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Ahmed S, Jafri L, Shah SMA, Bano N, Siddiqui I. Is it True Hypoparathyroidism? A Root Cause Analysis of Unusually Low Intact Parathyroid Hormone (iPTH) at a Clinical Laboratory. EJIFCC 2021; 32:442-450. [PMID: 35046762 PMCID: PMC8751400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Intact Parathyroid Hormone (iPTH) has a short half-life i.e. two to four minutes therefore the sampling regimen has to pass through a stringent pre-analytical process control. The aim of this study was to identify the causes of apparently falsely low iPTH encountered while signing out Laboratory reports by the Clinical Chemistry professionals. MATERIAL AND METHODS This report was conducted at the section of Clinical Chemistry, The Aga Khan University Hospital (AKUH) Karachi Pakistan from July to December 2017. Audit tool utilized was Plan-Do-Check-Act Cycle. After correlating with available clinical details and lab parameters, all low iPTH values (<16 pg/ml) were investigated by phone interview. A fresh sample was requested for non-correlating cases.Appropriate interventions were undertaken and a re-assessment was done from January to March 2018. RESULTS During the audit, 2559 iPTH samples were analyzed. 110 (4.3%) were identified as apparently falsely low. After recollection, the above 110 samples were immediately centrifuged, and cold chain maintained until re-analysis. 60 (2.4%) resulted with normal or elevated levels. The causes identified were poor compliance of staff with pre-analytical steps including delayed sample separation and unfavorable temperature chain maintenance. Interventions included online meetings with the staff country-wide and circulation of flyers detailing the pre-analytical steps via emails and hard copies. Re-audit showed reduction in number of apparently falsely low results to 30 out of a total of 1448 samples and 14 (0.96%) were investigated to be falsely low. CONCLUSION Stringent pre-analytical process control is vital for quality reporting and patient safety.
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Affiliation(s)
- Sibtain Ahmed
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Lena Jafri
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Nasreen Bano
- Section of Clinical Chemistry, Aga Khan University, Karachi, Pakistan
| | - Imran Siddiqui
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan,Corresponding author: Dr. Imran Siddiqui Professor, Department of Pathology and Laboratory Medicine Aga Khan University Hospital Stadium Road, P.O. Box 3500 Karachi Pakistan Phone: 021-34861927 E-mail:
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Barbato L, Campelo MD, Pigozzo S, Realdon N, Gandini A, Barbazza R, Coêlho ML, Bovo C, Marini P, Lima-Oliveira G. Rejection of hemolyzed samples can jeopardize patient safety. EJIFCC 2020; 31:15-20. [PMID: 32256285 PMCID: PMC7109497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In vitro hemolysis is the primary cause of sample/test rejection by the laboratory. CASE REPORT A 10-year-old, admitted with an asthma attack in the emergency-room, medicated with albuterol sulphate (intravenous bronchodilator that could induce hypokalemia), needed laboratory test monitoring. The physician prescribed the technical-nurse to perform blood sampling for: complete blood count, electrolytes, glucose, and blood gas analysis-within 30min after therapy. Samples were delivered to laboratory with a note "I had difficult to locate an appropriate access to perform the blood collection". LABORATORY RESULTS Glucose: 4.77 mmol/L. Complete blood count revealed discreet eosinophilia 0.13x109/L, and thrombocytopenia 18x109/L. However, platelet clumps were observed in peripheral blood smear. Blood gas analysis was unreported, laboratory informed that sample had micro clots.Electrolytes: laboratory did not report the results; sample hemolyzed. 0.9 g/L of free hemoglobin is the cut-off defined by the laboratory; the sample presented 2.3 g/L of free hemoglobin. 3.9 mmol/L of potassium was the unreported result vs 2.1 mmol/L in the new sample.Briefly, the laboratory technician was trained to hide potassium results on hemolyzed sample due to the potential overestimation. Even if the hemolyzed sample presented a potassium value close to the lower reference range value (3.5-5.1 mmol/L), reporting the potassium result could allow the physician starting proper therapy to revert the hypokalemia by albuterol sulfate. CONCLUSION The laboratory should be aware of the clinical patient conditions and of the related physician needs, before hiding results. Therefore, both the laboratory and the clinic personnel should communicate in order to guarantee the patient safety.
