5th EFLM Conference on Preanalytical Phase Zagreb (HR), 22-23 March 2019
Bibliographic record
Abstract
BACKGROUND-AIM:We describe a paradigmatic case of spurious hyperkalemia in blood gas analysis due to inappropriate transport conditions of a heparinized syringe.METHODS: A 51-year old male patient was admitted to the local hospital with dyspnea.Venous blood was drawn by a nurse into a 3.0 mL heparinized syringe (Smiths Medical), and sent to the central laboratory, for analysis of blood gases.RESULTS: Blood gas analysis, performed with GEM Premier 4000 (Instrumentation Laboratory), revealed a substantially normal blood gas profile except a high value of potassium (i.e., 5.2 mmol/L; local reference range on whole blood, 3.5-4.5 mmol/L).This result was unexpected by the requesting clinician, so that a second venous blood sample was immediately drawn by direct venipuncture into a 3.5 mL lithium-heparin blood tube (Vacutest, Kima), and sent to the laboratory for repeating potassium testing.The analysis, performed on Cobas 8000 (Roche Diagnostics) revealed normal values of plasma potassium (i.e., 4.6 mmol/L; local reference range in plasma, 3.5-5.0mmol/L) and hemolysis index (i.e., 5; 0.05 g/L).Due to suspect of spurious hemolysis, the heparinized blood was transferred from the syringe into a plastic tube and centrifuged.Both potassium and hemolysis index were then measured in this heparinized plasma, using Cobas 8000.The visual analysis of plasma after centrifugation was already consistent with the presence of hemolysis, which was then confirmed by high hemolysis index (i.e., 50; 0.5 g/L).The potassium value in centrifuged heparinized plasma was also consistent with hyperkalemia (i.e., 5.5 mmol/L).Investigation of the case revealed that spurious hemolysis was attributable to syringe transportation to the laboratory in direct contract with ice for ~15 min.CONCLUSIONS: This case emphasizes the importance of fulfilling strict criteria for blood sample transportation and the urgent need of equipping point of care analyzers with interference indices.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.106 | 0.058 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".