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Koch CD, Vera MA, El-Khoury JM. Rapid serum clot tubes reduce haemolysis due to pneumatic tube transport. J Clin Pathol 2022; 75:643-645. [PMID: 35273119 DOI: 10.1136/jclinpath-2021-208126] [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: 12/22/2021] [Accepted: 03/01/2022] [Indexed: 11/04/2022]
Abstract
AIMS Pneumatic tube systems (PTSs) are critical for modern hospital operations, allowing for rapid sample transport. Despite widespread use, PTSs can compromise specimen integrity and affect laboratory values. Our objective was to prove that rapid serum clot tubes (RST) provide protective benefits over plasma during PTS transport and can be a practical solution for certain PTS routes. METHODS In this study, we compared the effects of PTS transport on cell lysis indicators: h-index, lactate dehydrogenase (LDH) and potassium (K+), in RST versus lithium heparin gel separator tubes using 10 volunteers. RESULTS In comparison with plasma, RST showed a median reduction in PTS-induced haemolysis of 80.4% (p=0.0049), with a reduction in post-PTS median LDH concentration (49.7%, p=0.04) and K+ concentration (50.0%, p=0.0273). CONCLUSION This study demonstrates RST tubes can significantly reduce PTS-induced haemolysis and can be recommended for poor PTS routes.
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Affiliation(s)
- Christopher D Koch
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael A Vera
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joe M El-Khoury
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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2
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Robbiano C, Birindelli S, Dolci A, Panteghini M. Impact of managing affected results in haemolysed samples of an infant-maternity hospital using an unconventional approach. Clin Biochem 2021; 95:49-53. [PMID: 34077758 DOI: 10.1016/j.clinbiochem.2021.05.013] [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: 03/30/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The management of affected results in haemolysed samples (HS) is debated. In an infant-maternity setting, for reporting interfered test results, we provided the result itself, the degree of haemolysis (as free haemoglobin concentration), and a warning recommending sample recollection. We investigated the impact of this approach on sample quality and clinicians' decision-making. METHODS Free haemoglobin was measured on Beckman Coulter AU680 as haemolytic index. We estimated the total HS number, the clinical wards more affected by HS, the most interfered analytes, and the retesting rate of interfered tests, by comparing data from Apr-Dec 2017, the period just after the introduction of the new policy, vs. Apr-Dec 2018. RESULTS One year after the new report introduction, a significant HS decrease (5.8% vs. 7.8%, P < 0.001) was detected, together with a reduction of the frequency by which haemolysis affected results. The most affected wards, i.e., Paediatric and Neonatal Intensive Care Units, showed an improvement in sample quality (HS rate, 30.6% to 16.1%, P < 0.001, and 25.2% to 20.9%, P = 0.048, respectively). We noted a significant decrease in retesting after an alerted result for aspartate aminotransferase, magnesium, potassium, conjugated bilirubin, and lactate dehydrogenase. CONCLUSIONS Our approach led to a HS decrease, suggesting that the provided report could be a driving force for improvement of phlebotomy quality, also helping clinicians in deciding if retesting is essential or not.
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Affiliation(s)
- Cristina Robbiano
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy.
| | - Sarah Birindelli
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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Plebani M, Banfi G, Bernardini S, Bondanini F, Conti L, Dorizzi R, Ferrara FE, Mancini R, Trenti T. Serum or plasma? An old question looking for new answers. Clin Chem Lab Med 2021; 58:178-187. [PMID: 31525152 DOI: 10.1515/cclm-2019-0719] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/22/2019] [Indexed: 12/17/2022]
Abstract
Serum or plasma? An old question looking for new answers. There is a continual debate on what type of sample a clinical laboratory should use. While serum is still considered the gold standard and remains the required sample for some assays, laboratories must consider turn-around time, which is an important metric for laboratory performance and, more importantly, plays a critical role in patient care. In addition, a body of evidence emphasise the choice of plasma in order to prevent modifications of some analytes due to the coagulation process and related interferences. Advantages and disadvantages of serum and plasma are discussed on the basis of current literature and evidence. In addition, data are provided on the current utilisation of the samples (serum or plasma) in Italy and in other countries. Finally, a rationale for a possible switch from serum to plasma is provided.
