Hemolysis, or the rupturing of red blood cells, can occur in vivo or in vitro and is caused by hemolysins damaging the cell membrane. It accounts for about 60% of rejected blood specimens and can be caused by improper collection or handling techniques. Hemolysis causes problems in chemistry, hematology, and blood bank testing due to interference from the released cell contents. Careful venipuncture and avoidance of techniques that can damage cells, such as using too small a needle or leaving a tourniquet on too long, can prevent hemolysis.

2. HEMOLYSIS OR HAEMOLYSIS rupturing (lysis) of red blood cells
(erythrocytes) and the release of their contents (cytoplasm) into
into surrounding fluid (e.g. blood plasma).
https://en.wikipedia.org/wiki/Hemolysis

3. Hemolysis may occur in VIVOor in VITRO
(inside or outside the body).

4. Hemolysins damage host cytoplasmic membrane, causing
cell lysis and death by attacking the phospholipid of the
host cytoplasmic membrane.

5. Account for ∼60% of rejected specimens
http://clinchem.aaccjnls.org/content/46/2/306

6. CAUSES
1. Mixing tubes too vigorously
2. Exposure to heat
3. Using a needle with too small of a bore necessary for the venipuncture
4. Using too large a tube when using a butterfly needle
5. Not allowing sufficient time for alcohol to dry on puncture site
6. Leaving the tourniquet on for longer than one minute
7. “Milking” of the puncture site

7. 1. After cleansing the venipuncture site, allow to air dry before collecting blood
2. NEVER draw blood through a hematoma. If a hematoma forms during the venipuncture,
promptly remove the tourniquet, tube and needle (in that order). A new specimen might
need to be collected to prevent a hemolyzed sample.
3. If using a syringe, avoid drawing the plunger back too forcibly.
4. Avoid forcibly transferring the syringe’s contents into the tube.
5. Discontinue “sluggish” draws that can be caused by collapsed veins and/or improper
needle placement.
6. Gently invert the blood collection tube to mix additive and specimens as recommended by
the manufacturer of the tube
7. If using a serum or plasma tube, once the blood has clotted for the appropriate time
specified by the tube manufacturer, centrifuge at the recommended speed and time.
Centrifuge the blood specimen, if necessary, within 2 hours of collecting
PREVENTION
https://slph.ncpublichealth.com/doc/TechBulletins/SLPH-TechnicalBulletin-Vol14-Issue1.pdf

8. PROBLEM IN THE LAB
CHEMISTRY: Increased K+, Mg2+, AST/ALT
HEMATOLOGY: Decreased RBC count
BLOOD BANK: Inaccurate testing
SPECTROPHOTOMETRY due to interference
https://beaumontlaboratory.com/Global/Labs/PDFs/Prevent_Hemolysis.pdf

9. http://clinchem.aaccjnls.org/content/46/2/306

11. https://www.sciencedirect.com/science/article/pii/S0099176705002059

12. Hemolysis of blood
samples. Red blood cells
without (left and middle)
and with (right) hemolysis.
If as little as 0.5% of the red
blood cells are hemolyzed,
the released hemoglobin
will cause the serum or
plasma to appear pale red
or cherry red in color.[5]
Note that the hemolyzed
sample appears clearer,
because there are
significantly fewer cells to
scatter light.

14. https://slideplayer.com/slide/11359660/