Pseudohyperkalemia in a Patient with T-Cell Acute Lymphoblastic Leukemia and Hyperleukocytosis

Abstract

A 7-year-old girl presented with lymphadenopathy and bruising suggestive of leukemia. Complete blood count was significant for white blood cell count of 479,000/mm³. Basic metabolic panel sent via pneumatic tube system was significant for potassium > 10 mEq/L. The stat venous blood gas potassium level was 4.6 mEq/L. A 12-lead-ECG showed sinus tachycardia without peaked T-waves. It was determined that this was pseudohyperkalemia associated with significant hyperleukocytosis. This brief report discusses rare causes of pseudohyperkalemia that can be overlooked, and details the postulated mechanisms for pseudohyperkalemia in the setting of hyperleukocytosis.

Keywords

hyperkalemia - pseudohyperkalemia - hyperleukocytosis

• References

• 1 Mount DB. Causes and Evaluation of Hyperkalemia in Adults. In Forman JP, ed. 2017. UpToDate. Available at: https://www.uptodate.com/contents/causes-and-evaluation-of-hyperkalemia-in-adults . Accessed January 12, 2018
• 2 Dickinson H, Webb NJ, Chaloner C, Wynn RF, Bonney DK. Pseudohyperkalaemia associated with leukaemic cell lysis during pneumatic tube transport of blood samples. Pediatr Nephrol 2012; 27 (06) 1029-1031
• 3 Hartmann RC, Auditore JV, Jackson DP. Studies on thrombocytosis. I. Hyperkalemia due to release of potassium from platelets during coagulation. J Clin Invest 1958; 37 (05) 699-707
• 4 Sevastos N, Theodossiades G, Archimandritis AJ. Pseudohyperkalemia in serum: a new insight into an old phenomenon. Clin Med Res 2008; 6 (01) 30-32
• 5 Asirvatham JR, Moses V, Bjornson L. Errors in potassium measurement: a laboratory perspective for the clinician. N Am J Med Sci 2013; 5 (04) 255-259
• 6 Bertini A, Milani GP, Simonetti GD. , et al. Na(+), K(+), Cl(-), acid-base or H2O homeostasis in children with urinary tract infections: a narrative review. Pediatr Nephrol 2016; 31 (09) 1403-1409
• 7 Nijsten MW, de Smet BJ, Dofferhoff AS. Pseudohyperkalemia and platelet counts. N Engl J Med 1991; 325 (15) 1107
• 8 Rastegar A. Serum potassium. In: Walker HK, Hall WD, Hurst JW. , eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Chapter 195. Boston: Butterworths; 1990. . Available at: https://www.ncbi.nlm.nih.gov/books/NBK307/
• 9 Hawkins R. Measurement of whole-blood potassium–is it clinically safe?. Clin Chem 2003; 49 (12) 2105-2106
• 10 Lam HS, Chan MH, Ng PC. , et al. Are your hands clean enough for point-of-care electrolyte analysis?. Pathology 2005; 37 (04) 299-304
• 11 Colussi G, Cipriani D. Pseudohyperkalemia in extreme leukocytosis. Am J Nephrol 1995; 15 (05) 450-452
• 12 Chawla NR, Shapiro J, Sham RL. Pneumatic tube “pseudo tumor lysis syndrome” in chronic lymphocytic leukemia. Am J Hematol 2009; 84 (09) 613-614
• 13 Dimeski G, Bird R. Hyperleukocytosis: pseudohyperkalaemia and other biochemical abnormalities in hyperleukocytosis. Clin Chem Lab Med 2009; 47 (07) 880-881
• 14 Garwicz D, Karlman M. Early recognition of reverse pseudohyperkalemia in heparin plasma samples during leukemic hyperleukocytosis can prevent iatrogenic hypokalemia. Clin Biochem 2012; 45 (18) 1700-1702