SHM Converge Scientific Abstract ePoster Gallery-Missing a Warm Hug: In Vitro Hemolysis Causing Pseudohyperkalemia

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This case report describes pseudohyperkalemia caused by in vitro hemolysis in a patient with cold agglutinin disease (CAD). CAD is a rare autoimmune hemolytic anemia in which IgM autoantibodies trigger red blood cell agglutination and complement-mediated hemolysis, especially with cold exposure.<br /><br />A 63-year-old man with heart failure and CAD secondary to Waldenstrom macroglobulinemia was admitted for symptomatic anemia and fluid overload. While receiving IV furosemide, his electrolytes were being monitored. His first potassium level was 6.2 mEq/L, but the sample was hemolyzed. Two additional blood draws were also hemolyzed, including one taken without a tourniquet, raising concern for severe hemolysis in the body. However, other hemolysis-related indicators remained stable, suggesting the hemolysis might not be occurring in vivo.<br /><br />To test this, a fourth potassium sample was collected with precautions to prevent cold exposure: the vial was kept warm between the patient’s palms and transported immediately to the laboratory. This sample was not hemolyzed and showed a normal potassium level of 3.7 mEq/L. This confirmed that the earlier elevated potassium values were false results caused by in vitro hemolysis from exposure to cold.<br /><br />The case highlights that in patients with CAD, blood exposure to cold after collection can rapidly cause hemolysis and lead to pseudohyperkalemia. This can result in unnecessary tests or potentially harmful treatment. Simple preventive steps, such as keeping the blood sample warm during collection and transport, can avoid this problem.

Asset Subtitle

Joonkyung Lee

Meta Tag

Author List Elizabeth Guevara, Jesus Javier Rubio Castillon, Joonkyung Lee, Julie Kanevsky, Simrat Batth

Category Clinical Vignettes

Concept Cold Agglutinin Disease

Concept In Vitro Hemolysis

Concept Pseudohyperkalemia

Concept Agglutination

Concept Cold Exposure

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Joonkyung Lee

Track Adult

Keywords

pseudohyperkalemia

in vitro hemolysis

cold agglutinin disease

hemolyzed blood sample

hyperkalemia

autoimmune hemolytic anemia

IgM autoantibodies

complement-mediated hemolysis

Waldenstrom macroglobulinemia

blood sample warming

Cold Agglutinin Disease

In Vitro Hemolysis

Pseudohyperkalemia

Agglutination

Cold Exposure