The preanalytical phase is particularly important in haematology, where counts of particles and cells are performed in whole anticoagulated blood. The correct use and concentration of anticoagulant is mandatory to avoid spurious results, which can influence clinical decision. EDTA is the anticoagulant of choice, but it has some limits, especially for preserving stability and shape of platelets. Stability of haematological parameters is high, with the exception of leukocytes and reticulocytes. However, stability (and instrumental precision) should be evaluated together with biological variability and individuality index of various haematological parameters. Hematological tests are also influenced and interfered by high amounts of lipids and chylomicrons. The mixing procedure of the tubes after blood drawing and before analysis is also crucial for obtaining correct and valid data. There are some examples of interferences on automated haematological analysers which are used for diagnosing and screening pathological conditions. Cryoglobulins and erythrocytes parasites can induce spurious results of WBC, RBC and PLT, but the repeatability of these interferences could be used for alerting the pathologist and could reveal the presence of pathological proteins or blood parasites. New parameters have been proposed by modern haematological analysers, directly defined or calculated from traditional measures, but the clinical impact of these new parameters is often dependent on preanalytical variables.
1. Lippi G, Banfi G, Church S, Cornes M, De Carli G, Grankvist K, et al. Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for PreanalyticalPhase (WG-PRE). Clin Chem Lab Med 2015; 53: 357-70.
2. Lippi G. Governance of preanalytical variability: travelling the right path to the bright side of the moon? Clin Chim Acta 2009; 404: 32-6.
3. Simundic AM. Preanalyticalphase - an updated review of
Güzin Aykal, Hatice Esen, Cemile Öz and Ayşenur Yeğin
Venous blood sampling is one of the most important steps of the preanalyticalphase and is the most common invasive procedure in health care. Every step it consists of has a potential risk for patient safety ( 1 , 2 , 3 ). A large cumulative effect can be created by small variations in each step of phlebotomy. Furthermore, an additional layer of variability is introduced into the system with a very heterogeneous group of medical staff (laboratory technicians, nurses, etc.) that should be educated to perform phlebotomy. ( 4 , 5 ).
Pierangelo Bonini, Ferruccio Ceriotti, Gaia Mirandola and Chiara Signori
Misidentification and Other Preanalytical Errors
The largest number of laboratory errors occur in the preanalytical phase and are mainly due to educational and organizational reasons. The experience of our institution, as well as the results of an Italian interlaboratory effort to detect and reduce errors/risk of errors in laboratory medicine will be illustrated.
Fatma Demet Arslan, Inanc Karakoyun, Banu Isbilen Basok, Merve Zeytinli Aksit, Esma Celik, Kemal Dogan and Can Duman
1. Lippi G, Cadamuro J. Novel opportunities for improving the quality of preanalyticalphase. A glimpse to the future? J Med Biochem 2017; 36: 293–300.
2. Lippi G, Becan-McBride K, Behúlová D, Bowen RA, Church S, Delanghe J, et al. Preanalytical quality improvement: in quality we trust. Clin Chem Lab Med 2013; 51(1): 229–41.
3. Carraro P, Plebani M. Errors in a stat laboratory: types and frequencies 10 years later. Clin Chem 2007; 53(7): 1338–42.
4. Simundic AM, Cornes M, Grankvist K, Lippi G, Nybo M, Kovalevskaya S, et al
Güzin Aykal, Mustafa Keşapli, Özgür Aydin, Hatice Esen, Ayşenur Yeğin, Faruk Güngör and Necat Yilmaz
1. Simundic AM, Cornes M, Grankvist K, Lippi G, Nybo M, Kovalevskaya S, et al. Survey of national guidelines, education and training on phlebotomy in 28 European countries: an original report by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalyticalphase (WG-PA). Clin Chem Lab Med 2013; 51: 1585-93.
2. Aykal G, Yegin A, Aydin O, Yilmaz N, Ellidag HY. The impact of educational interventions on reducing the rejection rates in the preanalyticalphase. Turk J
Fatma Ucar, Gonul Erden, Mine Yavuz Taslipinar, Gulfer Ozturk, Zeynep Ginis, Erdem Bulut and Namik Delibas
Bachground: Sample classification and registration have been recognized as important and time-consuming processes in laboratories. There is increasing pressure on laboratories to automate processes due to intense workload and reduce manual procedures and errors. The aim of the present study was to evaluate the positive effects of an automatic tube registration and sorting system on specimen processing.
Methods: An automatic tube registration and sorting system (HCTS2000 MK2, m-u-t AG, Wedel, Germany) was evaluated. Turnaround time (TAT), rate of sample rejection and unrealized tests were examined 12 months pre- and post-implementation of the automatic tube sorting and registration system.
Results: The mean TAT of routine chemistry immunoassay, complete blood cell count (CBC) and coagulation samples were significantly improved (P<0.001). The number of rejected samples and unrealized tests was insignificantly decreased post-implementation of the system (0.4% to 0.2% and 4.5% to 1.4%, respectively) (P>0.05).
Conclusions: By reducing delays and errors in the preanalytical processing and sorting of samples, significant improvements in specimen processing were observed after implementation of the system. These results suggest that an automatic tube registration and sorting system may also be used to improve specimen processing in a higher-volume core laboratory.
Plebani M, Carraro P. Mistakes in a stat laboratory: Types and frequency. Clin Chem 1997; 43: 1348-51.
Dale JC, Novis DA. Outpatient phlebotomy success and reasons for specimen rejection: A Q-Probes study. Arch Pathol Lab Med 2002; 126: 416-9.
Data submitted for publication by Dr. Tester Ashavid.
Lippi G, Guidi GC. Risk management in the preanalyticphase of laboratory testing. Clin Chem Lab Med 2007; 45: 720
Gabriel Lima-Oliveira, Gian Cesare Guidi, Andre Valpassos Pacifici Guimaraes, Jose Abol Correa and Giuseppe Lippi
1. Lippi G, Guidi GC. Risk management in the preanalyticalphase of laboratory testing. Clin Chem Lab Med 2007; 45: 720–7.
2. Lima-Oliveira G, Lippi G, Salvagno GL, Picheth G, Guidi GC. Laboratory diagnostics and quality of blood collection. J Med Biochem 2015; 34: 88–94.
3. International Organization for Standardization. Medical laboratories – Requirements for quality and competence ISO document 15189. Geneva, Switzerland: International Organization for Standardization; 2012.
4. National System of Accreditation from Brazilian
LE, Williams RH, editor. Clinical Diagnostic Technology - The Total Testing Process, Volume 1: The PreanalyticalPhase. Washington: AACC Press, 2003: 112-13.
Plebani M. Errors in clinical laboratories or errors in laboratory medicine? Clin Chem Lab Med 2006; 44 (6): 750-9.
Holman JW, Mifflin TE, Felder RA, Demers LM. Evaluation of an automated preanalytical robotic workstation at two academic health centers. Clin Chem 2002; 48: 540-8.
Melanson SF, Lindeman N, Jarolim P. Selecting