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pISSN 2950-9114 eISSN 2950-9122
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Original Article

J Lab Med Qual Assur 2017; 39(3): 132-140

Published online September 30, 2017


Copyright © Korean Association of External Quality Assessment Service.

Algorithm for Differential Diagnosis of in Vitro and in Vivo Hemolysis in Anticoagulated Blood Specimens

Jong-Han Lee1, Yoonjung Kim2, Gilsung Yoo1, Juwon Kim1, Kap Jun Yoon1, Young Uh1

1Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea,
2Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea

Correspondence to:Young Uh Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Korea Tel: +82-33-741-1592 Fax: +82-33-731-0506 E-mail: u931018@yonsei.ac.kr
교신저자: 어 영 우)26426 강원도 원주시 일산로 20, 연세대학교 원주의과대학 진단검사의학교실 Tel: 033)741-1592, Fax: 033)731-0506, E-mail: u931018@yonsei.ac.kr

Received: April 14, 2017; Revised: August 18, 2017; Accepted: August 21, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



Hemolytic specimens contain components that interfere with clinical laboratory results. We evaluated previously published hemolysis indices (HI) and developed an algorithm for differentiating between mechanical hemolysis and immune-mediated hemolysis based on complete blood count (CBC).


Sixty-three residual EDTA (ethylenediamine tetraacetic acid)-anticoagulated blood specimens were obtained during regular health check-ups, and each specimen was divided into 3 aliquots (A control, B, and C group). Aliquots B and C were mechanically hemolysed by 2 and 5 aspirations, respectively, using a 25-gauge needle before testing; aliquot A was analysed immediately without hemolysis. Additionally, we collected 36 specimens from patients suspected of having immune-mediated hemolysis after thorough reviewing their various laboratory results including direct antiglobulin test. We compared CBC parameters between the groups (A, B, C, D [B+C], and E [immune-mediated hemolysis group]).


Our HI scoring system using the sum of red blood cell ghosts, measured hemoglobin-calculated hemoglobin, mean corpuscular hemoglobin concentration-corpuscular hemoglobin concentration mean, and mean platelet volume rather than mean corpuscular hemoglobin, effectively identified mechanical hemolysis; the results were similar to those of previous studies. Furthermore, the HI score using the sum of mean corpuscular volume, red cell distribution width, hemoglobin distribution width, polymorphonuclear %, and neutrophil % differentiated mechanical hemolysis from immune-mediated hemolysis (cut-off, 9; sensitivity, 91.7%; specificity, 92.9%; area under the receiver operating characteristic curve, 0.965 [95% confidence interval, 0.924–0.988]).


The newly developed algorithm may provide effective screening for detecting hemolysis and differential diagnosis of mechanical hemolysis and immune-mediated hemolysis based on CBC results.

Keywords: Hemolysis, Mechanical, Immune-mediated, Red blood cell, Complete blood count

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