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Lippi G, Cadamuro J. Novel Opportunities for Improving the Quality of Preanalytical Phase. A Glimpse to the Future? J Med Biochem 2017; 36:293-300. [PMID: 30581325 PMCID: PMC6294089 DOI: 10.1515/jomb-2017-0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/15/2017] [Indexed: 12/18/2022] Open
Abstract
The preanalytical phase is crucial for assuring the quality of in vitro diagnostics. The leading aspects which contribute to enhance the vulnerability of this part of the total testing process include the lack of standardization of different practices for collecting, managing, transporting and processing biological specimens, the insufficient compliance with available guidelines and the still considerable number of preventable human errors. As in heavy industry, road traffic and aeronautics, technological advancement holds great promise for decreasing the risk of medical and diagnostic errors, thus including those occurring in the extra-analytical phases of the total testing process. The aim of this article is to discuss some potentially useful technological advances, which are not yet routine practice, but may be especially suited for improving the quality of the preanalytical phase in the future. These are mainly represented by introduction of needlewielding robotic phlebotomy devices, active blood tubes, drones for biological samples transportation, innovative approaches for detecting spurious hemolysis and preanalytical errors recording software products.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of VeronaVerona, Italy
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical UniversitySalzburg, Austria
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Berda-Haddad Y, Faure C, Boubaya M, Arpin M, Cointe S, Frankel D, Lacroix R, Dignat-George F. Increased mean corpuscular haemoglobin concentration: artefact or pathological condition? Int J Lab Hematol 2016; 39:32-41. [PMID: 27566136 DOI: 10.1111/ijlh.12565] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In daily practice in haematology laboratories, spurious increased MCHC induces an analytical alarm and needs prompt corrective action to ensure delivery of the right results to the clinicians. The aim of this study was to establish a 'decision tree' using the new parameters red blood cells (RBC-O) and haemoglobin (HGB-O) from the Sysmex XN-10 RET obtained by flow cytometry to deliver appropriate results. METHODS From 128 unknown patients with MCHC > 365 g/L, all erythrocyte parameters including reticulocyte parameters were measured and analysed in parallel with blood smears, chemistry index and osmolarity. Differences between optical parameters (RBC-O, HGB-O) and usual parameters (RBC, HGB) obtained by impedance and photometry were reported also. RESULTS Four groups were defined from observations: -RBC agglutination (n = 22); -optical interference (n = 17); -RBC disease (n = 18); and -others (n = 71). The use of RBC-O and HGB-O permitted efficient correction of the abnormalities when RBC agglutination and/or optical interference were present in 36 of 39 patients. Reticulocyte parameters permitted to elaborate an RBC score that allowed a highly sensitive detection of RBC disease patients (17/18). CONCLUSION Based on new parameters, we propose a 'decision tree' that delivers time savings and supports biological interpretation in case of elevated MCHC.
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Affiliation(s)
- Y Berda-Haddad
- Department of Haematology and Vascular Biology, CHU Conception, AP-HM, Marseille, France
| | - C Faure
- Department of Haematology and Vascular Biology, CHU Conception, AP-HM, Marseille, France
| | - M Boubaya
- Clinical Research Unit, Avicenne Hospital, Bobigny, France
| | - M Arpin
- Department of Haematology and Vascular Biology, CHU Conception, AP-HM, Marseille, France
| | - S Cointe
- Department of Haematology and Vascular Biology, CHU Conception, AP-HM, Marseille, France.,VRCM, UMR-S1076, Aix -Marseille Université, INSERM, UFR de Pharmacie, Marseille, France
| | - D Frankel
- Department of Haematology and Vascular Biology, CHU Conception, AP-HM, Marseille, France
| | - R Lacroix
- Department of Haematology and Vascular Biology, CHU Conception, AP-HM, Marseille, France.,VRCM, UMR-S1076, Aix -Marseille Université, INSERM, UFR de Pharmacie, Marseille, France
| | - F Dignat-George
- Department of Haematology and Vascular Biology, CHU Conception, AP-HM, Marseille, France.,VRCM, UMR-S1076, Aix -Marseille Université, INSERM, UFR de Pharmacie, Marseille, France
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Wu ZQ, Lu J, Xu HG. Hemolysis Affects C-Peptide Immunoassay. J Clin Lab Anal 2016; 30:1232-1235. [PMID: 27231209 DOI: 10.1002/jcla.22008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/04/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND C-peptide is used widely as a marker of insulin secretion, and it participates in the inflammatory response and contributes to the development of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). Previous studies have reported that C-peptide measurement was unaffected by hemolysis. However, we found that hemolysis negatively affected C-peptide assay in routine laboratory practice. We further established and validated an individualized hemolysis correction equation to correct and report accurate serum C-peptide results for hemolyzed samples. METHODS We studied the effects of hemolysis on C-peptide assay by adding lysed self red blood cells (self-RBCs) to serum. An individualized correction equation was derived. Further, we evaluated the performance of this individualized correction equation by artificially hemolyzed samples. RESULTS C-peptide concentration decreased with increasing degree and exposure time of hemolysis. The individualized hemolysis correction equation derived: C-Pcorr = C-Pmeas /(0.969-1.5Hbserum/plasma -5.394 ×10-5 Time), which can correct bias in C-peptide measurement caused by hemolysis. CONCLUSIONS Hemolysis negatively affects C-peptide measurement. We can correct and report accurate serum C-peptide results for a wide range of degrees of sample hemolysis by individualized hemolysis correction equation for C-peptide assay. This correction would improve diagnostic accuracy and reduce inappropriate therapeutic decisions.
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Affiliation(s)
- Zhi-Qi Wu
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ju Lu
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hua-Guo Xu
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Ialongo C, Bernardini S. Phlebotomy, a bridge between laboratory and patient. Biochem Med (Zagreb) 2016; 26:17-33. [PMID: 26981016 PMCID: PMC4783087 DOI: 10.11613/bm.2016.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/06/2015] [Indexed: 12/28/2022] Open
Abstract
The evidence-based paradigm has changed and evolved medical practice. Phlebotomy, which dates back to the age of ancient Greece, has gained experience through the evolution of medicine becoming a fundamental diagnostic tool. Nowadays it connects the patient with the clinical laboratory dimension building up a bridge. However, more often there is a gap between laboratory and phlebotomist that causes misunderstandings and burdens on patient safety. Therefore, the scope of this review is delivering a view of modern phlebotomy to "bridge" patient and laboratory. In this regard the paper describes devices, tools and procedures in the light of the most recent scientific findings, also discussing their impact on both quality of blood testing and patient safety. It also addresses the issues concerning medical aspect of venipuncture, like the practical approach to the superficial veins anatomy, as well as the management of the patient's compliance with the blood draw. Thereby, the clinical, technical and practical issues are treated with the same relevance throughout the entire paper.
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Affiliation(s)
- Cristiano Ialongo
- Laboratory Medicine Department, "Tor Vergata" University Hospital, Rome, Italy
| | - Sergio Bernardini
- Laboratory Medicine Department, "Tor Vergata" University Hospital, Rome, Italy; Experimental Medicine and Surgery Department, "Tor Vergata" University, Rome, Italy
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