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Rigoni M, Tessarolo F. Venous blood collection systems using evacuated tubes: a systematic review focusing on safety, efficacy and economic implications of integrated vs. combined systems. Clin Chem Lab Med 2024; 0:cclm-2024-0460. [PMID: 38877871 DOI: 10.1515/cclm-2024-0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
Venous blood collection systems (VBCSs) are combinations of in-vitro diagnostics and medical devices, usually available as integrated set. However, purchasing and using a combination of devices from different sets is considered by clinical laboratories as an option to achieve specific sampling tasks or reduce costs. This systematic review aimed to retrieve available evidence regarding safety, efficacy, and economic aspects of VBCSs, focusing on differences between integrated and combined systems. The literature review was carried out in PubMed. Cited documents and resources made available by scientific organisations were also screened. Extracted evidence was clustered according to Quality/Efficacy/Performance, Safety, and Costs/Procurement domains and discussed in the current European regulatory framework. Twenty documents published between 2010 and 2021 were included. There was no evidence to suggest equivalence between combined and integrated VBCSs in terms of safety and efficacy. Scientific society's consensus documents and product standards report that combined VBCS can impact operators' and patients' safety. Analytical performances and overall efficacy of combined VBCSs are not guaranteed without whole system validation and verification. EU regulatory framework clearly allocates responsibilities for the validation and verification of an integrated VBCS, but not for combined VBCSs, lacking information about the management of product nonconformities and post-market surveillance. Laboratory validation of combined VBCS demands risk-benefit and cost-benefit analyses, a non-negligible organisational and economic burden, and investment in knowledge acquisition. Implications in terms of laboratory responsibility and legal liability should be part of a comprehensive assessment of safety, efficacy, and cost carried out during device procurement.
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Affiliation(s)
- Marta Rigoni
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- IRCCS Ca' Granda Foundation, Polyclinic Maggiore Hospital, Milan, Italy
| | - Francesco Tessarolo
- Department of Industrial Engineering, 19034 University of Trento , Trento, Italy
- Healthcare Research and Innovation Program, Bruno Kessler Foundation, Trento, Italy
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Nordin N, Ab Rahim SN, Wan Omar WFA, Zulkarnain S, Sinha S, Kumar S, Haque M. Preanalytical Errors in Clinical Laboratory Testing at a Glance: Source and Control Measures. Cureus 2024; 16:e57243. [PMID: 38559530 PMCID: PMC10981510 DOI: 10.7759/cureus.57243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/04/2024] Open
Abstract
The accuracy of diagnostic results in clinical laboratory testing is paramount for informed healthcare decisions and effective patient care. While the focus has traditionally been on the analytical phase, attention has shifted towards optimizing the preanalytical phase due to its significant contribution to total laboratory errors. This review highlights preanalytical errors, their sources, and control measures to improve the quality of laboratory testing. Blood sample quality is a critical concern, with factors such as hemolysis, lipemia, and icterus leading to erroneous results. Sources of preanalytical errors encompass inappropriate test requests, patient preparation lapses, and errors during sample collection, handling, and transportation. Mitigating these errors includes harmonization efforts, education and training programs, automated methods for sample quality assessment, and quality monitoring. Collaboration between laboratory personnel and healthcare professionals is crucial for implementing and sustaining these measures to enhance the accuracy and reliability of diagnostic results, ultimately improving patient care.
