An Expert Call to Action: Addressing the Risks of Undetected In Vitro Hemolysis in High-Risk Clinical Areas

A new peer‑reviewed Special Report published in the Journal of Applied Laboratory Medicine (JALM) is urging hospitals to take coordinated action to address the risks of undetected in vitro hemolysis, a preanalytical error with the potential to negatively impact patient care.¹

• ICU Physician Dr. Ramzy Rimawi on the Critical Role of Rapid Hemolysis Detection in the ICU
• Why Rapid, Reliable Results Matter in the ICU
• A Faster Path to Confident Care

Titled “Handling Hemolytic Blood Samples from High‑Risk Clinical Areas: A Call to Action,” the multi‑author report emphasizes that hemolysis can cause misinterpretation of critical test results—most notably potassium—and calls for a hospital‑wide approach to better detect, prevent, and manage hemolysis, especially in high‑risk settings such as emergency departments and intensive care units (ICU).¹

Why does this matter so much? The Special Report spotlights how hemolysis can go unrecognized in whole blood testing and how that can affect real‑time clinical decision‑making—where minutes matter and unnecessary sample recollection due to suspected in vitro hemolysis can introduce delays, and potentially lead to inappropriate patient management and decreased patient satisfaction.^2-6

One of the report’s contributing authors, Ramzy Husam Rimawi, MD, at Emory University School of Medicine, sees this issue firsthand. A specialist in Critical Care Medicine and Infectious Diseases, with more than a decade of experience, Dr. Rimawi provides lifesaving care to severely ill and vulnerable patients. For him, rapid hemolysis detection is essential in modern ICU care.

Dr. Ramzy Rimawi on the Critical Role of Rapid Hemolysis Detection in the ICU 

Time is one of the most important elements of patient care. In the ICU, time is rarely a luxury. Clinicians depend on accurate test results within minutes to make fast, informed decisions. Every delay carries risk, which in the ICU, can be fatal. When in vitro hemolysis is undetected, test results can be misleading, potentially prompting unnecessary interventions or masking true patient conditions. Rapid hemolysis detection helps ensure that results guiding care are accurate. 

Why Rapid, Reliable Results Matter in the ICU

In the ICU, he says, rapid hemolysis detection isn’t just a lab quality improvement—it can be a critical safeguard that helps clinicians act quickly and confidently when results are time‑sensitive.

In critical situations, the ability to quickly confirm whether a patient’s potassium level is accurate—or falsely altered due to hemolysis—can mean the difference between a life‑saving intervention and a life‑threatening error.

Hyperkalemia, for example, is among the most urgent lab results prompting action by ICU clinicians—especially in patients with renal failure or unstable electrolytes, according to Dr. Rimawi. It can cause arrhythmias and is linked to high mortality, if not promptly treated.^7,8

In many ICUs, Dr. Rimawi has observed that elevated potassium automatically triggers treatment with calcium, insulin, and dextrose. But if the result is falsely high, that treatment can dangerously lower potassium, increasing cardiac risk.⁷

“You can’t look at a patient and know their potassium is dangerously high,” says Dr. Rimawi. “If test results are wrong, treatment decisions can become dangerous.”

Without timely, accurate hemolysis detection, clinicians face two risky choices: wait for a repeat test, which delays critical treatment, or act on potentially flawed data, risking inappropriate patient management.^2,4,5

“You end up treating a number instead of the patient,” Rimawi notes.

A Faster Path to Confident Care

A new generation of blood gas systems incorporating whole blood hemolysis-detection technology is now available to help clinicians identify compromised samples in real time—an advancement that can significantly reduce the risks associated with delayed or inaccurate results in the ICU. This new technology—only available in the GEM^® Premier™ 7000 with iQM^®3—provides rapid hemolysis detection at the point of care to support expedited decision-making and enhanced patient care and efficiency.^2–6,11,12

For Dr. Rimawi, this innovation represents a crucial step forward. Beyond delivering lab-grade accuracy, he emphasizes that it’s also about protecting patients and improving workflow. By flagging hemolysis in whole blood samples in just 45 seconds, this innovation can improve operational efficiency and clinical-decision making.^2–6,11,12

Ultimately, Dr. Rimawi hopes that rapid hemolysis detection becomes standard practice in every ICU, helping clinicians make faster, more informed decisions and ensuring patients receive the best care.

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