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Affiliation(s)
- Mario Plebani
- Dipartimento Strutturale Medicina di Laboratorio, Azienda Ospedale Università di Padova, Padova, Italy
| | - Giuseppe Banfi
- Direttore Scientifico, IRCCS Istituto Ortopedico Galeazzi, Università Vita e Salute San Raffaele, Milan, Italy
| | - Sergio Bernardini
- Dipartimento di Medicina Sperimentale, Università degli Studi di Tor Vergata, Rome, Italy
| | - Francesco Bondanini
- Unità Operativa Complessa Patologia Clinica Presidio, Ospedaliero Sant'Eugenio/CTO ASL Roma 2, Rome, Italy
| | - Laura Conti
- Patologia Clinica, IRCCS Istituto Nazionale Tumori Regina Elena Roma, Rome, Italy
| | - Romolo Dorizzi
- Unità Operativa Patologia Clinica, AUSL della Romagna, Cesena, Italy
| | - Fulvio Enrico Ferrara
- Direttore Servizio Integrato di Medicina di Laboratorio e Anatomia Patologica, Centro Diagnostico Italiano Spa, Milan, Italy
| | - Rita Mancini
- Laboratorio Unico Metropolitano, AUSL Bologna, Bologna, Italy
| | - Tommaso Trenti
- Dipartimento di Medicina di Laboratorio e Anatomia Patologica Azienda Ospedaliera Universitaria e USL di Modena, Modena, Italy
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Pasqualetti S, Panteghini M. Highly sensitive troponin T measurement after pneumatic tube transportation: The sample type can make the difference. Clin Chim Acta 2019; 503:231-232. [PMID: 31678578 DOI: 10.1016/j.cca.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sara Pasqualetti
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
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Szoke D, Caruso S, Pasqualetti S, Aloisio E, Falvella FS, Dolci A, Panteghini M. Suppressing all test results in grossly hemolyzed samples: is this approach appropriate in every case? ACTA ACUST UNITED AC 2018; 57:e118-e120. [DOI: 10.1515/cclm-2018-1071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Dominika Szoke
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Via GB Grassi 74 , 20157 Milano , Italia , Phone: +39 02 3904 2683, Fax: +39 02 3904 2364
| | - Simone Caruso
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italia
| | - Sara Pasqualetti
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italia
| | - Elena Aloisio
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italia
| | | | - Alberto Dolci
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italia
| | - Mauro Panteghini
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco , Milano , Italia
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Lima-Oliveira G, Monneret D, Guerber F, Guidi GC. Sample management for clinical biochemistry assays: Are serum and plasma interchangeable specimens? Crit Rev Clin Lab Sci 2018; 55:480-500. [PMID: 30309270 DOI: 10.1080/10408363.2018.1499708] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The constrained economic context leads laboratories to centralize their routine analyses on high-throughput platforms, to which blood collection tubes are sent from peripheral sampling sites that are sometimes distantly located. Providing biochemistry results as quickly as possible implies to consolidate the maximum number of tests on a minimum number of blood collection tubes, mainly serum tubes and/or tubes with anticoagulants. However, depending on the parameters and their pre-analytical conditions, the type of matrix - serum or plasma - may have a significant impact on results, which is often unknown or underestimated in clinical practice. Importantly, the matrix-related effects may be a limit to the consolidation of analyses on a single tube, and thus must be known by laboratory professionals. The purpose of the present critical review is to put forward the main differences between using serum and plasma samples on clinical biochemistry analyses, in order to sensitize laboratory managers to the need for standardization. To enrich the debate, we also provide an additional comparison of serum and plasma concentrations for approximately 30 biochemistry parameters. Properties, advantages, and disadvantages of serum and plasma are discussed from a pre-analytical standpoint - before, during, and after centrifugation - with an emphasis on the importance of temperature, delay, and transport conditions. Then, differences in results between these matrices are addressed for many classes of biochemistry markers, particularly proteins, enzymes, electrolytes, lipids, circulating nucleic acids, metabolomics markers, and therapeutic drugs. Finally, important key-points are proposed to help others choose the best sample matrix and guarantee quality of clinical biochemistry assays. Moreover, awareness of the implications of using serum and plasma samples on various parameters assayed in the laboratory is an important requirement to ensure reliable results and improve patient care.
