Accessible Unlicensed Requires Authentication Published by De Gruyter July 9, 2019

Handling of hemolyzed serum samples in clinical chemistry laboratories: the Nordic hemolysis project

Gro Gidske, Kristin Moberg Aakre, Pål Rustad, Sverre Sandberg, Anna Norling, Jonna Pelanti, Gitte Henriksen, Ingunn Thorsteinsdottir and Gunn B.B. Kristensen



Some clinical chemistry measurement methods are vulnerable to interference if hemolyzed serum samples are used. The aims of this study were: (1) to obtain updated information about how hemolysis affects clinical chemistry test results on different instrument platforms used in Nordic laboratories, and (2) to obtain data on how test results from hemolyzed samples are reported in Nordic laboratories.


Four identical samples containing different degrees of hemolysis were prepared and distributed to 145 laboratories in the Nordic countries. The laboratories were asked to measure the concentration of cell-free hemoglobin (Hb), together with 15 clinical chemistry analytes. In addition, the laboratories completed a questionnaire about how hemolyzed samples are handled and reported.


Automated detection of hemolysis in all routine patient samples was used by 63% of laboratories, and 88% had written procedures on how to handle hemolyzed samples. The different instrument platforms measured comparable mean Hb concentrations in the four samples. For most analytes, hemolysis caused a homogenous degree of interference regardless of the instrument platform used, except for alkaline phosphatase (ALP), bilirubin (total) and creatine kinase (CK). The recommended cut-off points for rejection of a result varied substantially between the manufacturers. The laboratories differed in how they reported test results, even when they used the same type of instrument.


Most of the analytes were homogeneously affected by hemolysis, regardless of the instrument used. There is large variation, however, between the laboratories on how they report test results from hemolyzed samples, even when they use the same type of instrument.

Corresponding author: Gro Gidske, MSc, Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, P.O. Box 6165, 5892 Bergen, Norway, Phone: +47 55 97 95 00, Fax: +47 55 97 95 10


The authors would like to thank Mette Christophersen Tollånes, Noklus, for useful comments. The authors also gratefully acknowledge the financial support provided by the Nordic Society of Clinical Chemistry (NFKK).

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Supplementary Material

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Received: 2019-04-05
Accepted: 2019-06-06
Published Online: 2019-07-09
Published in Print: 2019-10-25

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