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Hello, At my previous position at a county hospital we only rerun high K (using direct ISE) when there was a suspicion in the absence of hemolysis. If you do rerun, how often do you get discrepant results between the first and second run? Typically the analytical step isn’t the issue. Hemolysis, fragile WBCs or K leaked from platelets etc are more commonly observed. Sometimes you have a sample being unseparated for a prolonged period of time. If we do suspect something along this line, we either cancelled the sample after talking to the medical team or reported the K with a comment. If the K was elevated in the presence of hemolysis then we added a canned comment with an estimated how much K may be elevated in relationship to the degree of H. Hope this helps. Thank you. Thomas On Mon, Oct 22, 2018 at 9:08 AM GRAY, Yusuf (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST) < [log in to unmask]> wrote: > Hi Helen, > > > > We set our Roche cobas 8000 systems to auto-repeat any potassium over 6.0 > mmol/L and it will do this on the same ISE module. > > > > Indices will show haemolysis and we reflex a calcium if not already > ordered to try to identify low level EDTA contamination. > > > > Then check collection time and centrifuge time, location it was taken etc > and check the original sample. > > > > Hope this helps > > > > Yusuf Gray > > Biomedical Scientist Team Manager - POCT | Pathology - Blood Sciences > > T: 01332 788537 | *M: 0737 938 0799* > > > > *T**ogether **E**veryone **A**chieves **M**ore* > > > > > > *From:* Clinical biochemistry discussion list [mailto: > [log in to unmask]] *On Behalf Of *Bertholf, Roger L., Ph.D. > *Sent:* 22 October 2018 13:36 > *To:* [log in to unmask] > *Subject:* Re: Potassium (again!) > > > > Dear Helen: > > > > Does “DISE” refer to direct potentiometry, such as one might have > available on a whole blood analyzer? If so, I’m curious, what would lead > you to suspect that direct potentiometry might produce a more accurate > (lower) potassium in patients with no clinical suspicion of hyperkalemia? > Hyperproteinemia or hyperlipidemia would produce falsely low potassium > measurements using indirect potentiometry, and you would expect direct > potentiometric measurement of electrolytes to produce higher results. > > > > I’d also be interested in how often you obtain significantly different > results on repeat measurement of potassium by the same method, but on > another instrument. > > > > Kind regards, > > > > Roger > > > > Roger L. Bertholf, PhD > > Medical Director of Clinical Chemistry > > Houston Methodist Hospital > > Professor of Clinical Pathology and Laboratory Medicine > > Weill Cornell Medicine > > > > *From:* Clinical biochemistry discussion list [ > mailto:[log in to unmask] <[log in to unmask]>] > *On Behalf Of *JERINA, Helen (UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST) > *Sent:* Monday, October 22, 2018 7:07 AM > *To:* [log in to unmask] > *Subject:* Potassium (again!) > > > > Hello Mailbase, > > > > I know potassium is a favourite topic of conversation here, but I couldn't > find anything substantial to answer my questions in the archives (although > I would fully accept that that may be down to my inability to search them > correctly!). > > > > What I'd like to know is: > > - Do you re-run high potassiums and, if you do, is this by the same > method or an alternative (e.g. re-check by DISE)? > - What do you do with results where you suspect an artefactual cause? > Do you take them out or do you report them with a comment? > > Here in Leicester, our policy is to re-analyse all potassium results >6.0 > mmol/L where there is no obvious explanation (e.g. poor renal function or > haemolysis). As we don't have DISE available in the lab we re-run by the > same method but on an alternative analyser. We report all results, adding a > comment where appropriate and always ask for a repeat if artefactual > increase is suspected. > > > We are reviewing our policy and there has been some discussion as to > whether repeating the analysis adds any value. It would be great to hear > what other labs do and I'm happy to share/collate any responses. > > > > Best wishes, > > > > Helen > > > > Helen Jerina PhD > > Senior Clinical Scientist > > > > Department of Chemical Pathology > > Level 4 Sandringham Building > > Leicester Royal Infirmary > > Leicester > > LE1 5WW > > > > > ******************************************************************************************************************** > > This message may contain confidential information. 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