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Affiliation(s)
- Gabriel Lima-Oliveira
- a Section of Clinical Biochemistry, Department of Neurosciences , Biomedicine and Movement Sciences, University of Verona , Verona , Italy.,b Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI) , Montevideo , Uruguay
| | - Denis Monneret
- c Department of Biochemistry and Molecular Biology , Lyon Sud Hospital Group, Hospices Civils de Lyon , Pierre Bénite , France
| | | | - Gian Cesare Guidi
- a Section of Clinical Biochemistry, Department of Neurosciences , Biomedicine and Movement Sciences, University of Verona , Verona , Italy.,b 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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7
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Aloisio E, Carnevale A, Pasqualetti S, Birindelli S, Dolci A, Panteghini M. Random uncertainty of photometric determination of hemolysis index on the Abbott Architect c16000 platform. Clin Biochem 2018; 57:62-64. [PMID: 29343410 DOI: 10.1016/j.clinbiochem.2018.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Automatic photometric determination of the hemolysis index (HI) on serum and plasma samples is central to detect potential interferences of in vitro hemolysis on laboratory tests. When HI is above an established cut-off for interference, results may suffer from a significant bias and undermine clinical reliability of the test. Despite its undeniable importance for patient safety, the analytical performance of HI estimation is not usually checked in laboratories. Here we evaluated for the first time the random source of measurement uncertainty of HI determination on the two Abbott Architect c16000 platforms in use in our laboratory. METHODS From January 2016 to September 2017, we collected data from daily photometric determination of HI on a fresh-frozen serum pool with a predetermined HI value of ~100 (corresponding to ~1g/L of free hemoglobin). Monthly and cumulative CVs were calculated. RESULTS During 21months, 442 and 451 measurements were performed on the two platforms, respectively. Monthly CVs ranged from 0.7% to 2.7% on c16000-1 and from 0.8% to 2.5% on c16000-2, with a between-platform cumulative CV of 1.82% (corresponding to an expanded uncertainty of 3.64%). Mean HI values on the two platforms were just slightly biased (101.3 vs. 103.1, 1.76%), but, due to the high precision of measurements, this difference assumed statistical significance (p<0.0001). CONCLUSIONS Even though no quality specifications are available to date, our study shows that the HI measurement on Architect c16000 platform has nice reproducibility that could be considered in establishing the state of the art of the measurement.
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Affiliation(s)
- Elena Aloisio
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy.
| | - Assunta Carnevale
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Sara Pasqualetti
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Sarah Birindelli
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Alberto Dolci
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
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Causes, consequences and management of sample hemolysis in the clinical laboratory. Clin Biochem 2017; 50:1317-1322. [DOI: 10.1016/j.clinbiochem.2017.09.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 12/15/2022]
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Dolci A, Giavarina D, Pasqualetti S, Szőke D, Panteghini M. Total laboratory automation: Do stat tests still matter? Clin Biochem 2017; 50:605-611. [PMID: 28390779 DOI: 10.1016/j.clinbiochem.2017.04.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
During the past decades the healthcare systems have rapidly changed and today hospital care is primarily advocated for critical patients and acute treatments, for which laboratory test results are crucial and need to be always reported in predictably short turnaround time (TAT). Laboratories in the hospital setting can face this challenge by changing their organization from a compartmentalized laboratory department toward a decision making-based laboratory department. This requires the implementation of a core laboratory, that exploits total laboratory automation (TLA) using technological innovation in analytical platforms, track systems and information technology, including middleware, and a number of satellite specialized laboratory sections cooperating with care teams for specific medical conditions. In this laboratory department model, the short TAT for all first-line tests performed by TLA in the core laboratory represents the key paradigm, where no more stat testing is required because all samples are handled in real-time and (auto)validated results dispatched in a time that fulfills clinical needs. To optimally reach this goal, laboratories should be actively involved in managing all the steps covering the total examination process, speeding up also extra-laboratory phases, such sample delivery. Furthermore, to warrant effectiveness and not only efficiency, all the processes, e.g. specimen integrity check, should be managed by middleware through a predefined set of rules defined in light of the clinical governance.
