HEMOLYSIS CHART

Venipuncture

Prolonged tourniquet time

Cleansing procedure with isopropyl alcohol

Needle placement

Tube choice

Hematoma

Collection Factors contributing to hemolysis

Venipuncture: possible consequences

Hand veins are fragile and easily traumatized

Venipuncture: Corrective Actions

Veins in the antecubital area of the arm are the veins of choice. If blood is drawn below this area, a 22g or 23 g needle used with a partial draw tube is suggested. A partial draw tube has reduced vacuum and less trauma. Make sure this partial draw tube has enough volume to maintain a proper blood-to-additive ratio

Prolonged tourniquet time (possible consequences)

Hemoconcentration can affect water balance of cells, causing rupture of the red blood cells

Prolonged tourniquet time (Corrective action)

Release the tourniquet as soon as blood flow is established in the first tube, if possible

Cleansing procedure with isopropyl alcohol

(possible consequences)

If venipuncture is performed before alcohol is allowed to dry, red cell will rupture

Cleansing procedure with isopropyl alcohol (corrective actions)

Allow alcohol to dry throughly

Needle occlusion (possible consequences)

may cause blood to flow slowly and initiate RBC shearing

Needle occlusion (corrective action)

The needle bevel may be positioned against the vein wall. Pull back slightly on the needle.

Avoid rotating or changing the angle of the needle

Tube choice (possible consequence)

Tube vacuum might cause blood to enter the tube forcefully and may cause cell repture

Tube choice (corrective actions)

If partial draw tube is not acceptable for the test (eg, protime), there may be smaller tubes available

Hematoma (possible consequences)

Specimens collected by penetrating through a hematoma may cause erroneous results

Hematoma (corrective actions)

Select another site. If another site is not available, collect distally to the hematoma

Vigorous mixing of tubes

Centrifuging specimens before 30 minutes after collection

Prolonged contact of serum or plasma with cells

Temperatures: elevated or decreased

Processing, Handling, and Transport Factors Contributing to hemolysis

Vigorous mixing of tube (possible consequences)

Vigorous mixing may cause the red blood cells to rupture

Vigorous mixing of tubes (corrective action)

Use gentle inversion only

Centrifuging specimens before 30 minutes after collection (possible consequences)

If the clot is not completely formed, serum separation from the red blood cell is incomplete

Centrifuging specimens before 30 mins after collection (corrective action)

Allow the specimen tube to remain vertical in the rack for a minimum of 30 minutes

Prolonged contact of serum/plasma with cells

(possible consequences)

hemoglobin released from hemolyzed cells will contaminate serum or plasma

Prolonged contact of serum/plasma with cells

(corrective actions)

Centrifuge the specimen after clotted, but within 2 hours after collection

Temperature-elevated or decreased

(possible consequences)

RBC membrane may rupture

Temperature-elevated or decreased

(corrective action)

Do not centrifuge specimens longer than 20 minutes. the heat generated in the centrifuge may cause red cells to lyse

Do not place the tubes or centrifuge on a counter exposed to extreme temperature variations (eg, next to autoclave)

Never refrigerate the specimen before centrifuging

When placing specimen boxes outside of the building, place them in an area that is not exposed to extreme hot and cold temperatures. If the weather is hot, place an ice pack in box, being careful that specimens are not directly touching it