Evaluation of Hemolysis, Icterus, and Lipemia Interference Effects in Biochemical Analysis Using an Automated Clinical Chemistry Analyzer

Abstract

Serum or plasma samples exhibiting hemolysis (H), icterus (I), or lipemia (L) are common preanalytical errors that affect the test results in clinical chemistry laboratories. Sample assessment with HIL index by spectrophotometry on an automated clinical chemistry analyzer is a reliable and commonly used method. The aim of this study is to evaluate the hemolysis, icterus, and lipemia effects in biochemical analysis using the Beckman Coulter AU5800 automated analyzer. The data, including semiquantitative and quantitative HIL indices and biochemical values, were collected from June to December 2023. The difference in biochemical values between HIL level (0) and other HIL index levels was compared. The correlation between biochemical values and the quantitative HIL index was determined, and linear regression models were generated to predict the clinically significant interference levels. Based on the HIL index data, the maximum interference level was evaluated in the present study up to level (2+). Clinically significant positive interference from hemolysis was detected for lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) at hemolysis index (HI) (1+), whereas clinically significant negative interference was detected for total bilirubin (TB) at HI (2+). Moreover, AST at lipemia index (LI) (2+) showed clinically significant positive interference from lipemia. No clinically significant interference was detected for alanine aminotransferase (ALT), direct bilirubin (DB), blood urea nitrogen (BUN), and magnesium up to HI (2+); cholesterol up to icterus index (II) (1+); and ALT up to LI (2+). In addition, the LDH linear regression model predicted both the hemolysis interference level and interference cutoff, even at the minimal hemolysis degree, HI level (0). Thus, the proper HIL index cutoff and interference level should be evaluated and established in the clinical laboratories to guide sample and patient’s result management for achieving patient safety.