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Affiliation(s)
- Alberto Dolci
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy.
| | - Davide Giavarina
- Clinical Chemistry and Hematology Laboratory, "San Bortolo" Hospital, Vicenza, Italy
| | - Sara Pasqualetti
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Dominika Szőke
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, "Luigi Sacco" University Hospital, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan Medical School, Milan, Italy
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10
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McCaughey EJ, Vecellio E, Lake R, Li L, Burnett L, Chesher D, Braye S, Mackay M, Gay S, Badrick T, Westbrook J, Georgiou A. Key factors influencing the incidence of hemolysis: A critical appraisal of current evidence. Crit Rev Clin Lab Sci 2016; 54:59-72. [PMID: 28013559 DOI: 10.1080/10408363.2016.1250247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hemolysis is a leading cause of pre-analytical laboratory errors. The identification of contributing factors is an important step towards the development of effective practices to reduce and prevent hemolysis. We performed a review of PUBMED, Embase, Medline and CINAHL to identify articles published between January 2000 and August 2016 that identified factors influencing in vitro hemolysis rates. The 40 studies included in this review provide excellent evidence that hemolysis rates are higher in Emergency Departments (EDs), for non-antecubital draws, for specimens drawn using an intravenous catheter compared to venipuncture and for samples transported by pneumatic tube compared to by hand. There is also good evidence that hemolysis rates are higher when specimens are not collected by professional phlebotomists, larger volume specimen tubes are used, specimen tubes are filled less than halfway and tourniquet time is greater than one minute. The results of this review suggest that hospitals and clinical laboratories should consider deploying phlebotomists in EDs, drawing all blood through a venipuncture, using the antecubital region as the optimum blood collection site and transporting specimens by laboratory assistant/other personnel, or if this in not practical, ensuring that pneumatic transport systems are validated, maintained and monitored. Studies also recommend making hemolysis a hospital-wide issue and ensuring high-quality staff training and adherence to standard operating procedures to reduce hemolysis rates. Awareness of the factors that influence hemolysis rates, and adoption of strategies to mitigate these risk factors, is an important step towards creating quality practices to reduce hemolysis rates and improve the quality of patient care.
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Affiliation(s)
- Euan James McCaughey
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia
| | - Elia Vecellio
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia.,b South Eastern Area Laboratory Services, NSW Health Pathology, Prince of Wales Hospital , Randwick , NSW , Australia
| | - Rebecca Lake
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia
| | - Ling Li
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia
| | - Leslie Burnett
- b South Eastern Area Laboratory Services, NSW Health Pathology, Prince of Wales Hospital , Randwick , NSW , Australia.,c Pathology North, NSW Health Pathology, Royal North Shore Hospital , St Leonards , NSW , Australia.,d Northern Clinical School, Sydney Medical School, University of Sydney , NSW , Australia
| | - Douglas Chesher
- c Pathology North, NSW Health Pathology, Royal North Shore Hospital , St Leonards , NSW , Australia.,d Northern Clinical School, Sydney Medical School, University of Sydney , NSW , Australia
| | - Stephen Braye
- c Pathology North, NSW Health Pathology, Royal North Shore Hospital , St Leonards , NSW , Australia.,e Pathology North, NSW Health Pathology , Newcastle , NSW , Australia , and
| | - Mark Mackay
- f Royal College of Pathologists Australasia Quality Assurance Program , St Leonards , NSW , Australia
| | - Stephanie Gay
- f Royal College of Pathologists Australasia Quality Assurance Program , St Leonards , NSW , Australia
| | - Tony Badrick
- f Royal College of Pathologists Australasia Quality Assurance Program , St Leonards , NSW , Australia
| | - Johanna Westbrook
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia
| | - Andrew Georgiou
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia
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