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Affiliation(s)
| | - Marise Danielle Campelo
- Clinical Laboratory Bioanalise, Teresina, Piaui, Brazil,Faculdade Integral Diferencial Facid-Wyden, Teresina, Piaui, Brazil
| | - Sara Pigozzo
- Pharmacy, University Hospital of Verona, Italy, Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Italy
| | - Nicola Realdon
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Italy
| | | | | | | | - Chiara Bovo
- Health Management, University Hospital of Verona, Italy
| | | | - Gabriel Lima-Oliveira
- Faculdade Integral Diferencial Facid-Wyden, Teresina, Piaui, Brazil, Section of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy,Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay,Corresponding author: Gabriel Lima-Oliveira Section of Clinical Biochemistry Department of Neurosciences Biomedicine and Movement Sciences University of Verona Italy E-mail:
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Stonys R, Banys V, Vitkus D, Lima-Oliveira G. Can chewing gum be another source of preanalytical variability in fasting outpatients? EJIFCC 2020; 31:28-45. [PMID: 32256287 PMCID: PMC7109498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION In the daily laboratory practice, there are patients coming to blood collection sites chewing sugar-free gum, considering it irrelevant to laboratory tests. The aim of this study was to evaluate whether a sugar-free chewing gum can interfere with laboratory tests. METHODS We studied 22 healthy volunteers. After a 12-hour overnight fasting, the first blood sample was collected between 8:00 and 8:30 a.m. Then, immediately after the first venous blood collection, the subjects started chewing the gum (declared sugar-free) for 20 min. Subsequent venous blood samples were collected at 1, 2, and 4 hours after chewing the gum. Significant differences between samples were assessed by the Wilcoxon ranked-pairs test. RESULTS Among all the results, statistically significant differences (p < 0.05) between basal and × hours after chewing sugar-free gum were observed for the following parameters: cortisol, insulin, C-peptide, triglycerides, uric acid, urea, amylase, alanine aminotransferase, lipase, creatine kinase, total bilirubin, direct bilirubin, phosphate, iron, potassium, thyroid stimulating hormone, red blood cell count, hematocrit, hemoglobin, mean cell volume, red cell distribution width, white blood cell count, lymphocytes, neutrophils, and eosinophils; whereas, coagulation tests were not impacted by chewing sugar-free gum. CONCLUSIONS We recommend instructing the patients to avoid the use of chewing gum before blood collection for laboratory tests.
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Affiliation(s)
- Ricardas Stonys
- Center of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Valdas Banys
- Center of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania, Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Dalius Vitkus
- Center of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania, Department of Physiology, Biochemistry, Microbiology and Laboratory Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Gabriel Lima-Oliveira
- Section of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy,Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay,Corresponding author: Gabriel Lima-Oliveira Section of Clinical Biochemistry Department of Neurosciences Biomedicine and Movement Sciences University of Verona Italy E-mail:
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Flores CFY, de las Mercedes Hurtado Pineda Á, Bonilla VMC, Sáenz-Flor K. Sample Management: Stability of Plasma and Serum on Different Storage Conditions. EJIFCC 2020; 31:46-55. [PMID: 32256288 PMCID: PMC7109503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND OBJECTIVE The analytes stability on serum and plasma are critical for clinical laboratory, especially if there is a delay in their processing or if they need to be stored for future research. The objective of this research was to determine the stability of K3EDTA-plasma and serum on different storage conditions. MATERIALS AND METHODS A total of thirty healthy adults were studied. The serum/plasma samples were centrifuged at 2000g for 10 minutes. Immediately after centrifugation, the serum/plasma analytes were assayed in primary tubes using a Cobas c501 analyzer (T0); the residual serum/plasma was stored at either 2-8°C or -20°C for 15 (T15) and 30 days (T30).Mean concentrations changes in respect of initial concentrations (T0) and the reference change values were calculated. For assessing statistical difference between samples, the Wilcoxon ranked-pairs test was applied. RESULTS We evidenced instability for total bilirubin, uric acid, creatinine and glucose at T15 and T30 and stored at -20°C (p<0.05). However, potential clinical impact significance were observed only for total bilirrubin T30 at -20°C, and creatinine T30 at 2-8°C. CONCLUSIONS Our results had shown that storage samples at -20°C is a better way to preserve glucose, creatinine, and uric acid. Therefore, laboratories should freeze their samples as soon as possible to guarantee proper stability when there is need to repeat analysis, verify a result, or add a laboratory testing.
