Overview
Hemolysis is the rupture of red blood cells releasing intracellular contents into serum or plasma, which can artificially raise or interfere with certain analyte results. Its laboratory significance is that some requested results become unreliable at moderate-to-marked degrees of hemolysis.
Classification
| Decision checkpoint | Action |
|---|---|
| Mild hemolysis, analyte not significantly affected | May report per local SOP |
| Moderate/marked hemolysis, sensitive analyte requested | Reject and request recollection |
| Hemolysis-sensitive result appears critical | Verify specimen quality before treating as a true critical value |
| Recollection not immediately possible | Communicate limitation to the requesting clinician |
| Reporting is permitted by SOP | State clearly which result may be affected and why |
Morphologic Features
Hemolysis appears as a pink-to-red tinge in serum or plasma, ranging from a faint blush (mild) to opaque deep red (marked). Many laboratories grade it visually or with an automated hemolysis index.
Laboratory Characteristics
- Commonly affects potassium, LDH, and AST; effect on other analytes is test-specific
- Degree of interference generally increases with degree of hemolysis
- Preventable in most cases, collection technique is the leading cause
Reference Intervals
Not applicable as a patient reference interval. Hemolysis index thresholds and accept/reject/comment rules are defined by local laboratory procedure and analyzer manufacturer guidance.
Clinical and Laboratory Significance
Hemolysis itself is not a patient diagnosis, its significance is that it can produce a falsely abnormal (most often falsely elevated) result for sensitive analytes, risking an incorrect clinical decision if not recognized and handled correctly.
Differential Considerations
Distinguish in vitro hemolysis (collection/handling/transport artifact) from true in vivo hemolysis reflecting a patient condition, history, other clinical findings, and pattern across analytes help separate the two; when uncertain, treat the in vitro possibility as needing specimen-quality assessment first.
Comparison Tables
Hemolysis checkpoints
| Pressure point | Safe response | Unsafe shortcut |
|---|---|---|
| Clinician needs result urgently | Assess degree, check affected analytes, communicate honestly | Comment and release without checking severity |
| Result looks critical | Verify specimen quality before critical-value action | Call it in as a true critical value immediately |
| Recollection inconvenient | Explain why recollection protects the patient | Report an unreliable value to avoid a repeat draw |
Classification Frameworks
Not applicable . WHO disease classifications do not define hemolysis specimen-handling decisions.
Laboratory Notes
- Grade the hemolysis; match action to which analytes are affected
- Reject/recollect for seriously affected results, never silently release
- Verify before treating a hemolysis-inflated value as a true critical result
References
Authoritative textbooks, guidelines, and reviews supporting this reference entry. Verify reference intervals, critical limits, and reflex criteria against institutional protocols and current guideline editions.
Textbooks
- McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Elsevier; 2021. (Laboratory quality and management chapters, verify current edition.)
CLSI and Professional Guidelines
- Institutional laboratory SOPs, locally adopted quality policies, and manufacturer instructions for use (IFU). Always verify current local practice.
Frequently Asked Questions
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