Much has already been discussed about the source and prevention of hemolysis as a pre-analytical variable.
To review, these preventive steps include:
- Using the appropriate gauge needle for the evacuated tube size during collection
- Inverting the collected sample tubes gently and not aggressively mixing
- Minimizing the time between blood collection and centrifugation
- Transporting samples at a suitable temperature
- Centrifuging blood at an appropriate gravitational force
- Confirming an intact gel barrier between cells and serum or plasma
- Testing the pneumatic delivery system to ensure sample integrity is maintained
If hemolysis is found despite these collective efforts, the source may be in vivo, or may be occurring within the circulation secondary to an underlying condition. In such cases, confirmed by recollection and special handling to avoid transport-related sources of hemolysis, the ordering physician should be immediately notified.