Irene Regan writes that despite doing major literature searches there seems to be no consensus regarding what coagulation results should be released when there is a suspicion of in vivo hemolysis such as in disseminated intravascular coagulation (DIC), when the samples are grossly haemolysed. Currently, Irene issues a fibrinogen (Clauss) and in this case she generally confirms this using a correction with normal plasma due to haemolysed nature of the sample or because the fibrinogen is extremely low. Do you have any advise?
Hello, Irene, this is an interesting question, and it is true there is little documentation about what specific interferences arise in hemolysis. The experts routinely advise a recollect when there is visible hemolysis resulting from an improper collection, however there is nothing you can do about in vivo hemolysis. Hemolysis implies both platelet and coagulation factor activation, generating unreliable results across the board. Additionally, hemolysis interferes with the determination of the clotting endpoint or with chromogenic assays in optical instrumentation.
My suggestion is to employ an electro-mechanical clot-based instrument for your coagulation determinations and append a comment warning of possible interference. When diagnosing DIC, check the package insert for your D-dimer kit to learn the manufacturer’s claims regarding the degree of hemolysis interference. Do the same for any chromogenic assays you may perform.
This is an excellent question, and I await comments from other contributors, including possible references they may have run across. Thank you.