{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T19:04:45Z","timestamp":1793905485016,"version":"4.8.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T00:00:00Z","timestamp":1728432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Pseudohyperkalemia is well known in acute or chronic lymphocytic leukemia, but it is very rare in acute myeloid leukemia (AML). The lab flagging system for leukocytosis to prevent pseudohyperkalemia may not work.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 55 year-old white man with AML was sent to emergency department for transfusion due to severe anemia. Blood test showed severe leukocytosis and elevated potassium. Repeated blood test showed his potassium was even higher. Anti-hyperkalemic medical treatment was given. He was then diagnosed with pseudohyperkalema.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Investigation<\/jats:title>\n                <jats:p>I was repeatedly reassured that the lab\u2019s manual flagging system for leukocytosis was the key in reaching the correct diagnosis. My persistent inquiries, however, revealed that the flagging system was not functioning in the care of this patient. It was clinicians\u2019 suspicion of pseudohyperkalema that led to the correct diagnosis, although the clinicians\u2019 recommendation of obtaining a heparinized plasma for test did not play a role because all blood samples were already heparinized. The cause of pseudohyperkalemia was pneumatic tube transport. After this incident, our laboratory is investigating the options of using the Laboratory Information System to automatically flag the results and Clinical Laboratory Scientists to make the chemistry team more aware of potentially erroneous potassium results due to pseudohyperkalemia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Pseudohyperkalemia associated with leukocytosis still occurs. This is the first case of pneumatic tube transport causing pseudohyperkalemia associated with AML. When significant leukocytosis, thrombocytosis, hyperproteinemia, or hyperlipidemia is present, whole blood should be utilized for potassium measurements and walked to the lab instead of sent by pneumatic tube transport. Even in a lab with a manual flagging system, there is still room to improve by implementing an automatic flagging system.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12245-024-00734-x","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T08:02:46Z","timestamp":1728460966000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Manual flagging failed to identify pseudohyperkalemia in acute myeloid leukemia: case report"],"prefix":"10.1186","volume":"17","author":[{"given":"Yangming","family":"Cao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,9]]},"reference":[{"key":"734_CR1","first-page":"938","volume":"34","author":"RC Hartmann","year":"1955","unstructured":"Hartmann RC, Mellinkoff SM. Relationship of platelets to serum potassium concentration. J Clin Invest. 1955;34:938. (Abstr).","journal-title":"J Clin Invest"},{"key":"734_CR2","doi-asserted-by":"publisher","unstructured":"Mansoor S, Holtzman NG, Emadi A. Reverse pseudohyperkalemia: an important clinical entity in chronic lymphocytic leukemia. Case Rep Hematol. 2015; Sep 27. https:\/\/doi.org\/10.1155\/2015\/930379","DOI":"10.1155\/2015\/930379"},{"issue":"6","key":"734_CR3","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1001\/jama.1970.03170060071017","volume":"211","author":"LC Chumbley","year":"1970","unstructured":"Chumbley LC. Pseudohyperkalemia in acute myelocytic leukemia. JAMA. 1970;211(6):1007\u20139.","journal-title":"JAMA"},{"issue":"6","key":"734_CR4","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1097\/00000441-197406000-00006","volume":"267","author":"J Salomon","year":"1974","unstructured":"Salomon J. Spurious hypoglycemia and hyperkalemia in myelomonocytic leukemia. Am J Med Sci. 1974;267(6):359\u2013563.","journal-title":"Am J Med Sci"},{"key":"734_CR5","unstructured":"Goubella A, Thooft A, Creteur J, Vincent J-L. Pseudo-hyperkalemia and hyperleukocytosis. Rev Med Brux 2013; May-Jun;34(3):179\u201380 [Article in French]."},{"issue":"3","key":"734_CR6","first-page":"243","volume":"3","author":"H Darapu","year":"2014","unstructured":"Darapu H, Koya S, Paluri R. Clinical implication of pseudohyperkalemia in patients with leukocytosis \u2013 a case report. Int J Med Health Sci July. 2014;3(3):243\u20134.","journal-title":"Int J Med Health Sci July"},{"key":"734_CR7","doi-asserted-by":"crossref","unstructured":"Avelar T. Reverse pseudohyperkalemia in a patient with chronic lymphocytic leukemia. Perm J 2014 Fall; 18(4): e150\u20132.","DOI":"10.7812\/TPP\/14-084"},{"issue":"2","key":"734_CR8","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1053\/j.ajkd.2023.01.441","volume":"82","author":"R Chowdhury","year":"2023","unstructured":"Chowdhury R, et al. Spurious electrolyte and acid-base disorders in the patient with cancer: a review. Am J Kidney Dis. 2023;82(2):237\u201342.","journal-title":"Am J Kidney Dis"},{"key":"734_CR9","unstructured":"Kiger J. Mayo Clinic\u2019s 1949 \u2018Iron Monster\u2019 pneumatic tubes still makes thousands of deliveries a day. Post Bulletin. April 12, 2024. https:\/\/www.postbulletin.com\/health\/mayo-clinics-1949-iron-beast-pneumatic-tubes-still-makes-thousands-of-deliveries-a-day. Accessed Jun 9, 2024."},{"issue":"3","key":"734_CR10","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1093\/ajcp\/70.3.400","volume":"70","author":"DK Weaver","year":"1978","unstructured":"Weaver DK, Miller D, Leventhal EA, Tropeano V. Evaluation of a computer-directed pneumatic-tube system for pneumatic transport of blood specimens. Am J Clin Pathol. 1978;70(3):400\u20135.","journal-title":"Am J Clin Pathol"},{"issue":"4","key":"734_CR11","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1053\/j.ajkd.2005.06.005","volume":"46","author":"PS Kellerman","year":"2005","unstructured":"Kellerman PS, Thornbery JM. Pseudohyperkalemia due to pneumatic tube transport in a leukemic patient. Am J Kidney Dis. 2005;46(4):746\u20138.","journal-title":"Am J Kidney Dis"},{"key":"734_CR12","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/S0002-9343(88)80086-X","volume":"85","author":"A Blumberg","year":"1988","unstructured":"Blumberg A, Weidmann P, Shaw S, Gnadinger M. Effect of various therapeutic approaches on plasma potassium and major regulating factors in terminal renal failure. Am J Med. 1988;85:507\u201312.","journal-title":"Am J Med"},{"key":"734_CR13","unstructured":"Kbennett. One minute guide to: whole blood potassium. Johns Hopkins Medicine. April 22, 2019. https:\/\/medicine-matters.blogs.hopkinsmedicine.org\/2019\/04\/one-minute-guide-to-whole-blood-potassium\/. Accessed Jun 9, 2024."}],"container-title":["International Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12245-024-00734-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12245-024-00734-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12245-024-00734-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T06:02:01Z","timestamp":1729058521000},"score":1,"resource":{"primary":{"URL":"https:\/\/intjem.biomedcentral.com\/articles\/10.1186\/s12245-024-00734-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,9]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["734"],"URL":"https:\/\/doi.org\/10.1186\/s12245-024-00734-x","relation":{},"ISSN":["1865-1380"],"issn-type":[{"value":"1865-1380","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,9]]},"assertion":[{"value":"20 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 September 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 October 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This article does not contain any studies with animals performed by the author.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable due to the death of the patient.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"the author has no conflict of interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"149"}}