Point of care haemolysis detection
Topic Status Complete
Point of care haemolysis detection in blood samples that may be deemed unfit for laboratory analysis.
Outcome of the appraisal
HTW undertook an evidence review to address the following question: is point-of-care haemolysis detection in secondary care clinically and cost effective in comparison to haemolysis detection in central laboratories?
The evidence identified was judged to be of limited applicability to decision makers. There was a lack of sufficient evidence on the utility of the test particularly in relation to how its use influences the need for re-sampling, and time taken for re-sampling, when blood tests are taken and haemolysis is present.
The HTW Assessment Group concluded that there is currently insufficient evidence on point of care haemolysis detection to inform the production of Guidance at this time. Therefore, this topic will not progress to Appraisal Panel and will not receive HTW Guidance recommendations.
Evidence Appraisal Report 021 gives a full report of the evidence on this topic.
Why was this topic appraised?
Haemolysis is the release of haemoglobin and other intracellular components from red blood cells into the surrounding plasma following damage or disruption to the cell membrane. Haemolysis has been shown to introduce a meaningful bias in several blood gas and electrolyte parameters. Clinicians therefore run the risk of basing clinical decisions on erroneous data due to haemolysis, which can lead to adverse events.
Point-of-care testing enables healthcare personnel to test blood for haemolysis directly at the patient’s side.
Plain language summary
Haemolysis is when red blood cells rupture/burst and their contents are released into the fluid that makes up blood, called plasma. This can happen during or after a blood sample is taken. This is a problem because the haemolysis can influence the results of some blood tests. Blood tests are an essential part of diagnosing and treating multiple illnesses, so it is important that the results of bloods tests are accurate. Haemolysis is the most common reason why a blood sample gets rejected and another sample is required.
Point-of-care (POC) testing, also known as near-patient testing, for haemolysis enables healthcare personnel to test blood for haemolysis directly at the patient’s side, before the blood sample is sent away to the laboratory. If no haemolysis is detected, then the sample can be sent to the laboratory; if is it detected, then another sample can be taken straight away. This means that patients will not have to keep coming back to have blood samples taken and test results will not face delays due to haemolysis in samples. In addition, POC testing means that blood inserted into blood gas analysers can be checked for haemolysis. Blood gas analysers currently do not have haemolysis-detection capabilities.
Health Technology Wales looked for evidence that POC haemolysis detection is an effective method compared to usual methods of haemolysis detection. There is evidence that suggests that POC haemolysis detection can accurately detect the presence of haemolysis in blood samples. However, there was no evidence found that POC haemolysis detection reduces the time required for sample analysis, nor was there any evidence found relating to patient satisfaction with testing in this way. It is therefore unclear whether POC haemolysis testing can make blood sampling more efficient for staff and patients, or whether its introduction would save money. Because of this uncertainty, HTW will not be producing guidance on the use of this technology at this present time.