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      • Record: found
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      Effects of specimen haemolysis on complete blood count results by Abbott Alinity hq System

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          Abstract

          Introduction

          The current study aimed to assess the interference of in vitro haemolysis on complete blood count (CBC) using Abbott Alinity hq system, and to determine which haemolysis levels affect the reliability of sample results.

          Materials and methods

          Blood samples obtained from 25 volunteers in K3-EDTA tubes were divided into four aliquots. The first aliquot was not subjected to any intervention. The second, third and fourth aliquots were passed through a fine needle 2, 4 and 6 times, respectively. Complete blood count was performed by multi-angle polarized scatter separation technology and haemolysis index (HI) was assessed from the plasma samples separated by centrifugation. Five groups were formed according to the HI values. The percentage biases between the results of non-haemolysed and haemolysed groups were compared with the desirable bias limits from The European Federation of Clinical Chemistry and Laboratory Medicine database and reference change values (RCVs).

          Results

          In groups 1 to 4, the effects of haemolysis on CBC parameters were acceptable comparing to the analytical bias except for lymphocytes (7.26%-7.42%), MCH (2.59%), and MCHC (0.47%-2.81%). Results of group 5 (gross haemolysis) showed decreases in HCT(- 4.56%), RBC (- 4.07%) count and increase in lymphocyte (11.60%) count higher than the analytical performance specifications. Moreover, variations in MCH (4.65%) and MCHC (5.24%) were exceeding the RCVs.

          Conclusions

          Gross haemolysis (haemoglobin concentration > 10 g/L) is likely to produce unreliable CBC results on non-pathological samples. Further studies including pathological specimens are needed.

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          Most cited references19

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          The detection and prevention of errors in laboratory medicine.

          Mario Plebani (2010)
          The last few decades have seen a significant decrease in the rates of analytical errors in clinical laboratories. Evidence demonstrates that pre- and post-analytical steps of the total testing process (TTP) are more error-prone than the analytical phase. Most errors are identified in pre-pre-analytic and post-post-analytic steps outside of the laboratory. In a patient-centred approach to the delivery of health-care services, there is the need to investigate, in the TTP, any possible defect that may have a negative impact on the patient. In the interests of patients, any direct or indirect negative consequence related to a laboratory test must be considered, irrespective of which step is involved and whether the error depends on a laboratory professional (e.g. calibration/testing error) or non-laboratory operator (e.g. inappropriate test request, error in patient identification and/or blood collection). Patient misidentification and problems communicating results, which affect the delivery of diagnostic services, are recognized as the main goals for quality improvement. International initiatives aim at improving these aspects. Grading laboratory errors on the basis of their seriousness should help identify priorities for quality improvement and encourage a focus on corrective/preventive actions. It is important to consider not only the actual patient harm sustained but also the potential worst-case outcome if such an error were to reoccur. The most important lessons we have learned are that system theory also applies to laboratory testing and that errors and injuries can be prevented by redesigning systems that render it difficult for all health-care professionals to make mistakes.
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            Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories.

            Giuseppe Lippi, Norbert J. C. Blanckaert, Sol Green … (2007)
            Prevention of medical errors is a major goal of healthcare, though healthcare workers themselves have not yet fully accepted or implemented reliable models of system error, and neither has the public. While there is widespread perception that most medical errors arise from an inappropriate or delayed clinical management, the issue of laboratory errors is receiving a great deal of attention due to their impact on the quality and efficiency of laboratory performances and patient safety. Haemolytic specimens are a frequent occurrence in clinical laboratories, and prevalence can be as high as 3.3% of all of the routine samples, accounting for up to 40%-70% of all unsuitable specimens identified, nearly five times higher than other causes, such as insufficient, incorrect and clotted samples. This article focuses on this challenging issue, providing an overview on prevalence and leading causes of in vivo and in vitro haemolysis, and tentative guidelines on identification and management of haemolytic samples in clinical laboratories. This strategy includes continuous education of healthcare personnel, systematic detection/quantification of haemolysis in any sample, immediate clinicians warning on the probability of in vivo haemolysis, registration of non-conformity, completing of tests unaffected by haemolysis and request of a second specimen for those potentially affected.
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              Hemolyzed specimens: a major challenge for emergency departments and clinical laboratories.

              Giuseppe Lippi, Mario Plebani, Salvatore Di Somma … (2024)
              The term hemolysis designates the pathological process of breakdown of red blood cells in blood, which is typically accompanied by varying degrees of red tinge in serum or plasma once the whole blood specimen has been centrifuged. Hemolyzed specimens are a rather frequent occurrence in laboratory practice, and the rate of hemolysis is remarkably higher in specimens obtained in the Emergency Department (ED) as compared with other wards or outpatient phlebotomy services. Although hemolyzed specimens may reflect the presence of hemolytic anemia, in most cases they are due to preanalytical sources related to incorrect procedures or failure to follow procedures for collection, handling and storage of the samples; some of these are typical of the ED. Since hemolyzed specimens are often an important cause of relationship, economic, organizational and clinical problems between the ED and the clinical laboratory, it is essential to develop effective processes for systematically identifying unsuitable specimens (e.g. by using the hemolysis index), differentiating in vitro from in vivo hemolysis, troubleshooting the potential causes, and maintaining good relations between the clinical laboratory and the ED.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Biochem Med (Zagreb)
                Journal ID (iso-abbrev): Biochem Med (Zagreb)
                Journal ID (publisher-id): BM
                Title: Biochemia Medica
                Publisher: Croatian Society of Medical Biochemistry and Laboratory Medicine
                ISSN (Print): 1330-0962
                ISSN (Electronic): 1846-7482
                Publication date (Print and electronic): 15 October 2021
                Publication date (Electronic): 15 October 2021
                Publication date (Print): 15 October 2021
                Volume: 31
                Issue: 3
                Electronic Location Identifier: 030706
                Affiliations
                [1 ]deptDepartment of Biochemistry , Afyonkarahisar Health Sciences University , Afyonkarahisar, Turkey
                [2 ]deptDepartment of Biochemistry , Ankara City Hospital , Ankara, Turkey
                [3 ]Department of Biochemistry, Faculty of Medicine, Harran University, Sanliurfa , Turkey
                [4 ]Department of Biochemistry, Lüleburgaz State Hospital, Kırklareli , Turkey
                Author notes
                [* ]Corresponding author: mujganercan@ 123456hotmail.com
                Article
                Publisher ID: bm-31-3-030706
                DOI: 10.11613/BM.2021.030706
                PMC ID: 8495619
                SO-VID: 1f515a53-ba15-4e54-9ce1-6c5aec5e637d
                Copyright © Croatian Society of Medical Biochemistry and Laboratory Medicine.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution ( http://creativecommons.org/licenses/by/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 25 May 2021
                Date accepted : 28 August 2021
                Categories
                Subject: Original Articles

                Keywords: complete blood count,reference change values,haemolysis,interference
                Data availability:
                Keywords: complete blood count, reference change values, haemolysis, interference

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