21. Pseudohyperkalemia due to pneumatic transport in acute lymphocytic leukemia patients: Report of two cases

Tran Thi Chi Mai, Bui Ngoc Lan, Vu Thi Tu Uyen

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Tóm tắt

Pseudohyperkalemia occurs occasionally in leukemic patients with excessively elevated white blood cells. Early diagnosis of pseudohyperkalemia is crucial for proper treatment. Increased white blood cell fragility coupled with mechanical trauma may be the causal mechanism. We describe two cases of pseudohyperkalemia caused by mechanical disruption of white blood cells due to pneumatic tube transport of the specimens. In case when the white blood cell is extraordinarily elevated, specimen should be delivered in person instead of using pneumatic tube transport and specimen should be analyzed as soon as possible. Whole blood potassium analysis by blood gas analyzer is more reliable to confirm or rule out pseudohyperkalemia.

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Tài liệu tham khảo

1. Stankovic AK, Smith S. Elevated serum potassium values: The role of preanalytic variables. Am J Clin Pathol. 2004;121:105-12.
2. Jeffery J, Sharma A, Ayling RM. Detection of haemolysis and reporting of potassium results in samples from neonates. Ann Clin Biochem. 2009;46:222-5.
3. Abraham B, Fakhar I, Tikaria A, et al. Reverse pseudohyperkalemia in a leukemic patient. Clin Chem. 2008;54:449-51.
4. Garwicz D, Karlman M, Ora I. Reverse pseudohyperkalemia in heparin plasma samples from a child with T cell acute lymphoblastic leukemia with hyperleukocytosis. Clin Chim Acta. 2011;412:396-7.
5. Meng QH, Krahn J. Reverse pseudohyperkalemia in heparin plasma samples from a patient with chronic lymphocytic leukemia. Clin Biochem. 2011;44:728-30.
6. Kellerman PS, Thornbery JM. Pseudohyperkalemia due to pneumatic tube transport in a leukemic patient. Am J Kidney Dis. 2005;46:746-8.
7. Guiheneuf R, Vuillaume I, Mangalaboyi J, et al. Pneumatic transport is critical for leukaemic patients with major leukocytosis: what precautions to measure lactate dehydrogenase, potassium and aspartate aminotransferase? Ann Clin Biochem. 2010;47:94-6.
8. Ifudu O, Markell MS, Friedman EA. Unrecognized pseudohyperkalemia as a cause of elevated potassium in patients with renal disease. Am J Nephrol. 1992;12:102-4.
9. Nijsten MW, de Smet BJ, Dofferhoff AS. Pseudohyperkalemia and platelet counts. N Engl J Med. 1991;325:1107.
10. Sevastos N, Theodossiades G, Efstathiou S, et al. Pseudohyperkalemia in serum: the phenomenon and its clinical magnitude. J Lab Clin Med. 2006;147:139-44.
11. Ruddy KJ, Wu D, Brown JR. Pseudohyperkalemia in chronic lymphocytic leukemia. J Clin Oncol. 2008;26(16):2781-2782.
12. Moreno G, Gunsolus IL. Reverse pseudohyperkalemia and pseudohyponatremia in a patient with B-cell non-Hodgkin lymphoma. Clin Biochem. 2020;78:63-65.
13. Ghersin Z, Ghersin Z , Fernandes ND , Winkler A, Yager P. Pseudohyperkalemia and Pseudohyponatremia in two Children with T-Cell Acute Lymphoblastic Leukemia. J Pediatr. 2021;232:294-298.
14. Don BR, Sebastian A, Cheitlin M, et al. Pseudohyperkalemia caused by fist clenching during phlebotomy. N Engl J Med. 1990;322:1290-2.
15. Colussi G. Pseudohyperkalemia in leukemias. Am J Kidney Dis. 2006;47(2):373.
16. Chawla NR, Shapiro J, Sham RL. Pneumatic tube “pseudo tumor lysis syndrome” in chronic lymphocytic leukemia. Am J Hematol. 2009;84(9):613-4.
17. Wiederkehr MR, Moe OW. Factitious hyperkalemia. Am J Kidney Dis. 2000;36(5):1049-1053.
18. Huang YC, Huang FL, Tsai SF, et al. Pseudohyperkalemia accompanying actual hyperphosphatemia and hypocalcemia in an adolescent with T-lymphoblastic lymphoma. Clinical Biochemistry. 2022;101:5-8.
19. Rahmani B , Patel S, Seyam O, et al. Current understanding of tumor lysis syndrome. Hematol Oncol. 2019;37(5):537-547.
20. Meng QH, Wagar EA. Pseudohyperkalemia: a new twist on an old phenomenon. Crit Rev Clin Lab Sci. 2015;52(2):45-55.