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Original Research
Audit of handling haemolysed, lipaemic and icteric samples in KwaZulu-Natal chemical pathology laboratories
Submitted: 23 January 2026 | Published: 25 June 2026
About the author(s)
Lamla L.-R. Siganagana, Department of Health Science, Faculty of Chemical Pathology, University of KwaZulu-Natal, Durban, South Africa; and, Department of Health Science, Faculty of Chemical Pathology, Stellenbosch University, Cape Town, South AfricaVerena Gounden, Department of Health Science, Faculty of Chemical Pathology, University of KwaZulu-Natal, Durban, South Africa; and, Department of Clinical Biochemistry, Hospital Galway, Galway, Ireland
Unathi Ngxamngxa, Department of Health Science, Faculty of Chemical Pathology, University of KwaZulu-Natal, Durban, South Africa
Abstract
Background: Pre-analytical errors in laboratory testing, such as haemolysis (release of haemoglobin and intracellular components), icterus (elevated bilirubin), and lipaemia (high lipid levels) collectively known as high concentrations of lipids (HIL) are common. Their detection, reporting, and mitigation require proper protocols.
Aim: This study assessed practices in handling chemistry samples affected by HIL within public laboratories in KwaZulu-Natal (KZN), focusing on detection methods and rejection monitoring.
Setting: This study was conducted at the National Health Laboratory Service (NHLS) chemistry laboratory at Inkosi Albert Luthuli Central Hospital, Durban, South Africa, between 01 August 2021 and 31 October 2021.
Methods: Standardised questionnaires were distributed to NHLS laboratories in KZN. Data from the NHLS Central Data Warehouse (August 2021 – October 2021) were extracted for commonly ordered chemistry panels (urea, electrolytes, liver function tests) to review HIL reporting. Analysis was performed using Microsoft Excel.
Results: Detection and management of HIL samples varied. Most laboratories did not report HIL interference, even with abnormal results, potentially compromising patient care. Failure to disclose interference reduces accuracy and reliability, affecting diagnosis and treatment. Some laboratories rejected haemolysed samples regardless of severity. For icterus and lipaemia, many laboratories did not specify corrective measures such as ultracentrifugation, microcentrifugation, or dilution.
Conclusion: Practices for detecting and managing HIL interference are inconsistent across KZN laboratories. A lack of standardised reporting and unclear handling protocols for icterus and lipaemia highlight the need for improved guidelines to ensure reliable patient results.
Contribution: This study provides insight into how NHLS laboratories in KZN were handling specimens affected by HIL.
Keywords
Sustainable Development Goal
Metrics
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