Improving home haemodialysis: Stability evaluation of routine clinical chemistry analytes in blood samples of haemodialysis patients

Introduction: A growing number of dialysis patients is treated with home haemodialysis. Our current pre-analytical protocols require patients to centrifuge the blood sample and transfer the plasma into a new tube at home. This procedure is prone to errors and precludes accurate bicarbonate measurement, required for determining dialysate bicarbonate concentration and maintaining acid-base status. We therefore evaluated whether cooled overnight storage of gel separated plasma is an acceptable alternative. Materials and methods: Venous blood of 34 haemodialysis patients was collected in 2 lithium heparin blood collection tubes with gel separator (LH PSTTM II, REF 367374; Becton Dickinson, New Jersey, USA). One tube was analysed directly for measurement of bicarbonate, potassium, calcium, phosphate, glucose, urea, lactate, aspartate aminotransferase (AST), and lactate dehydrogenase (LD); whereas the other was centrifuged and stored unopened at 4 °C and analysed 24 h later. To measure analyte stability after 24 h of storage, the mean difference was calculated and compared to the total allowable error (TEa) which was used as acceptance limit. Results: Potassium (Z = - 4.28, P < 0.001), phosphate (Z = - 3.26, P = 0.001), lactate (Z = - 5.11, P < 0.001) and AST (Z = - 2.71, P = 0.007) concentrations were higher, whereas glucose (Z = 4.00, P < 0.001) and LD (Z = 3.13, P = 0.002) showed a reduction. All mean differences were smaller than the TEa and thus not clinically relevant. Bicarbonate (Z = 0.69, P = 0.491), calcium (Z = - 0.23, P = 0.815) and urea (Z = 0.81, P =0.415) concentrations were stable. Conclusions: Our less complex, user-friendly pre-analytical procedure resulted in at least 24 h stability of analytes relevant for monitoring haemodialysis, including bicarbonate. This allows shipment and analysis the next day

Erratum : Sawtooth potassium and hemoglobin results (Clinical Chemistry (2019) 65 (1463–1464) DOI: 10.1373/clinchem.2019.304394)

CASE DESCRIPTION A 5-year-old boy was admitted with dyspnea, fever, night sweats, and unexplained bruising. Radiography revealed several pulmonary consolidations, and laboratory investigations showed marked hyperleukocytosis with 90% blasts. He was diagnosed with T-cell acute lymphoblastic leukemia. Hemoglobin (Hb)2 and potassium results in the subsequent days, during therapy, showed a sawtooth pattern [Fig. 1: central lab, solid dots; point of care (POC), open dots]. The physician was confused and unsure what Hb and potassium results to act on and contacted the laboratory. (Figure Presented)

Erratum : Sawtooth potassium and hemoglobin results (Clinical Chemistry (2019) 65 (1463–1464) DOI: 10.1373/clinchem.2019.304394)

CASE DESCRIPTION A 5-year-old boy was admitted with dyspnea, fever, night sweats, and unexplained bruising. Radiography revealed several pulmonary consolidations, and laboratory investigations showed marked hyperleukocytosis with 90% blasts. He was diagnosed with T-cell acute lymphoblastic leukemia. Hemoglobin (Hb)2 and potassium results in the subsequent days, during therapy, showed a sawtooth pattern [Fig. 1: central lab, solid dots; point of care (POC), open dots]. The physician was confused and unsure what Hb and potassium results to act on and contacted the laboratory. (Figure Presented)