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Affiliation(s)
- Carlos Fernando Yauli Flores
- Clinical Laboratory, Hospital General Docente Ambato, Ambato, Ecuador
- Clinical Laboratory, Faculty of Health Sciences, Universidad Técnica de Ambato, Ambato, Ecuador
| | | | | | - Klever Sáenz-Flor
- Synlab Solutions in Diagnostics, Quito, Ecuador
- Universidad Central del Ecuador, Quito, Ecuador
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Caruso B, Bovo C, Guidi GC. Causes of Preanalytical Interferences on Laboratory Immunoassays - A Critical Review. EJIFCC 2020; 31:70-84. [PMID: 32256291 PMCID: PMC7109499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The immunoassays methods need avoiding interferences that can influence result interpretation. Main sources of interference arise from either patient status, preparation and physiology or laboratory process and procedures. The aim of this non-systematic critical review is to highlight the preanalytical interferences on laboratory immunoassays. Blood hormone profile changes according with age and depending on sex: these are important variables, mainly in newborn, during both sexual maturation and childbearing. Gonadotropins FSH and LH show a sharp increase with age in females, whereas in males LH appears rather stable. With age both males and females show progressive decay of the hormone profile. Stress causes variations, as it influences GH, prolactin, Cortisol and the total/free ratio of thyroid hormone. Diurnal variations, day of cycle, influence by estrogens on thyroid hormone are relevant for result variability. Paraproteins and autoantibodies can interfere in some assays particularly drug, vitamin D and thyroid hormone. As regards the variables due to sample matrix, and to evacuated tubes components, some additives and anticoagulants have been reported to influence specific assays, e.g. thyroid hormone. Hemolysis, lipemia and bilirubin cause interferences on specific techniques/tests, e.g. ferritin, TSH, Vitamin B12, progesterone and folic acid. Nicotine and cocaine addictions interfere with some hormones. Thus, laboratory professionals should be aware of preanalytical problems particularly important when dealing with the immunoassays, by taking appropriate actions to avoid any relevant interferences.
