How should one deal with a hemolyzed or icteric specimen for a CBC?
A. Specimens with increas¬ed bilirubin (icteric specimens) do not generally interfere with the performance of a CBC. Elevated bilirubin levels may be associated with hemolysis, which does affect the CBC. Hemolysis, if significant, is always a problem primarily because of the plasma hemoglobin and, depending on the mechanism of the hemolysis, secondarily because of effects on cellular elements. Whenever there is significant hemolysis there will be a discrepancy between the hemoglobin (measured after lysis of red cells so it includes both cellular and plasma hemoglobin) and red cells/hematocrit (based only on intact cells). If the hemolysis is a result of improper specimen collection, it is a cause for specimen rejection and re-collection. If the hemolysis truly represents the condition of the patient (intravascular red cell destruction), then the discrepancy is expected and the laboratory should note it and indicate its cause. In centers that perform plasma hemoglobin determinations, it
