Reverse Pseudohyperkalemia in a Patient with Chronic Lymphocytic Leukemia

Hyperkalemia in a Patient With Leukemia

“…In the context of fragile leukemic cells, heparin in the plasma collection tube may cause cell membrane damage during sample processing. 3 Although the exact mechanism is not fully understood, heparin possibly causes a change in the permeability of leukocyte cell membrane with subsequent lysis through phospholipase activation. 4 Mechanical forces such as the use of pneumatic transport systems can also cause potassium to "leak" from intact cells, possibly through mechanosensitive potassium channels.…”

Reverse pseudohyperkalemia: Verify potassium levels before initiating treatment

“…It must be quickly recognized and treated because of the high risk of lethal arrhythmias and cardiac arrest. On the other hand, identifying the presence of pseudohyperkalemia is crucial to avoid the complications caused by treating pseudohyperkalemia and thereby inducing actual hypokalemia [7,8].…”

“…Thrombocytes undergo degranulation and aggregation during the clotting process while also releasing K + , thus leading to elevated serum K + concentration [2,4]. The causes of pseudohyperkalemia are summed up in Table 1 [7]. The presence of pseudohyperkalemia should be strongly suspected whenever hyperkalemia and hemolysis, extreme leukocytosis, or thrombocytosis coexists.…”

Hyperkalemia: Inpatient PaniK

“…In a remarkable case of "reverse" pseudohyperkalemia, heparininduced damage of white cells in plasma produced potassium levels greater than the serum levels and resulted in dialysis after hyperkalemia was shown refractory to treatment. 8 No electrocardiographic changes were detected at plasma potassium levels of .8 mmol/L. For pseudohyperkalemia from leukocytosis, the height of the leukocyte increase is the obvious clue.…”

“…These are reviewed by Avelar. 8 I wonder how many times my colleagues and I have been asked to consult on a patient for pseudohyperkalemia and/or consider the patient for hemodialysis. The easiest way to determine whether fist-clenching hyperkalemia has occurred is to examine the patient's bruised arm for multiply "missed" venipuncture sites and to ask him/her about fist clenching.…”