Abstract
Hyperkalemia is a life threatening electrolyte derangement that must be recognized and treated quickly. Pseudohyperkalemia is defined as a difference between serum and plasma potassium concentration of more than 0.4 meq/L with serum values on the higher side when both the samples are obtained at the same time, remain at room temperature and are tested within 1 h of sample collection. Given the implication of basing medical decisions on falsely elevated potassium levels, timely identification of the entity of pseudohyperkalemia and differentiating it from true hyperkalemia becomes utmost important. Here we present a case report of a 36 year old female admitted with a provisional diagnosis of pyrexia of unknown origin with hepatosplenomegaly and anaemia under evaluation. During hospital stay her potassium levels in whole blood, serum and plasma reportedly differed significantly. An abnormal WBC count beyond assay range was reported and during subsequent investigations this lead to a peripheral smear being advised and diagnosis revealed chronic lymphoblastic leukaemia with blast crisis and 86% blast cells. In patients with leukocytosis and thrombocytosis, pseudohyperkalemia may exist in the absence of electrocardiogram changes or other clinical manifestations of true hyperkalemia thus leading to reevaluation of potassium values in serum, plasma and whole blood to arrive at the true picture.
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References
Asirvatham JR, Moses V, Bjornson L. Errors in potassium measurement: a laboratory perspective for the clinician. N Am J Med Sci. 2013;5(4):255–9.
Nijsten MW, de Smet BJ, Dofferhoff AS. Pseudohyperkalemia and platelet counts. N Engl J Med. 1991;325:1107.
Hartmann RC, Melinkoff AM. The relationship of platelets to the serum potassium concentration. J Clin Investig. 1955;34:938.
Nilsson IM, Skanse B, Bjorkman SE, et al. Platelet function in thrombocythemia. Acta Med Scand. 1960;167:353–68.
Bronson WR, DeVita VT, Carbone PP, Cotlove E. Pseudohyperkalemia due to release of potassium from white blood cells during clotting. N Engl J Med. 1966;274(7):369–75.
Colussi G. Pseudohyperkalemia in leukaemias. Am J Kidney Dis. 2006;47(2):373.
Sevastos N, Theodossiades G, Archimandritis AJ. Psuedohyperkalemia in serum: a new insight into an old phenomenon. Clin Med Res. 2008;6:30–2.
Colussi G, Cipriani D. Pseudohyperkalemia in extreme leukocytosis. Am J Nephrol. 1995;15(5):450–2.
Garwicz D, Karlman M, Øra 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.
Mansoor S, Holtzman NG, Emadi A. Reverse pseudohyperkalemia: an important clinical entity in chronic lymphocytic leukemia. Case Rep Hematol. 2015;2015:930379. https://doi.org/10.1155/2015/930379
Johansson P, Eisele L, Klein-Hitpass L, et al. Percentage of smudge cells determined on routine blood smears is a novel prognostic factor in chronic lymphocytic leukemia. Leuk Res. 2010;34(7):892–8.
Nowakowski GS, Hoyer JD, Shanafelt TD, et al. Using smudge cells on routine blood smears to predict clinical outcome in chronic lymphocytic leukemia: a universally available prognostic test. Mayo Clin Proc. 2007;82(4):449–53.
Ivaska J, Pallari H-M, Nevo J, Eriksson JE. Novel functions of vimentin in cell adhesion, migration, and signaling. Exp Cell Res. 2007;313(10):2050–62.
Hamblin TJ, Davis Z, Gardiner A, Oscier DG, Stevenson FK. Unmutated Ig V(H) genes are associated with a more aggressive form of chronic lymphocytic leukemia. Blood. 1999;94(6):1848–54.
Kröber A, Seiler T, Benner A, et al. VH mutation status, CD38 expression level, genomic aberrations, and survival in chronic lymphocytic leukemia. Blood. 2002;100(4):1410–6.
Deaglio S, Vaisitti T, Aydin S, Bergui L, D’Aerena G, Bonello L, et al. CD38 and ZAP-70 are functionally linked and mark CLL cells with high migratory potential. Blood. 2007;110(12):4012–21.
Smalley R, Cook S, Chan M. The case best not shaken or stirred! Chronic lymphocytic leukaemia and hyperkalemia. Kidney Int. 2010;77:167–8.
Sulaiman RA, Cornes MP, Whitehead S, Othonos N, Ford C, Gama R. Effect of order of draw of blood samples during phlebotomy on routine biochemistry results. J Clin Pathol. 2011;64:1019–20.
Gabriel LO, Giuseppe L, Gian LS, Martina M, Geraldo P, Gian CG. Incorrect order of draw could be mitigate the patient safety: a phlebotomy management case report. Biochem Med. 2013;23(2):218–22.
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Mahto, M., Kumar, M., Kumar, S. et al. Pseudohyperkalemia in Serum and Plasma: The Phenomena and Its Clinical Implications. Ind J Clin Biochem 36, 235–238 (2021). https://doi.org/10.1007/s12291-020-00889-3
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DOI: https://doi.org/10.1007/s12291-020-00889-3