in blood gas testing: electrolytes. www.acutecaretesting.org Oct 2003.
2. Lippi G, Fontana R, Avanzani P et al. Influence of spurious hemolysis on blood gas analysis. Clin Chem Lab Med 2013; 51: 1651-4.
3. Grenache D et al. Integrated and automatic mixing of whole blood: An evaluation of a novel blood gas analyzer. Science Direct 2006; 375, 1-2; 153 – 157
4. Benoit M et al. Evaluation and advantages of an automatic magnetic mixing of syringes integrated with a whole blood gas analyzer. Scandinavian Journal of Clinical & Laboratory Investigation 2009; 69, 5: 628-32.
5. Dukic L et al. Blood gas testing and related measurements: National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochemia Medica 2016; 26, 3: 318-36.

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