American Journal of Kidney Diseases
Volume 56, Issue 4 , Pages 686-692 , October 2010

Reducing the Incidence of Pseudohyperkalemia by Avoiding Making a Fist During Phlebotomy: A Quality Improvement Report

  • Masanori Seimiya, PhD

      Affiliations

    • Division of Laboratory Medicine, Chiba University Hospital, Chiba City, Chiba, Japan
    • Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
    • Corresponding Author InformationAddress correspondence to Masanori Seimiya, PhD, Division of Laboratory Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
    • ,
  • Toshihiko Yoshida, BSc

      Affiliations

    • Division of Laboratory Medicine, Chiba University Hospital, Chiba City, Chiba, Japan
    • ,
  • Yuji Sawabe, BHSc

      Affiliations

    • Division of Laboratory Medicine, Chiba University Hospital, Chiba City, Chiba, Japan
    • ,
  • Kazuyuki Sogawa, PhD

      Affiliations

    • Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
    • ,
  • Hiroshi Umemura, MD, PhD

      Affiliations

    • Division of Laboratory Medicine, Chiba University Hospital, Chiba City, Chiba, Japan
    • Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
    • ,
  • Kazuyuki Matsushita, MD, PhD

      Affiliations

    • Division of Laboratory Medicine, Chiba University Hospital, Chiba City, Chiba, Japan
    • Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
    • ,
  • Fumio Nomura, MD, PhD

      Affiliations

    • Division of Laboratory Medicine, Chiba University Hospital, Chiba City, Chiba, Japan
    • Department of Molecular Diagnosis, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan

Received 25 December 2009 ,Accepted 18 June 2010.

References 

  1. Bellevue R, Dosik H, Spergel G, Gussoff BD. Pseudohyperkalemia and extreme leukocytosis. J Lab Clin Med. 1975;85(4):660–664
  2. Abraham B, Fakhar I, Tikaria A, et al. Reverse pseudohyperkalemia in a leukemic patient. Clin Chem. 2008;54(2):449–451
  3. Sevastos N, Theodossiades G, Efstathiou S, Papatheodoridis GV, Manesis E, Archimandritis AJ. Pseudohyperkalemia in serum: the phenomenon and its clinical magnitude. J Lab Clin Med. 2006;147(3):139–144
  4. Iolascon A, Stewart GW, Ajetunmobi JF, et al. Familial pseudohyperkalemia maps to the same locus as dehydrated hereditary stomatocytosis (hereditary xerocytosis). Blood. 1999;93(9):3120–3123
  5. Lippi G, Salvagno GL, Montagnana M, Brocco G, Cesare Guidi G. Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing. Clin Chem Lab Med. 2006;44(8):1009–1014
  6. Kellerman PS, Thornbery JM. Pseudohyperkalemia due to pneumatic tube transport in a leukemic patient. Am J Kidney Dis. 2005;46(4):746–748
  7. Smalley RM, Cook S, Chan MR. The Case | Best not shaken or stirred! (Chronic lymphocytic leukemia and hyperkalemia). Kidney Int. 2010;77(2):167–168
  8. Don BR, Sebastian A, Cheitlin M, Christiansen M, Schambelan M. Pseudohyperkalemia caused by fist clenching during phlebotomy. N Engl J Med. 1990;322(18):1290–1292
  9. Linnet K. Performance of Deming regression analysis in case of misspecified analytical error ratio in method comparison studies. Clin Chem. 1998;44(5):1024–1031
  10. Martin RF. General Deming regression for estimating systematic bias and its confidence interval in method-comparison studies. Clin Chem. 2000;46(1):100–104
  11. Farber SJ, Pellegrino ED, Conan NJ, Earle DP. Observations on the plasma potassium level of man. Am J Med Sci. 1951;221(6):678–687
  12. Statland BE, Bokelund H, Winkel P. Factors contributing to intra-individual variation of serum constituents: 4 (Effects of posture and tourniquet application on variation of serum constituents in healthy subjects). Clin Chem. 1974;20(12):1513–1519
  13. Hill AB, Nahrwold ML, Noonan D, Northrop P. A comparison of methods of blood withdrawal and sample preparation for potassium measurements. Anesthesiology. 1980;53(1):60–63
  14. Wiederkehr MR, Moe OW. Factitious hyperkalemia. Am J Kidney Dis. 2000;36(5):1049–1053
  15. Clinical and Laboratory Standards Institute. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard. 5th ed. Pennsylvania, National Committee for Clinical Laboratory Standards (NCCLS) document H3-A5. 2003;23(32):1-35.
  16. Krishnan AV, Colebatch JG, Kiernan MC. Hypokalemic weakness in hyperaldosteronism: activity-dependent conduction block. Neurology. 2005;65(8):1309–1312

 Originally published online as doi:10.1053/j.ajkd.2010.06.014 on September 1, 2010.

PII: S0272-6386(10)01077-2

doi: 10.1053/j.ajkd.2010.06.014

American Journal of Kidney Diseases
Volume 56, Issue 4 , Pages 686-692 , October 2010

Article Tools

* Image Usage & Resolution