Automated and cost-efficient early detection of hemolysis in patients with extracorporeal life support: Use of the hemolysis-index of routine clinical chemistry platforms

• Published in: Journal of critical care Vol. 51; pp. 29 - 33
• Main Authors: Bosma, Madeleen, Waanders, Frans, Van Schaik, H.P., Van Loon, Douwe, Rigter, Sander, Scholten, Erik, Hackeng, Chris M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2019; Elsevier Limited
• Subjects: Clinical chemistry; Clotting; Critical care; ECLS; ECMO; Embolisms; Free hemoglobin; Hemoglobin; Hemolysis; Hirsch index; Information systems; Laboratories; Patients; Surgical apparatus & instruments; Netherlands; ECMO; Hemolysis; Free hemoglobin; Clinical chemistry; ECLS; Clotting
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2019.01.028

Patients with extracorporeal life support (ECLS) are at risk for hemolysis-related complications. Therefore, monitoring of free hemoglobin (fHb) levels is indicated. Conventional methods for fHb are laborious and not always available. Here we evaluated the suitability of the hemolysis-index (H-index), an internal quality control parameter of clinical chemistry platforms, as a clinical parameter for ECLS patients. The performance of the H-index assay was evaluated using standard procedures. Furthermore, H-index data from ECLS patients (n = 56) was analyzed retrospectively. The H-index significantly correlated with fHb and showed good analytical performance. During ECLS 19.6% of the patients had an H-index above 20 in at least 2 consecutive blood draws, indicating significant hemolysis. In the patients with clot formation in the pumphead the H-index peaked above 100. Visible clots at other locations did not always coincide with hemolysis. H-index peaks were more prevalent in patients that died during ECLS support. We conclude that the H-index is a suitable and cost-efficient alternative for the conventional fHb analysis with good analytic performance. The H-index aids in the early detection of hemolysis in patients with ECLS. A repeated H-index>20 was a predictor of mortality. •Patients with extracorporeal life support are at risk for hemolysis-related complications.•The hemolysis-index is a suitable and cost-efficient clinical parameter for ECLS patients.•The hemolysis-index aids in the early detection of hemolysis in patients with ECLS.•The hemolysis index predicted mortality in ECLS patients.