Why does thrombocytosis cause Pseudohyperkalemia?

Marked increase in platelet count (thrombocytosis) was the first identified cause of pseudohyperkalemia [5]. It is due to increased in vitro release of potassium from activated platelets during the process of clotting and is therefore only a problem if serum is used to measure potassium.

Can high platelets cause hyperkalemia?

In conclusion, a high number of platelets in the blood can release potassium ions to the plasma environment, causing pseudo-hyperkalemia, leading to the decision for hospitalization and inappropriate treatments.

What can cause Pseudohyperkalemia?

Several other biochemical and environmental factors can contribute to pseudohyperkalemia including leukocytosis, thrombocytosis, temperature storage, collection, and possibly pressurized centrifugal forces. Beyond hemolysis, leukocytosis or elevated white blood cells, can be a possible cause of pseudohyperkalemia.

Does thrombocytosis affect potassium?

Thrombocytosis is a cause of falsely elevated serum potassium concentrations, and phosphorus concentrations may be similarly distorted. Because plasma concentrations are not affected, the difference between the serum and plasma concentrations detects spurious elevations.

What does Pseudohyperkalemia refer to?

Pseudohyperkalemia is the term applied to the clinical situation in which in vitro lysis of cellular contents leads to measurement of a high serum potassium level that does not reflect the true in vivo level.

How can you prevent Pseudohyperkalemia?

Regarding causes of pseudohyperkalemia, the Clinical Laboratory and Standards Institute (or CLSI) has a number of relevant recommendations in the guideline document CLSI GP41-ED 7, also called “Collection of Diagnostic Venous Blood Specimens.” The guidelines suggest keeping tourniquet time under one minute, avoiding …

How is Pseudohyperkalemia detected?

Pseudohyperkalemia can be confirmed by determining plasma potassium in vacuum tubes with lithium heparin after centrifugation, and/or by whole blood potassium determination in electrolyte balanced lithium heparin syringe (5).

How is Pseudohyperkalemia diagnosed?

The diagnosis of pseudohyperkalemia can be made by comparing the level of serum and plasma potassium with an expectation that the serum potassium will be higher than the plasma potassium [8].

Why does hemolysis cause high potassium?

Of all routine blood tests plasma/serum potassium measurement is one of the most sensitive to the effect of hemolysis because red-cell potassium concentration is so much higher than that of plasma (approximately 20 times higher); hemolysis causes a spuriously high plasma potassium concentration.

What infections cause thrombocytosis?

Essential thrombocythemia (ET) was the most common cause of primary thrombocytosis. Among secondary, non-infectious etiologies, tissue damage was the most common, followed by malignancy and iron-deficiency anemia. The most common infectious causes of thrombocytosis were soft-tissue, pulmonary and GI infections.

What causes Pseudohyperkalemia in patients with essential thrombocythemia?

This report demonstrated a case of pseudohyperkalemia due to a combination of thrombocytosis and leukocytosis in a patient with essential thrombocythemia. The concentration of potassium was much higher in serum than in plasma and whole blood.

When should Pseudohyperkalemia be considered in the evaluation of hyperkalemic patients?

Prior to reporting unexpected hyperkalemia result, pseudohyperkalemia should always be considered by the laboratory. Such potassium results require investigation in case it is pseudohyperkalemia, which may be due to thrombocytosis and leukocytosis.

Can centrifugation cause Pseudohyperkalemia?

It means that mechanical stress such as centrifugation can contribute to spurious hyperkalemia. Prior to reporting unexpected hyperkalemia result, pseudohyperkalemia should always be considered by the laboratory. Such potassium results require investigation in case it is pseudohyperkalemia, which may be due to thrombocytosis and leukocytosis.

What are the causes of reverse Pseudohyperkalemia?

Additionally the presence of heparin has been associated with increased fragility of WBCs which is often termed reverse pseudohyperkalemia. Thrombocytosis, or elevated platelets, has also been associated with instances of pseudohyperkalemia.