Rapid screening model for identifying patients with suspected intravascular hemolysis to improve patient care and reduce sample rejection rates in clinical chemistry

Rapid screening model for identifying patients with suspected intravascular hemolysis to improve patient care and reduce sample rejection rates in clinical chemistry

Gabriel Garang Pioth, Gay Janet Davis, Uba Nwose, Philip Bwititi

Int. J. Bio. Lab. Sci 2021(10)1:12-20 【Abstract】【PDF】

Abstract

The importance of developing a rapid screening model is critical for identifying patients with intravascular hemolysis to improve patient care and reduce sample rejection rates. Specimen hemolysis is a leading cause of spurious test results in clinical chemistry. Intravascular hemolysis releases cell-free hemoglobin into the serum and haptoglobin irreversibly binds hemoglobin to form a hemoglobin-haptoglobin complex, which is cleared in the circulation by the monocyte-macrophage scavenger receptor CD163 in the liver and spleen. The depleted serum haptoglobin in a hemolyzed sample is used to diagnose intravascular hemolysis. However, haptoglobin testing may take hours or days to confirm intravascular hemolysis. The aim of this study was to investigate the relationship between intravascular markers of hemolysis and haptoglobin in hemolyzed specimens. This study retrospectively mined archived data from the laboratory database between February 2017 and February 2018 from patients 6 months of age and above. The Statistical Package for Social Science was used for data analysis. The partial plot results showed a strong relationship between hemolysis markers and haptoglobin levels. Multiple regression models that predict serum haptoglobin levels in intravascularly hemolyzed samples were analyzed. Although the results showed a strong relationship between dependent and independent variables, the data did not demonstrate a clinically significant relationship or establish cause and effect. The use of a larger sample size along with adequate controls in preanalytical, analytical, biological and environmental variables would likely improve the clinical significance of the model. With proper modifications and validations, this model has the potential to provide a rough estimate of the haptoglobin levels and reduce cost as well as sample rejection rates. Due to the numerous hemolytic diseases, this model could be used to direct the clinicians to select the appropriate test for diagnosis of intravascular hemolysis.

Key words: haptoglobin, intravascular hemolysis, extravascular hemolysis, turnaround time, in vivo hemolysis, in vitro hemolysis, hemolysis markers.