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Affiliation(s)
- Nani Nordin
- Pathology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Siti Nadirah Ab Rahim
- Pathology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, MYS
| | | | - Sarah Zulkarnain
- Pathology, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Susmita Sinha
- Physiology, Khulna City Medical College and Hospital, Khulna, BGD
| | - Santosh Kumar
- Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Mainul Haque
- Karnavati Scientific Research Center (KSRC), Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
- Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
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Colombini A, Divieto C, Tomaiuolo R, Mortati L, Petiti J, Di Resta C, Banfi G. The total testing process harmonization: the case study of SARS-CoV-2 serological tests. Clin Chem Lab Med 2023; 61:2084-2093. [PMID: 37540644 DOI: 10.1515/cclm-2023-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023]
Abstract
The total testing process harmonization is central to laboratory medicine, leading to the laboratory test's effectiveness. In this opinion paper the five phases of the TTP are analyzed, describing, and summarizing the critical issues that emerged in each phase of the TTP with the SARS-CoV-2 serological tests that have affected their effectiveness. Testing and screening the population was essential for defining seropositivity and, thus, driving public health policies in the management of the COVID-19 pandemic. However, the many differences in terminology, the unit of measurement, reference ranges and parameters for interpreting results make analytical results difficult to compare, leading to the general confusion that affects or completely precludes the comparability of data. Starting from these considerations related to SARS-CoV-2 serological tests, through interdisciplinary work, the authors have highlighted the most critical points and formulated proposals to make total testing process harmonization effective, positively impacting the diagnostic effectiveness of laboratory tests.
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Affiliation(s)
| | - Carla Divieto
- Istituto Nazionale di Ricerca Metrologica INRIM, Turin, Italy
| | - Rossella Tomaiuolo
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Jessica Petiti
- Istituto Nazionale di Ricerca Metrologica INRIM, Turin, Italy
| | | | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Zaninotto M, Graziani MS, Plebani M. The harmonization issue in laboratory medicine: the commitment of CCLM. Clin Chem Lab Med 2022; 61:721-731. [PMID: 36383396 DOI: 10.1515/cclm-2022-1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
Abstract
The analytical quality of the clinical laboratory results has shown a significant improvement over the past decades, thanks to the joint efforts of different stakeholders, while the comparability among the results produced by different laboratories and methods still presents some critical issues. During these years, Clinical Chemistry and Laboratory Medicine (CCLM) published several papers on the harmonization issue over all steps in the Total Testing Process, training an important number of laboratory professionals in evaluating and monitoring all the criticisms inherent to the pre-analytical, as well as analytical and post analytical phases: from the consensus statement on the most informative testing in emergency setting, to the prevention and detection of hemolysis or to patients identification and tube labeling procedures, as far as to different approaches to harmonize hormones measurements or to describe new reference methods or to harmonize the laboratory report. During these years the commitment of the journal, devoted to the harmonization processes has allowed to improve the awareness on the topic and to provide specific instruments to monitor the rate of errors and to improve patients safety.
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Lippi G, von Meyer A, Cadamuro J, Simundic AM. Blood sample quality. ACTA ACUST UNITED AC 2019; 6:25-31. [PMID: 29794250 DOI: 10.1515/dx-2018-0018] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 11/15/2022]
Abstract
Several lines of evidence now confirm that the vast majority of errors in laboratory medicine occur in the extra-analytical phases of the total testing processing, especially in the preanalytical phase. Most importantly, the collection of unsuitable specimens for testing (either due to inappropriate volume or quality) is by far the most frequent source of all laboratory errors, thus calling for urgent strategies for improving blood sample quality and managing data potentially generated measuring unsuitable specimens. A comprehensive overview of scientific literature leads us to conclude that hemolyzed samples are the most frequent cause of specimen non-conformity in clinical laboratories (40-70%), followed by insufficient or inappropriate sample volume (10-20%), biological samples collected in the wrong container (5-15%) and undue clotting (5-10%). Less frequent causes of impaired sample quality include contamination by infusion fluids (i.e. most often saline or glucose solutions), cross-contamination of blood tubes additives, inappropriate sample storage conditions or repeated freezing-thawing cycles. Therefore, this article is aimed to summarize the current evidence about the most frequent types of unsuitable blood samples, along with tentative recommendations on how to prevent or manage these preanalytical non-conformities.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37100 - Verona, Italy
| | - Alexander von Meyer
- Institute for Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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Kilpatrick ES, Sandberg S. An overview of EFLM harmonization activities in Europe. Clin Chem Lab Med 2018; 56:1591-1597. [PMID: 29924732 DOI: 10.1515/cclm-2018-0098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 04/03/2018] [Indexed: 01/22/2023]
Abstract
Abstract
The European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) has initiated many harmonization activities in all phases of the examination process. The EFLM is dealing with both the scientific and the educational aspects of harmonization, with the intention of disseminating best practice in laboratory medicine throughout Europe. Priorities have been given (1) to establish a standard for conducting and assessing biological variation studies and to construct an evidence based EFLM webpage on biological variation data, (2) to harmonize preanalytical procedures by producing European guidelines, (3) to improve test ordering and interpretation, (4) to produce other common European guidelines for laboratory medicine and play an active part in development of clinical guidelines, (5) to establish a common basis for communicating laboratory results to patients, (6) to harmonize units of measurement throughout Europe, (7) to harmonize preanalytical procedures in molecular diagnostics and (8) to harmonize and optimize test evaluation procedures. The EFLM is also now launching the 5th version of the European Syllabus to help the education of European Specialists in Laboratory Medicine (EuSpLM), which is being supported by the development of e-learning courses. A register of EuSpLM is already established for members of National Societies in EU countries, and a similar register will be established for specialists in non-EU countries.
