How does a blood sample with broken red blood cells affect the test results?

The article was written by BS. Tran Thi Huyen Trang, Laboratory Department, Vinmec Times City International General Hospital

RBC rupture in the body is the result of biochemical, immunological, physiological or chemical mechanisms. Blood samples with broken red blood cells have a great influence on test results such as spectral noise, chemical noise.

RBC rupture (hemolysis) is defined as the release of the contents of red blood cells and other blood cells into the plasma. The release of hemoglobin causes serum or plasma to appear pale red to cherry red.

Hemolysis in the body is the result of biochemical, immunological, physiological or chemical mechanisms. Hemolysis can be intravascular and extravascular. Intravascular hemolysis is rare and usually results from a transfusion reaction or hemolytic anemia. Extravascular hemolysis is quite common and occurs during improper venipuncture, handling, transport, and storage techniques that cause pre-examination errors.

Release of components of blood cells into plasma or serum. Some cellular components have a concentration 10 times higher in the cell than extracellular, hemolysis in serum/plasma leads to increased concentrations of these components (e.g. Potassium, Aspartate aminotransferase, lactate dehydrogenase...) . Spectral/colorimetric interference by hemoglobin: Hemoglobin absorbs light very strongly at 415 nm so it can cause interference in some assays where absorbance is measured at wavelengths close to maximum absorbance of oxyhemoglobin (410, 540, 580 nm). Chemical interference: Blood cell components can interfere directly or indirectly with the measurement of analytes. Adenylate kinase released from erythrocytes can cause elevation of creatine kinase and elevation of CK-MB. Free hemoglobin with peroxidase pseudo-activity inhibits diazonium coloration. Cellular-released proteases reduce the activity of coagulation factors and increase the formation of fibrinolysis products. Hemoglobin may cause interference by reacting with one or more components of the reagent.

Common blood chemistry tests affected by hemolysis

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