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Affiliation(s)
- Beatrice Caruso
- Medical Laboratory Direction, “Carlo Poma” Hospital, Mantua, Italy
| | - Chiara Bovo
- Health Management, University Hospital of Verona, Italy
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Arredondo ME, Aranda E, Astorga R, Brennan-Bourdon LM, Campelo MD, Flores S, Medel C, Manríquez I, Ochoa P, Varela B, Salinas CV, Lima-Oliveira G. Breakfast can Affect Routine Hematology and Coagulation Laboratory Testing: An Evaluation on Behalf of COLABIOCLI WG-PRE-LATAM. TH OPEN 2019; 3:e367-e376. [PMID: 31853513 PMCID: PMC6917510 DOI: 10.1055/s-0039-3401002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/25/2019] [Indexed: 10/26/2022] Open
Abstract
Laboratories worldwide perform both hematological and coagulation testing on patients avoiding fasting time. In 2017, the Latin America Confederation of Clinical Biochemistry (COLABIOCLI) commissioned the Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) to study preanalytical variability and establish guidelines for preanalytical procedures to be applied by clinical laboratories and health care professionals. This study, on behalf of COLABIOCLI WG-PRE-LATAM, aims to evaluate the effect of the breakfast on routine hematology and coagulation laboratory testing. We studied 20 healthy volunteers who consumed a breakfast containing a standardized amount of carbohydrates, proteins, and lipids. We collected blood specimens for routine hematology and coagulation laboratory testing before breakfast and 1, 2, and 4 hours thereafter. Significant differences between samples were assessed by the Wilcoxon ranked-pairs test. Statistically significant differences ( p < 0.05) between basal and 4 hours after the breakfast were observed for red blood cells, hemoglobin, hematocrit, mean corpuscular volume, white blood cells, neutrophils, lymphocytes, monocytes, mean platelet volume, and activated partial thromboplastin time. In conclusion, the significant variations observed in several hematological parameters, and activated partial thromboplastin time due to breakfast feeding demonstrate that the fasting time needs to be carefully considered prior to performing routine hematological and coagulation testing to avoid interpretive mistakes of test results, and to guarantee patient safety. Therefore, COLABIOCLI WG-PRE-LATAM encourages laboratory quality managers to standardize the fasting requirements in their laboratory, i.e., 12 hours.
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Affiliation(s)
| | - Eduardo Aranda
- Laboratory of Thrombosis and Hemostasis, Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Lorena Michele Brennan-Bourdon
- Clinical Laboratory Network from the State of Jalisco, Public Health State Laboratory (LESP), Comisión Para la Protección Contra Riesgos Sanitarios del Estado de Jalisco (COPRISJAL), Guadalajara, Mexico
| | | | | | | | | | - Patricia Ochoa
- Facultad de Medicina, Universidad Católica de Cuenca, Cuenca, Ecuador
| | | | | | - Gabriel Lima-Oliveira
- Section of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Bajaña W, Aranda E, Arredondo ME, Brennan-Bourdon LM, Campelo MD, Espinoza E, Flores S, Ochoa P, Vega V, Varela B, Lima-Oliveira G. Impact of an Andean breakfast on biochemistry and immunochemistry laboratory tests: an evaluation on behalf COLABIOCLI WG-PRE-LATAM. Biochem Med (Zagreb) 2019; 29:020702. [PMID: 31015784 PMCID: PMC6457920 DOI: 10.11613/bm.2019.020702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/19/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction In Andean countries, specifically in Ecuador, a food transition in the population has been observed because of economic growth. The Working Group for Preanalytical Phase in Latin America (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI) was established in 2017, and its main purpose is to study preanalytical variability and establish guidelines for preanalytical procedures in order to be implemented by clinical laboratories and healthcare professionals in Latin America. The aim of this study on behalf of COLABIOCLI WG-PRE-LATAM was to evaluate whether an Andean breakfast can interfere with routine biochemistry and immunochemistry laboratory tests. Materials and methods We studied 20 healthy volunteers who consumed an Andean breakfast containing a standardized amount of carbohydrates, proteins and lipids. We collected blood specimens for laboratory tests before breakfast and 1, 2, and 4 hours thereafter. Significant differences between samples were assessed by the Wilcoxon ranked-pairs test. Results The Andean breakfast statistically (P ≤ 0.05), modified the results of the following tests: triglycerides, insulin, cortisol, thyroid stimulating hormone, free thyroxine, total protein, albumin, urea, creatinine, lactate dehydrogenase, alkaline phosphatase, amylase, lipase, total bilirubin, direct bilirubin, iron, calcium, phosphorus, magnesium, and uric acid. Conclusions Andean breakfast can influence the routine biochemistry and immunochemistry laboratory tests and might expose patient safety to some risks. Therefore, the COLABIOCLI WG-PRE-LATAM calls attention and highlights that the fasting time needs to be carefully considered when performing blood testing in order to prevent spurious results and thus, reduce laboratory errors.
