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Early recognition of reverse pseudohyperkalemia in heparin plasma samples during leukemic hyperleukocytosis can prevent iatrogenic hypokalemia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Inflammation, Klinisk kemi och farmakologi)
2012 (English)In: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, Vol. 45, no 18, 1700-1702 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate the cause of apparent hyperkalemia in leukemic heparin plasma. Design and methods: Lithium heparin plasma and serum samples from a patient with chronic lymphocytic leukemia (CLL) with hyperleukocytosis were transported by either a pneumatic tube system or manual transport and analyzed either immediately or after 4 h. Results: Pneumatic tube transported samples resulted in higher plasma potassium levels than manually transported samples. Serum potassium was lower than plasma potassium, confirming the suspicion of "reverse" pseudohyperkalemia. Letting the pneumatic tube transported samples stand on the bench for 4 h before centrifugation surprisingly resulted in decreased or unchanged plasma potassium. Conclusions: The reverse pseudohyperkalemia in heparin plasma samples from a CLL patient was caused by pneumatic tube transport. Our results suggest extracellular leakage of potassium, followed by active transport of potassium into intact leukemic cells. This is the first Swedish case of reverse pseudohyperkalemia in a CLL patient, where clinical suspicion of false hyperkalemia and awareness of the phenomenon lead to a rapid laboratory diagnosis. The demonstration of reverse pseudohyperkalemia prevented potentially dangerous medical interventions, such as potassium lowering treatment.

Place, publisher, year, edition, pages
2012. Vol. 45, no 18, 1700-1702 p.
Keyword [en]
Chronic lymphocytic leukemia, Hyperleukocytosis, Plasma, Potassium, Hyperkalemia
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-191035DOI: 10.1016/j.clinbiochem.2012.07.104ISI: 000312048900033OAI: oai:DiVA.org:uu-191035DiVA: diva2:585266
Available from: 2013-01-09 Created: 2013-01-09 Last updated: 2015-05-19

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