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Affiliation(s)
- Eric S Kilpatrick
- Professor of Pathology and Laboratory Medicine, Weill Cornell Medicine, Division Chief, Clinical Biochemistry, Department of Pathology, Sidra Medicine, 2nd Mezzanine Level, PO Box 26999, Doha, Qatar
| | - Sverre Sandberg
- Norwegian Quality Improvement of Laboratory Examinations, Bergen, Norway
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Ozarda Y, Ichihara K, Bakan E, Polat H, Ozturk N, Baygutalp NK, Taneli F, Guvenc Y, Ormen M, Erbayraktar Z, Aksoy N, Sezen H, Demir M, Eskandari G, Polat G, Mete N, Yuksel H, Vatansev H, Gun F, Akin O, Ceylan O, Noyan T, Gozlukaya O, Aliyazicioglu Y, Kahraman S, Dirican M, Tuncer GO, Kimura S, Eker P. A nationwide multicentre study in Turkey for establishing reference intervals of haematological parameters with novel use of a panel of whole blood. Biochem Med (Zagreb) 2017; 27:350-377. [PMID: 28694726 PMCID: PMC5493180 DOI: 10.11613/bm.2017.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/08/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION A nationwide multicentre study was conducted to establish well-defined reference intervals (RIs) of haematological parameters for the Turkish population in consideration of sources of variation in reference values (RVs). MATERIALS AND METHODS K2-EDTA whole blood samples (total of 3363) were collected from 12 laboratories. Sera were also collected for measurements of iron, UIBC, TIBC, and ferritin for use in the latent abnormal values exclusion (LAVE) method. The blood samples were analysed within 2 hours in each laboratory using Cell Dyn and Ruby (Abbott), LH780 (Beckman Coulter), or XT-2000i (Sysmex). A panel of freshly prepared blood from 40 healthy volunteers was measured in common to assess any analyser-dependent bias in the measurements. The SD ratio (SDR) based on ANOVA was used to judge the need for partitioning RVs. RIs were computed by the parametric method with/without applying the LAVE method. RESULTS Analyser-dependent bias was found for basophils (Bas), MCHC, RDW and MPV from the panel test results and thus those RIs were derived for each manufacturer. RIs were determined from all volunteers' results for WBC, neutrophils, lymphocytes, monocytes, eosinophils, MCV, MCH and platelets. Gender-specific RIs were required for RBC, haemoglobin, haematocrit, iron, UIBC and ferritin. Region-specific RIs were required for RBC, haemoglobin, haematocrit, UIBC, and TIBC. CONCLUSIONS With the novel use of a freshly prepared blood panel, manufacturer-specific RIs' were derived for Bas, Bas%, MCHC, RDW and MPV. Regional differences in RIs were observed among the 7 regions of Turkey, which may be attributed to nutritional or environmental factors, including altitude.
