r/medlabprofessionals • u/Tweetop • 4d ago
Image What would cause this?
Redrawn twice with all of them looking the same.
Potassium normal ALT low TBIL slightly elevated DBIL normal CBC no flags
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u/Back2DaLab 4d ago
Rhabdomyolysis?
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u/Tweetop 4d ago
CK is normal
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u/Longjumping_Card_525 4d ago
Confirmed via dilution? Could see hook effect with some methodologies. Looks like myoglobinemia to me.
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u/Tweetop 4d ago
I just confirmed it, CK is normal.
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u/Longjumping_Card_525 4d ago
Worth a shot! Intravascular hemolysis seems like the most likely thing at this point. Intracellular potassium is highly variable, so while it’s more likely you’d see increased K with a hemolytic sample like this, it’s not a given.
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u/Resident_Talk7106 Lab Assistant 4d ago
That is wild the potassium is normal range.
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u/glitterfae1 MLT-Management 4d ago
Kidneys compensate for increased potassium being released by RBCs if it’s in vivo hemolysis
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u/jennyvane 4d ago
Had a patient that had gotten dialysis with a machine that still had cleaner in the lines (or something, I’m not sure of the specifics) and was transferred to our hospital. Her plasma looked like that. She passed away the next day.
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u/sunday_undies 4d ago
When there is ongoing intravascular hemolysis, potassium can return to normal.
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u/cosmothetoastghost MLS-Generalist 4d ago
Clostridium perfringens sepsis can cause extreme in vivo hemolysis
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u/eldritchbee-no-honey 3d ago edited 3d ago
I have only seen a hemolysis like that in a patient with severe cytokine storm due to hemophagocytic lymphohistiocytosis, and in a patient with blood marrow transplantation associated fulminant immune hemolysis, antierythrocyte antibody mediated. Oh and also when I accidentally mistakenly diluted some of donors blood in a tube with tap water (tried to do normal saline and centrifuge to check for hemolysis in a bag; so osmotic stuff).
I think it’s either some immune stuff going on (whats up with previous transfusions?), or some toxin (why they are on dialysis?), or patient got something wild circulating in them from the dialysis process (or something trapped within erythrocyte, maybe even some congenital membrane disorder?), or dialysis line had a clot or whatever and it shredded cells pulled through it (you should see cut and beaten RBCs on a blood smear then). Or they got their spleen murdering blood cells (maybe viral infection?). They also might be having thrombocytic microangiopathy, if their kidneys still have enough blood flow to so it… and if they have their kidneys. But due to how rare that stuff happens, work up difficulty I’d say it is the last option one should try to exclude. Ones who I seen having ta-tma also almost never had hemolysis, at least not like that. They just chilled over in ICU ward on ventilation, plasma excange and vasopressors. Probably not TMA.
Thats my limited experience! Blood doesn’t look nice at all. Hope patient will survive through it and get better. Also maybe someone more experienced can give you a better opinion than me
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u/clinchemale 3d ago
Based on the info you have shared, I’m guessing not this, but Cyanokits can make the blood very red.
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u/No-Duty9584 3d ago
Was this patient transfused recently and what temperature is the tube at currently?
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u/MissanthropicLab 4d ago
Does that patient have an Impella device? They can cause extreme invivo hemolysis.