RELATIONSHIP BETWEEN

SUPORIOUS HYPERKALEMIA WITH

THROMBOCYTOSIS AND
LEUKOCYTOSIS
A Synopsis submitted in fulfillment of the
requirement for the degree of
B. Sc (Hons) MEDICAL LABORATORY TECHNOLOGY
Batch: 2014-2018
By
Muhammad Raqib Saleem
Roll no. 08
UNIVERSITY OF HEALTH SCIENCES
LAHORE, PAKISTAN

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 Synopsis Performa

Title of Research Project: Relationship between suporious hyperkalemia

with thrombocytosis and leukocytosis

Discipline: Medical Laboratory Technology(Revised Scheme)

Name of the Applicant: D.O.B:

04- - 01 – 1993
Muhammad Raqib Saleem

Nationality: Pakistani NIC # 34301-7971735-5

Address: D.H.Q hospital , servant colony , house # J-11 , khanewal

Phone No: Email:

0305-1959925 m.raqibsaleem786@gmail.com

Qualification: Student of B.Sc (Hons) Medical Laboratory Technology (Revised

Scheme)

Name of Parent institute:

Allama Iqbal Medical College, Lahore.

Name of Supervisor: Signature Date

Prof Dr Fouzia Ashraf

Name of Co-supervisor: Signature Date

Dr Farhan Rasheed

Head of Department: Signature Date

Prof Dr Ambereen Anwar

INTRODUCTION

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 Hyperkalemia is marked elevation of serum potassium level usually occurs in renal
failure, Adrenal insufficiency, Massive tissue, Rhabdomylysis, Tumor lysis syndrome,
Ketoacidosis
Pseudohyperkalmia: Also known as factitious hyperkalemia defined as when serum potassium
concentration exceeded that of plasma by more than (0.4mmol/L)[1] provided that sample are
collect under strict techniques, It is an in vitro phenomenon in which rise in serum potassium
concentration with concurrently normal plasma potassium concentration. It was originally
attributed to the release of potassium from platelet during platelet aggregation and coagulation is
a significant correlation between platelets and pseudohyperkalemia.
Causes of pseudohyperkalemia:
Tight tourniquet, excessive arm exercise, mechanical trauma during venipuncture,
centrifugation before clot formation, contamination with anticoagulant, drawing sample from
the vein or line where potassium infused.
All above these are technical errors which cause false or pseudohyperkalemia. All these
errors can be ruled out if sample taken under strict technical condition.
Thrombocytosis or leukocytosis and Familial pseudohyperkalemia are also causes of false
potassium level in routine lab chemistry. Familial pseudohyperkalemia is a rare autosomal
dominant inherited disorder in which there is an abnormal red cell permeability leading to
exercise K+ leakage. It is a temperature (Particularly below 20C0.
Thrombocytosis: is a major cause of pseudohyperkalemia in serum. So patient with marked
elevation with thrombocyte or leukocytosis or myeloproliferative disease (defective bone
marrow). Plasma rather than serum. Potassium should be measured. Other causes of
thrombocytosis includes anemia, oral contraceptive, infection or inflammation, post splenectomy
and cancer.
In all above condition when thrombocytes or leukocytes are increased. This phenomenon of
peseudohyperkalmia increased in patients. When platelets start aggregate or start to clot
formation [2]. They release potassium on degranulation. Activated platelet are more profound to
degranulate [3]. So they released more potassium from platelet so aggregation of platelet occur at
higher speed. Leukocyte also degranulate because they release mediators. In patients with
thrombocytosis had white blood cells greater than 10000cu/mm.
The in vitro aspects of pseudohyperkalaemia caused by thrombocythemia and leukocytosis have
been studied in some detail [4]. The approximate potassium content per litre of cell volume is 70
mEq" L- i for platelets,2 and 93 mEq. L -t for white cells. The greatest amount of potassium
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release occurs within minutes of clotting in the test tube, [5] and although the precise
mechanism for the release is uncertain, it is known that if clotting is prevented, the potassium
concentration will remain with- in normal limits. This can be accomplished, as in our patient, by
using an anticoagulant such as heparin or ethylenediaminetetraacetic acid (EDTA). However, if
heparin is used as the anticoagulant, then potassium based heparin preparations should be
avoided [6]. Is Normally, 0.1-0.2 ml of sodium heparin (1000 1~" mi -I) will more than
adequately anticoagulate 5 ml of blood.

In vitro when blood is collected for routine chemistry and serum electrolyte measurement. Blood
clothing occur. Platelet or leukocytes deregulate they release potassium from cell which cause
increase serum potassium. As potassium is a critical element in our body. A patient with high
false potassium level but no ECG evidence of potassium disturbance, no arrhythmias show. Try
to compensate high potassium level with giving insulin or other treatment which cause the
patient to be hypoglycemia or death. Same occur with hypokalemia patient with each evident of
arrhythmias but normal potassium level. Pseudohyperkalemia compensate this deficiency falsely.
AIMS AND OBJECTIVES:
I want to explore the relationship between thrombocytosis and leukocytosis with
psuedohyperkalemia. We take a blood sample of some patient thrombocytosis or
leukocytosis in plane and sodium citrate vail and check the relationship between the
results.

 Study Design: Cross-sectional study.

 Duration of Study: 6- 8 months

 Study Setting:
The study will be carried out in Chemical section of Pathology department, Allama
Iqbal Medical College, Lahore, Pakistan.
 Study Population;
Patients presenting on OPD as well as admitted in different wards of Jinnah Hospital
Lahore, Pakistan and fulfill inclusion and exclusion criteria

 Sample Size:

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 A total of samples will be collected from different wards of Jinnah hospital,
Lahore.
 Sampling Technique: Simple Random Sampling
INCLUSION CRITERIA:
 All clinical samples both from male and female patients from indoor/admitted patients
EXCLUSION CRITERIA:
MATERIALS AND METHODS

MATERIALS:
 Plain vial
 Citerate vial
 EDTA vial
INSTRUMENTATION
 Beckman Coulter AU480
 Sysmex Kx-21
 Centrifuge
 Pippets

METHOD:

PROCEDURE:

RESULTS:

DATA ANALYSIS:

DATA COLLECTION INSTRUMENT:

REFERENCES:
1. Wiederkehr MR, Moe OW. Factitious Hyperkalaemia. Am J Kidney Dis 2000 ;
2. 36: 1049-53.
3. Hartmann RC, Auditore JV, Jakson DP. Studies on thrombocytosis. I. Hyperkalemia due
to release of potassium from platelets during coagulation. J clin invest 1959; 37:699-707
4. Frick PG. Pseudohyperkalemia in thrombocytosis. Schweiz Med Wochenschr 1960;
90:433-435
5. Ingrain RH Jr, Seki M. Pseudohyperkalemia with throm- bocytosis. N Engl J Med 1962;
267: 895-900.

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6. Parker NE, Jacobs P. Pseudohyperkalaemia - a cause of diagnostic confusion. S Afr Med
J 1981; 60: 973-4.Young DS, Bermes EW. Specimen collection and process- ing, sources
of biological variation. In: Tietz NW (Ed.). Fundamentals of Clinical Chemistry, 3rd ed.,
Philadelphia: WB Saunders Co, 1987; 270. 16

Allama Iqbal Medical College Lahore

Department of Pathology
Chemical Section

Name of the patient: ________________________ Age: _______________

Registration number: ________________________ Sex: _______________

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Ward: _______________________

Clinical History of specimen:__________________________________________

__________________________________________________________________