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Affiliation(s)
- Yesim Ozarda
- Department of Medical Biochemistry, Uludag University School of Medicine, Bursa, Turkey
| | - Kiyoshi Ichihara
- Department of Laboratory Sciences, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Ebubekir Bakan
- Department of Medical Biochemistry, Ataturk University School of Medicine, Erzurum, Turkey
| | - Harun Polat
- Department of Medical Biochemistry, Ataturk University School of Medicine, Erzurum, Turkey
| | - Nurinnisa Ozturk
- Department of Medical Biochemistry, Ataturk University School of Medicine, Erzurum, Turkey
| | - Nurcan K Baygutalp
- Department of Medical Biochemistry, Ataturk University School of Medicine, Erzurum, Turkey
| | - Fatma Taneli
- Department of Medical Biochemistry, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Yesim Guvenc
- Department of Medical Biochemistry, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Murat Ormen
- Department of Medical Biochemistry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Zubeyde Erbayraktar
- Department of Medical Biochemistry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Nurten Aksoy
- Department of Medical Biochemistry, Harran University School of Medicine, Urfa, Turkey
| | - Hatice Sezen
- Department of Medical Biochemistry, Harran University School of Medicine, Urfa, Turkey
| | - Meltem Demir
- Department of Medical Biochemistry, Medicalpark Hospital, Antalya, Turkey
| | - Gulcin Eskandari
- Department of Medical Biochemistry, Mersin University School of Medicine, Mersin, Turkey
| | - Gurbuz Polat
- Department of Medical Biochemistry, Mersin University School of Medicine, Mersin, Turkey
| | - Nuriye Mete
- Department of Medical Biochemistry, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Hatice Yuksel
- Department of Medical Biochemistry, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Husamettin Vatansev
- Department of Medical Biochemistry, Selçuk University School of Medicine, Konya, Turkey
| | - Fatma Gun
- Department of Medical Biochemistry, Selçuk University School of Medicine, Konya, Turkey
| | - Okhan Akin
- Department of Medical Biochemistry, Keçiören Teaching and Research Hospital, Ankara, Turkey
| | - Ozlem Ceylan
- Department of Medical Biochemistry, Keçiören Teaching and Research Hospital, Ankara, Turkey
| | - Tevfik Noyan
- Department of Medical Biochemistry, Ordu University School of Medicine, Ordu, Turkey
| | - Ozgul Gozlukaya
- Department of Medical Biochemistry, Ordu University School of Medicine, Ordu, Turkey
| | - Yuksel Aliyazicioglu
- Department of Medical Biochemistry, Karadeniz Teknik University School of Medicine, Trabzon, Turkey
| | - Sevim Kahraman
- Department of Medical Biochemistry, Karadeniz Teknik University School of Medicine, Trabzon, Turkey
| | - Melahat Dirican
- Department of Medical Biochemistry, Uludag University School of Medicine, Bursa, Turkey
| | - Gul Ozlem Tuncer
- Department of Medical Biochemistry, Uludag University School of Medicine, Bursa, Turkey
| | - Shogo Kimura
- Department of Laboratory Sciences, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Pinar Eker
- Department of Medical Biochemistry, Kuzey Laboratories, Fatih Sultan Mehmet Hospital, Istanbul
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Lippi G, Simundic AM. The EFLM strategy for harmonization of the preanalytical phase. ACTA ACUST UNITED AC 2017; 56:1660-1666. [DOI: 10.1515/cclm-2017-0277] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/27/2017] [Indexed: 11/15/2022]
Abstract
Abstract
The Working Group for the Preanalytical Phase (WG-PRE) was officially established by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) in 2013, with the aim of improving harmonization in the preanalytical phase across European member societies. Since its early birth, the WG-PRE has already completed a number of projects, including harmonizing the definition of fasting status, patient and blood tubes identification, color coding of blood collection tubes, sequence of tubes during blood drawing and participation in the development of suitable preanalytical quality indicators. The WG-PRE has also provided guidance on local validation of blood collection tubes, has performed two European surveys on blood sampling procedures and has organized four European meetings to promote the importance of quality in the preanalytical phase. The future activities entail development and validation of an external quality assessment scheme focused on preanalytical variables, development and dissemination of a survey about the local management of unsuitable samples in clinical laboratories, as well as release of EFLM phlebotomy guidelines. This article summarizes all recent achievements of the WG-PRE and illustrates future projects to promote harmonization in the preanalytical phase.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry , University Hospital of Verona , P.le LA Scuro 10, 37134 Verona , Italy , European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE)
| | - Ana-Maria Simundic
