Hemolysis Rates Across Care Settings: What Clinicians Should Know

Dr. Christopher Farnsworth: "Hemolysis is a Universal Issue Across the Country"

A recently published multi-institutional study in Clinical Biochemistry demonstrated that hemolysis in whole blood potassium samples is a widespread challenge across U.S. hospitals, with consistently high rates observed across various academic medical centers.¹ The findings suggest that undetected hemolysis is not necessarily an isolated issue, but a nationwide patient safety concern that can contribute to inaccurate potassium results, delayed treatment, unnecessary sample recollection, and increased healthcare costs.¹

Titled "Multi-institution Comparison of Whole Blood Potassium Hemolysis Rates," the study evaluated nearly 38,000 whole blood samples collected over eight months at four academic medical centers. Researchers found an overall hemolysis rate of 10%, with the highest rates occurring in emergency departments (ED), marking the first study to demonstrate that elevated hemolysis rates are consistently observed across geographically diverse hospital systems.¹

One of the study's lead authors, Dr. Christopher Farnsworth, Co-Medical Director of Clinical Chemistry and Medical Director of Point-of-Care Testing at Barnes-Jewish Hospital, explains why he believes broader adoption of innovative technology is necessary to improve patient safety and laboratory quality.

Hospitals nationwide continue to contend with operational pressures, including staffing constraints and supply challenges. At the same time, preanalytical variability remains a persistent and clinically meaningful contributor to laboratory testing errors. Preanalytical issues can affect specimen integrity, result interpretation, and downstream care decisions.^1-3

Hemolysis can arise from specimen collection/handling (in vitro) or from patient pathology (in vivo). In vitro hemolysis is the most common type of preanalytical laboratory error, accounting for up to 70% of all preanalytical errors, and can directly influence potassium measurements and patient care.^1-3 While clinicians are aware of hemolysis, few recognize just how pervasive the problem is throughout different hospital settings.

“When hemolysis goes undetected, clinicians may be making treatment decisions based on a potassium results that doesn't reflect what's actually happening in the patient," Dr. Farnsworth shared.

Time is one of the most important elements of patient care.^1,2 In the Intensive Care Unit (ICU), time is rarely a luxury. Clinicians depend on accurate test results within minutes to make fast, informed decisions. When in vitro hemolysis is undetected, test results can be misleading, potentially prompting unnecessary interventions or masking true patient conditions.⁴ Rapid hemolysis detection helps ensure that results guiding care are accurate.

Multi-Institution Findings: Hemolysis Patterns Across Care Settings

The findings point to a broader challenge for hospitals: hemolysis is not confined to a single institution, region, or care setting. Similar rates across geographically diverse sites suggest that specimen quality is a widespread issue, reinforcing the need for reliable methods to identify hemolysis at the point of care.⁵

“We have never seen a study of this scale examining the prevalence of hemolysis in specimens tested at the point of care, so observing similar rates across such geographically diverse sites was surprising,” said Dr. Farnsworth. “There is no existing manuscript comparing hemolysis rates across different hospital settings or across the US, so these data are entirely new.”

The study highlights that hemolysis can occur across a wide range of clinical settings. Preanalytical factors that affect specimen quality can occur broadly, across routine collection and handling processes, underscoring why hemolysis is not limited to any one unit.^1-3

Clinical Impact: Potassium Results, Throughput Delays, and Repeat Testing

Potassium measurement is notably susceptible to the effects of in vitro hemolysis, and uncertainty about specimen quality can create real clinical tension—particularly when a reported value does not match the patient’s presentation. ^2,6

Historically, when a point-of-care potassium result is reported as elevated, but the clinical findings do not align, teams may respond with additional steps—repeat sample collection, confirmatory testing, or delayed decisions—until hemolysis can be ruled out.² This approach is understandable, but it has consequences: repeated collections can lead to patient discomfort and consume nursing time, while additional testing and waiting can affect flow, adding time and cost, in busy acute care settings.^2,7,8

In the ED, for example, hemolyzed blood samples have been associated with prolonged throughput time and increased costs, highlighting the broader operational and economic burden of hemolysis.^7,8

Reducing In Vitro Hemolysis: Training, Standardization, and Earlier Detection

Prevention strategies commonly focus on preanalytical processes, including standardized collection/handling practices and targeted education regarding causes of in vitro hemolysis.^1,9

However, Dr. Farnsworth explains that training alone may not fully resolve hemolysis in settings where blood collection is time-pressured, across varied roles, and in unpredictable clinical conditions.

Dr. Farnsworth notes that these realities underscore the need for technology that can identify hemolysis at the point of care, rather than relying on training and collection practices alone. Detecting hemolysis before a potassium result is acted upon can help clinicians recognize when a result may be unreliable and avoid decisions based on a compromised sample.

Point of Care Whole Blood Hemolysis Detection: Clinical Use and Interpretation

Until recently, hemolysis detection was not possible with point-of-care technology. However, in 2024, Werfen introduced the GEM^® Premier^™ 7000 with iQM^®3—the first blood gas testing system capable of detecting hemolysis in whole blood samples in 45 seconds.^10,11

Clinically, the value of earlier hemolysis detection lies in the decision pathway it enables: identifying specimen quality issues before acting on a potentially confounded potassium result may help prevent inappropriate patient management decisions and reduce workflow inefficiencies.^{2,6, 7-9}

Dr Farnsworth also notes that this study is an important step toward helping hospitals quantify the true impact of hemolysis on patient care and justify investments in new, innovative technologies.

“With blood gas testing that detects hemolysis at the point of care, we’re looking at the potential for reduced length of stay, lower costs, and ultimately improved care for our patients,” said Dr. Farnsworth. “Having the ability to quantify these factors makes the need for improved technology unmistakably clear.”

References

RC Hem Article J WW REV00 5.26