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Tareq Abadl Explains Hemolysis and Potassium Measurement Connections
Tareq Abadl/LinkedIn
Dec 28, 2025, 15:06

Tareq Abadl Explains Hemolysis and Potassium Measurement Connections

Tareq Abadl, Medical Laboratory Specialist and Director of the Blood Bank at Dr. Abdelkader Al-Mutawakkil Hospital, shared a post on LinkedIn:

“Hemolysis and Potassium Measurement.

Tareq Abadl Explains Hemolysis and Potassium Measurement Connections

First: Hemolyzed Sample (Pre-analytical Error)

When hemolysis occurs during blood collection, handling, or transport, potassium leaks from red blood cells into serum or plasma.

Intracellular potassium concentration in RBCs is ~20–25× higher than in plasma.

Even mild hemolysis can cause a false elevation of potassium.

This is called Pseudo-hyperkalemia (not a true patient condition).

Correct laboratory action:

Reject the sample and do not report potassium.

Add a clear comment: Sample rejected due to hemolysis.

Request recollection while avoiding common causes:

Use an appropriate needle (preferably 21G or larger).

Avoid prolonged tourniquet use and excessive suction.

Do not shake the tube vigorously.

Separate serum/plasma from cells promptly.

Avoid heat exposure and transport delays.

Second: In Vivo (Pathological) Hemolysis

Hemolysis occurs inside the patient, not during sampling.

In this situation, elevated potassium may be real (True hyperkalemia).

Laboratory findings supporting in vivo hemolysis:

  • LDH
  • Indirect (unconjugated) bilirubin
  • Haptoglobin
  • Reticulocyte count

Peripheral smear abnormalities (e.g., schistocytes, spherocytes)

Important precautions:

Do not rely on visibly hemolyzed serum samples.

Use more reliable alternatives:

Plasma potassium (lithium heparin tube).

Whole blood potassium via blood gas analyzer (less affected by hemolysis).

Always correlate with clinical context:

ECG changes suggestive of hyperkalemia

Renal failure or other risk factors

Consistency with other hemolysis markers

Additional Key Points

Severe thrombocytosis or leukocytosis can cause Pseudo-hyperkalemia due to potassium release during clotting, even without visible hemolysis.

In such cases, plasma or whole blood potassium is preferred over serum.

Never act on a potassium value without clinical correlation.

Summary

  • Hemolyzed sample (pre-analytical error) → Invalid result, reject and recollect.
  • In vivo hemolysis → Potassium may be truly elevated; use alternative measurement methods.
  • Thrombocytosis / leukocytosis → Consider Pseudo-hyperkalemia.
  • Interpretation must always match the clinical picture, not just the number.”

Explore hematology with Tareq Abadl on Hemostasis Today.

blood collection Health hemolysis Hemostasis Hemostasis Today In Vivo (Pathological) Hemolysis Medicine Potassium Measurement Pre-analytical Error Tareq Abadl thrombosis
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