- European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE) ; and Department of Medical Laboratory Diagnostics , University Hospital Sveti Duh , Zagreb , Croatia
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Lima-Oliveira G, Volanski W, Lippi G, Picheth G, Guidi GC. Pre-analytical phase management: a review of the procedures from patient preparation to laboratory analysis. Scand J Clin Lab Invest 2017; 77:153-163. [PMID: 28266238 DOI: 10.1080/00365513.2017.1295317] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The pre-analytical phase encompasses all the procedures before the start of laboratory testing. This phase of the testing process is responsible for the majority of the laboratory errors, since the related procedures involve many sorts of non-laboratory professionals working outside the laboratory setting, thus without direct supervision by the laboratory staff. Therefore, either correct organization or management of both personnel and procedures that regard blood specimen collection by venipuncture are of fundamental importance, since the various steps for performing blood collection represent per se sources of laboratory variability. The aim of this (non-systematic) review addressed to healthcare professionals is to highlight the importance of blood specimen management (from patient preparation to laboratory analyses), as a tool to prevent laboratory errors, with the concept that laboratory results from inappropriate blood specimens are inconsistent and do not allow proper treatment nor monitoring of the patient.
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Affiliation(s)
- Gabriel Lima-Oliveira
- a Post-Graduate Program of Pharmaceutical Sciences, Department of Clinical Analyses , Federal University of Parana , Curitiba , Parana , Brazil
- b Laboratory of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences , University of Verona , Italy
| | - Waldemar Volanski
- a Post-Graduate Program of Pharmaceutical Sciences, Department of Clinical Analyses , Federal University of Parana , Curitiba , Parana , Brazil
| | - Giuseppe Lippi
- b Laboratory of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences , University of Verona , Italy
| | - Geraldo Picheth
- a Post-Graduate Program of Pharmaceutical Sciences, Department of Clinical Analyses , Federal University of Parana , Curitiba , Parana , Brazil
| | - Gian Cesare Guidi
- a Post-Graduate Program of Pharmaceutical Sciences, Department of Clinical Analyses , Federal University of Parana , Curitiba , Parana , Brazil
- b Laboratory of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences , University of Verona , Italy
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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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11
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Lippi G, Banfi G, Church S, Cornes M, De Carli G, Grankvist K, Kristensen GB, Ibarz M, Panteghini M, Plebani M, Nybo M, Smellie S, Zaninotto M, Simundic AM. Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE). Clin Chem Lab Med 2016; 53:357-70. [PMID: 25490032 DOI: 10.1515/cclm-2014-1051] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 10/28/2014] [Indexed: 11/15/2022]
Abstract
Laboratory diagnostics develop through different phases that span from test ordering (pre-preanalytical phase), collection of diagnostic specimens (preanalytical phase), sample analysis (analytical phase), results reporting (postanalytical phase) and interpretation (post-postanalytical phase). Although laboratory medicine seems less vulnerable than other clinical and diagnostic areas, the chance of errors is not negligible and may adversely impact on quality of testing and patient safety. This article, which continues a biennial tradition of collective papers on preanalytical quality improvement, is aimed to provide further contributions for pursuing quality and harmony in the preanalytical phase, and is a synopsis of lectures of the third European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)-Becton Dickinson (BD) European Conference on Preanalytical Phase meeting entitled 'Preanalytical quality improvement. In pursuit of harmony' (Porto, 20-21 March 2015). The leading topics that will be discussed include unnecessary laboratory testing, management of test request, implementation of the European Union (EU) Directive on needlestick injury prevention, harmonization of fasting requirements for blood sampling, influence of physical activity and medical contrast media on in vitro diagnostic testing, recent evidence about the possible lack of necessity of the order of draw, the best practice for monitoring conditions of time and temperature during sample transportation, along with description of problems emerging from inappropriate sample centrifugation. In the final part, the article includes recent updates about preanalytical quality indicators, the feasibility of an External Quality Assessment Scheme (EQAS) for the preanalytical phase, the results of the 2nd EFLM WG-PRE survey, as well as specific notions about the evidence-based quality management of the preanalytical phase.