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Affiliation(s)
- Wilson Bajaña
- International Laboratories Services, INTERLAB S.A., Guayaquil, Ecuador
| | - Eduardo Aranda
- Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay
| | - Maria Elena Arredondo
- BIONET S.A., Santiago, Chile.,Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay
| | - Lorena Michele Brennan-Bourdon
- Clinical Laboratory Network from the state of Jalisco, Public Health State Laboratory (LESP), Comisión para la Protección contra Riesgos Sanitarios del Estado de Jalisco (COPRISJAL), Mexico.,Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay
| | | | - Edgar Espinoza
- Servicio de Acreditación Ecuatoriano (SAE), Quito, Ecuador
| | - Silvia Flores
- Universidad Peruana Cayetano Heredia, Lima, Perú.,Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay
| | - Patricia Ochoa
- Facultad de Medicina Universidad Católica de Cuenca, Cuenca, Ecuador.,Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay
| | | | - Beatriz Varela
- LAC, Montevideo, Uruguay.,Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay
| | - Gabriel Lima-Oliveira
- Section of Clinical Biochemistry; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay
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Kieboom BCT, Hoorn EJ, Ramakers C, van Rooij FJA, Ikram MA, Hofman A, van Duijn CM, Heeringa J, Zietse R, Peeters RP, Stricker BH, de Rijke YB. Standard process-oriented workflow introduces pre-analytical error when used in large study sample batches. Clin Chem Lab Med 2018; 56:e277-e279. [PMID: 29858899 DOI: 10.1515/cclm-2018-0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/02/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Brenda C T Kieboom
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Inspectorate of Health Care, Utrecht, The Netherlands
| | - Ewout J Hoorn
- Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J A van Rooij
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Heeringa
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert Zietse
- Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Inspectorate of Health Care, Utrecht, The Netherlands.,Department of Internal Medicine and Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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Lima-Oliveira G, Guidi GC, Salvagno GL, Lippi G. The impact of fist clenching and its maintenance during venipuncture on routine hematology testing. J Clin Lab Anal 2016; 31. [PMID: 27897313 DOI: 10.1002/jcla.22108] [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: 09/20/2016] [Accepted: 11/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevention of a disturbance of the blood vessel allows phlebotomists to collect a blood specimen by venipuncture that will truly mirror the patient condition. This study was aimed to evaluate the impact of repeated fist clenching and maintenance of the fist during blood collection by venipuncture for routine hematology testing. METHODS Blood were collected from 16 healthy volunteers with two separate sequential procedures, entailing standard venipuncture with hand opened throughout blood collection, or clenching the fist six times before venipuncture and maintaining the fist until completion of blood collection. The parameters tested included red blood cell (RBC) count, hemoglobin, hematocrit, mean corpuscular volume (MCV), RBC distribution width, white blood cell count and differential, including neutrophils, lymphocytes, monocytes, eosinophils, basophils, large unstained cells, platelet count, mean platelet volume, and reticulocytes. The results were reported as median and interquartile range. The comparison of data obtained with the two different venipuncture procedures (i.e., with or without fist clenching and closed hand) was performed with Wilcoxon-Mann-Whitney ranked-pairs test. The degree of statistical significance was set at P<.01. RESULTS AND CONCLUSION Fist clenching and maintenance during blood collection for routine hematology testing was effective to increase the MCV by 1.2% (P<.001). All others hematological parameters were not significantly biased by fist clenching, though hematocrit, neutrophils, eosinophils, and reticulocytes displayed mindful of trends. We hence advise patients against clenching their fist before blood collection for hematology testing.
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Affiliation(s)
- Gabriel Lima-Oliveira
- Section of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences - University of Verona, Verona, Italy
| | - Gian Cesare Guidi
- Section of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences - University of Verona, Verona, Italy
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences - University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences - University of Verona, Verona, Italy
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