Abkhazia Institute for Social and Economic Research

Hemolysis, Lipemic Serum or Plasma (Turbidity), and other interference with results
Basal state = early in the morning after a 12 hour fast.  This basal state allows for comparison of a patient’s test results with normal values or reference ranges for patients in the same age group.  However, all of the following patient physiologic variable can affect test results in various ways:

• age
• altitude from sea level
• diet
• diurnal variation, especially if unusual sleep pattern
• drug therapy
• exercise
• fever
• gender
• jaundice
• position
• pregnancy
• smoking
• stress
• temperature and humidity

(falsely increase results for potassium, magnesium, iron, lactate dehydrogenase, phosphorus, ammonia, and TP)
Improper phlebotomy techniques (Using small needle, pulling a syringe plunger back too fast, expelling the blood vigorously into a tube, shaking tubes vigorously, improper storage temperature)
Normal serum or plasma is a clear and light yellow to straw in color. Turbid serum or plasma appears cloudy or milky. Serum or plasma may be cloudy due to bacterial contamination or chronic or transient high lipid levels in the patient's blood. The primary dietary sources of lipids (fatty substances) are meats, butter, cream, and cheese. Patients who consume these foods within the 24-hour period immediately preceding collection of a blood specimen may have temporarily elevated lipid levels, which may be manifested by cloudy or lipemic serum. Lipemic serum or plasma may not be a true indicator of the patient's physiologic state. Regardless of diet and length of fast, some patients may produce cloudy specimens. To avoid dietary-induced high lipid levels prior to testing, many physicians require patients to exclude the high-fat foods from their diets or to fast for 12-14 hours prior to specimen collection. For morning specimen collection, the laboratory recommends that the patient be required to fast from 6 PM on the previous evening.
a. Chilled samples -blood gases, gastrin, ammonia, lactic acid, renin, catecholamine,
parathyroid hormone, ACTH and glucagon.
b. Protect from light - bilirubin, vitamin B12, carotene, folate and urine samples for
porphyrin determination.
1) Bilirubin is a byproduct of red cell breakdown, if excessive amounts
accumulate in babies can cause brain damage.
2) It is light sensitive, and falsely decreased results may be obtained when
improperly transported.
3) Protect from light by wrapping in foil or placing in a box.
c. Warmed samples -cold agglutinins and cryoglobulin.
d. Microbiology samples should be delivered to the department immediately to enhance
ability to grow pathogenic organisms.
e. Positioning vacuum tubes after collection.
1) Maintain microtainers and vacuum tubes in an upright, vertical position.
2) This is done to for two purposes: Promote clot formation, if required and
reduce possibility of hemolysis.
* Specimen timing or storage problems, whether the specimen is any good if it was left out all night at room temperature unspun or even spun.═ What kind of errors would we expect it this happened to a specimen? chemical activity and degeneration of the cells within the tube will take place, and test results may be altered. Low glucose level, High potassium and LDH levels.
If, for example, fasting blood glucose test is needed many things can affect the test results.
Consuming food or drink less than 12 hours before testing will affect fasting blood glucose test results. If the meal eaten just before the 2-hour postprandial test is not high in carbohydrates, the test may not be accurate. Medications that can raise blood glucose levels include birth control pills, phenytoin (Dilantin), furosemide (Lasix), triamterene (Dyrenium, Dyazide), hydrochlorothiazide (Esidrix, Hydro Par, Oretic), niacin, and corticosteroids (prednisone or hexadrol). Medications that can lower blood glucose levels include clofibrate (Atromid), high blood pressure medications such as propranolol (Inderal), and some medications used to treat depression. Drinking alcohol may also lower blood glucose levels. Illness or emotional stress, smoking, and caffeine can raise blood sugar levels. Rough handling, contamination, or inadequate refrigeration of the blood sample can cause inaccurate test results.