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12
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Jones AW, Ericsson E. Decreases in blood ethanol concentrations during storage at 4 °C for 12 months were the same for specimens kept in glass or plastic tubes. Pract Lab Med 2016; 4:76-81. [PMID: 28856195 PMCID: PMC5574521 DOI: 10.1016/j.plabm.2016.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 12/01/2022] Open
Abstract
Background The stability of ethanol was investigated in blood specimens in glass or plastic evacuated tubes after storage in a refrigerator at 4 °C for up to 12 months. Methods Sterile blood, from a local hospital, was divided into 50 mL portions and spiked with aqueous ethanol (10% w/v) to give target concentrations of 0.20, 1.00, 2.00 and 3.00 g/L. Ethanol was determined in blood by headspace gas chromatography (HS-GC) with an analytical imprecision of <3% (coefficient of variation, CV%). Aliquots of blood were re-analysed after 2, 7, 14, 28, 91, 182 and 364 days of storage at 4 °C. Results The standard deviation (SD) of analysis by HS-GC was 0.0059 g/L at 0.20 g/L and 0.0342 g/L at 3.00 g/L, corresponding to CVs of 2.9% and 1.1%, respectively. The decreases in blood ethanol content were analytically significant after 14–28 days of storage for both glass and plastic tubes The mean (lowest and highest) loss of ethanol after 12 months storage was 0.111 g/L (0.084–0.129 g/L) for glass tubes and 0.112 g/L (0.088–0.140 g/L) for plastic tubes. The corresponding percentage losses of ethanol were 43–45% at a starting concentration of 0.20 g/L and 3.9–4.1% at 3.00 g/L. Conclusion The concentration of ethanol in blood gradually decreases during storage at 4 °C. After 12 months storage the absolute decrease in concentration was ~0.11 g/L when the starting concentration ranged from 0.20 to 3.0 g/L. Decreases in ethanol content were the same for specimens kept in glass or plastic evacuated tubes.
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Affiliation(s)
- A W Jones
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.,Department of Clinical Pharmacology, Medical Faculty, University of Linköping, Sweden
| | - E Ericsson
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
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13
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Ozarda Y. Reference intervals: current status, recent developments and future considerations. Biochem Med (Zagreb) 2016; 26:5-16. [PMID: 26981015 PMCID: PMC4783089 DOI: 10.11613/bm.2016.001] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/18/2015] [Indexed: 11/30/2022] Open
Abstract
Reliable and accurate reference intervals (RIs) for laboratory analyses are an integral part of the process of correct interpretation of clinical laboratory test results. RIs given in laboratory reports have an important role in aiding the clinician in interpreting test results in reference to values for healthy populations. Since the 1980s, the International Federation of Clinical Chemistry (IFCC) has been proactive in establishing recommendations to clarify the true significance of the term 'RIs, to select the appropriate reference population and statistically analyse the data. The C28-A3 guideline published by the Clinical and Laboratory Standards Institute (CLSI) and IFCC is still the most widely-used source of reference in this area. In recent years, protocols additional to the Guideline have been published by the IFCC, Committee on Reference Intervals and Decision Limits (C-RIDL), including all details of multicenter studies on RIs to meet the requirements in this area. Multicentric RIs studies are the most important development in the area of RIs. Recently, the C-RIDL has performed many multicentric studies to obtain common RIs. Confusion of RIs and clinical decision limits (CDLs) remains an issue and pediatric and geriatric age groups are a significant problem. For future studies of RIs, the genetic effect would seem to be the most challenging area.
The aim of the review is to present the current theory and practice of RIs, with special emphasis given to multicenter RIs studies, RIs studies for pediatric and geriatric age groups, clinical decision limits and partitioning by genetic effects on RIs.
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Affiliation(s)
- Yesim Ozarda
- Department of Medical Biochemistry, Uludag University School of Medicine, Bursa, Turkey
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