Ann Lab Med.  2016 Nov;36(6):599-602. 10.3343/alm.2016.36.6.599.

Development of a Novel Quality Improvement Indicator Based on the Hemolysis Index

• Lee EJ
• Kim M
• Kim HS
• Park MJ
• Lee YK
• Kang HJ

• KMID: 2373600
• DOI: http://doi.org/10.3343/alm.2016.36.6.599

Abstract

Hemolysis frequently causes preanalytical errors in laboratory measurements. We aimed to develop a quality improvement indicator for evaluating the extent of inappropriate procedures causing hemolysis in clinical samples collected in medical care units. We defined the threshold value of the hemolysis index (H index) causing significant interference with analyte measurement and analyzed the H index values of clinical samples in relation to the threshold. The H index threshold value causing a 10% bias in the measurement of lactate dehydrogenase was found to be 25. The monthly mean H index and monthly frequency of samples with an H index >25 were significantly different among the types of ward (P=0.001, respectively), and significantly decreased after replacement of a laboratory centrifuge lacking temperature control (20.6±0.58 vs 23.30±1.08, P=0.01; 23.4±1.69% vs 32.6±1.78%, P=0.01). The monthly mean H index and the monthly frequency of samples with an H index above a threshold value may be useful quality improvement indicators for detection of inappropriate procedures in the acquisition and handling of blood samples in medical care units.

Keyword

H index; Hemolysis; Quality improvement indicator; Preanalytical error

MeSH Terms

Hemoglobins/analysis
Hemolysis
Humans
L-Lactate Dehydrogenase/analysis
Laboratories, Hospital/*standards
Quality Improvement/*standards
Specimen Handling
Hemoglobins
L-Lactate Dehydrogenase

Figure

• 

  Fig. 1 Correlation between the H index and Hb concentration (A). Interference with the measurement of LD caused by increased hemolysis in a sample (B). The solid line represents the original concentration of LD, and the dotted lines denote a 10% difference from the original level. The H index value of 25 was expected to cause a 10% bias in the measurement. The distribution of H index values among all the requested routine chemistry samples in a given month (C). The proportion of samples with an H index >25 was 25.2%.Abbreviations: H index, hemolysis index; LD, lactate dehydrogenase.

• 

  Fig. 2 The monthly mean H index (A) and the monthly frequency of samples with an H index over 25 (B) by the type of ward. The data are presented as the mean±SD of monthly values during six months (from January to June 2015). The differences within each pair of groups were analyzed by the Mann-Whitney U test.Abbreviations: H index, hemolysis index; ER, emergency room; MICU, medical intensive care unit; GW, general ward; OPD, outpatient department.

• 

  Fig. 3 The monthly mean H index (A) and the monthly frequency of samples with an H index over 25 (B) before and after replacement of a centrifuge lacking temperature control in a clinical laboratory (January 9, 2015, indicated with an arrow). Differences in the monthly mean H index or monthly frequency of samples with an H index over 25 before (from September to December 2014) and after centrifuge replacement (from February to June 2015) were analyzed by the Mann-Whitney U test.Abbreviation: H index, hemolysis index.

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