From the Research
Pseudohyperkalemia is most commonly caused by hemolysis during blood collection, thrombocytosis, and leukocytosis, rather than vitamin D deficiency or secondary hyperparathyroidism, as these conditions are more directly related to alterations in calcium and phosphorus homeostasis than potassium levels 1, 2, 3, 4, 5.
Causes of Pseudohyperkalemia
The causes of pseudohyperkalemia can be broadly categorized into:
- Pre-analytical errors, such as hemolysis during blood collection, prolonged tourniquet application, and excessive fist clenching during blood draw
- Analytical errors, such as delayed sample processing and cold storage of blood samples
- Biological factors, such as thrombocytosis (high platelet count) and leukocytosis (elevated white blood cell count)
Relationship to Vitamin D and Secondary Hyperparathyroidism
While vitamin D deficiency and secondary hyperparathyroidism are significant concerns in patients with chronic kidney disease, they are not directly related to the causes of pseudohyperkalemia 2, 3, 4, 5. These conditions are more closely associated with alterations in calcium and phosphorus homeostasis, rather than potassium levels.
Clinical Implications
It is essential to distinguish between true hyperkalemia and pseudohyperkalemia, as true hyperkalemia requires urgent treatment, while pseudohyperkalemia does not require potassium-lowering interventions. A repeat blood draw with careful technique is recommended when pseudohyperkalemia is suspected, avoiding excessive tourniquet time, minimal fist clenching, prompt sample processing, and using appropriate collection tubes 1.