Preanalytical quality improvement - an interdisciplinary journey, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE).

Since the beginning of laboratory medicine, the main focus was to provide high quality analytics. Over time the importance of the extra-analytical phases and their contribution to the overall quality became evident. However, as the initial preanalytical processes take place outside of the laboratory and mostly without its supervision, all professions participating in these process steps, from test selection to sample collection and transport, need to engage accordingly.

Breakfast can Affect Routine Hematology and Coagulation Laboratory Testing: An Evaluation on Behalf of COLABIOCLI WG-PRE-LATAM.

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.

Impact of an Andean breakfast on biochemistry and immunochemistry laboratory tests: an evaluation on behalf COLABIOCLI WG-PRE-LATAM.

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.

[Joint EFLM-COLABIOCLI recommendation for venous blood sampling].

This document provides a joint recommendation for venous blood sampling of the European federation of clinical chemistry and laboratory medicine (EFLM) Working Group for preanalytical phase (WG-PRE) and Latin American working group for preanalytical phase (WG-PRE-LATAM) of the Latin America confederation of clinical biochemistry (COLABIOCLI). It offers guidance on the requirements for ensuring that blood collection is a safe and patient-centered procedure and provides practical guidance on how to successfully overcome potential barriers and obstacles to its widespread implementation. The target audience for this recommendation are healthcare staff members directly involved in blood collection.

Sample management for clinical biochemistry assays: Are serum and plasma interchangeable specimens?

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.

Preanalytical aspects on short- and long-term storage of serum and plasma.

Following an ordered clinical chemistry plasma/serum test, ideally the venous blood specimen is adequately collected at a health care facility, then swiftly transported to and readily handled, analyzed and sometimes interpreted at a clinical chemistry laboratory followed by a report of the test result to the ordering physician to finally handle the result. However, often there are practical as well as sample quality reasons for short- or long-term storage of samples before and after analysis. If there are specific storage needs, the preanalytical handling practices are specified in the laboratory's specimen collection instructions for the ordered test analyte.

Joint EFLM-COLABIOCLI Recommendation for venous blood sampling.

This document provides a joint recommendation for venous blood sampling of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE) and Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI). It offers guidance on the requirements for ensuring that blood collection is a safe and patient-centered procedure and provides practical guidance on how to successfully overcome potential barriers and obstacles to its widespread implementation. The target audience for this recommendation are healthcare staff members directly involved in blood collection.

Dark Chocolate Intake Acutely Enhances Neutrophil Count in Peripheral Venous Blood.

Beside the well-established impact on decreasing the risk of cardiovascular diseases (1), recent attention has been paid to the relationship between cocoa-containing foods and the immune system (2), showing that dark chocolate consumption enhances the systemic defense against bacterial (3) and viral (4) infections. Hence, the current study aimed at investigating the acute effect of dark chocolate intake on peripheral blood leukocytes.

Preanalytical Nonconformity Management Regarding Primary Tube Mixing in Brazil.

Background: The multifaceted clinical laboratory process is divided in three essential phases: the preanalytical, analytical and postanalytical phase. Problems emerging from the preanalytical phase are responsible for more than 60% of laboratory errors. This report is aimed at highlighting and discussing nonconformity (e.

Patient posture for blood collection by venipuncture: recall for standardization after 28 years.

Background: Although data about the effect of posture on routine hematological testing were published 28 years ago, this pre-analytical issue has not been standardized so far. This study was planned to evaluate whether postural changes influence the results of hematology testing.

Methods: A complete blood count was performed in 19 healthy volunteers after 25min in the supine position, 20min in a sitting position and 20min stationary standing in an upright position.

The impact of fist clenching and its maintenance during venipuncture on routine hematology testing.

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.

Estimating the intra- and inter-individual imprecision of manual pipetting.

Background: Despite the importance of manual pipetting of fluids such as water, solutions, buffers, reagents, or biological samples in daily laboratory practice, the intra- and inter-individual imprecision of this activity has not been recently described in scientific publications.

Methods: Twenty laboratory operators were randomly enrolled for this study. Imprecision of manual pipetting was estimated by asking each laboratory professional to dispense 1 mL, 100 μL or 10 μL of distilled water for 10 consecutive times with three certified pipettes into a 50-mL plastic container placed into a gravimetric balance.

Abnormal gel flotation caused by contrast media during adrenal vein sampling.

Introduction: During adrenal venous sampling (AVS) procedure, radiologists administer a contrast agent via the catheter to visualize the proper catheter position.

Materials And Methods: A patient with primary aldosteronism diagnostic-hypothesis was admitted for AVS. A venogram was performed to
confirm the catheter's position with 2mL of Iopamidol 300 mg/mL.

Mixing of thawed coagulation samples prior to testing: Is any technique better than another?

Objective: Thus study was aimed to investigate whether the mixing technique could influence the results of routine and specialized clotting tests on post-thawed specimens.

Methods: The sample population consisted of 13 healthy volunteers. Venous blood was collected by evacuated system into three 3.

Estimation of the imprecision on clinical chemistry testing due to fist clenching and maintenance during venipuncture.

Objectives: An experimental study was planned to assess the influence on routine clinical chemistry parameters of fist making prior to, and maintenance during, venipuncture.

Design And Methods: Blood was collected from 16 healthy volunteers with two separate sequential procedures, entailing standard venipuncture with hand opened throughout blood collection, or clenching the fist 6 times before venipuncture and maintaining the fist until completion of blood collection. After separation of lithium-heparin plasma at vacuum tubes with gel separator, 28 routine clinical chemistry parameters and serum indices were measured on Roche Cobas 6000 〈c501〉 module.

Venous stasis and whole blood platelet aggregometry: a question of data reliability and patient safety.

The assessment of platelet function by multiple electrode aggregometry (MEA) (Multiplate, Roche Diagnostics GmbH) is common in laboratory hematology. As regards the ISO 15189:2012 international standard, appropriate use of laboratory equipment requires appropriate pre-examination activities (e.g.

Laboratory Diagnostics and Quality of Blood Collection.

Diagnostic blood samples collected by phlebotomy are the most common type of biological specimens drawn and sent to laboratory medicine facilities for being analyzed, thus supporting caring physicians in patient diagnosis, follow-up and/or therapeutic monitoring. Phlebotomy, a relatively invasive medical procedure, is indeed critical for the downstream procedures accomplished either in the analytical phase made in the laboratory or in the interpretive process done by the physicians. Diagnosis, management, treatment of patients and ultimately patient safety itself can be compromised by poor phlebotomy quality.

In vitro diagnostic company recalls and medical laboratory practices: an Italian case.

Introduction: In vitro human diagnostic (IVD) company recalls are a common practice aimed to either minimize a potential error or eliminate an existing failure. In this case report, we aim to provide a critical analysis of a recent IVD recall and to provide a practical framework about what to do when an IVD company recalls product(s) based on the International Organization for Standardization--ISO 15189:2012 standard.

Case Report: In 2014, Abbott Laboratories® (Green Oaks, IL) published an urgent field safety notice regarding a product recall (Architect Intact parathyroid hormone (PTH) Assay List Number 8K25) with immediate action required.

Influence of posture on routine hemostasis testing.

Biological variability is an important aspect for appropriate interpretation of hemostasis testing, but unreliable evidence has been provided to date regarding the effect of different postures on first-line clotting tests such as activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen. Variation of APTT, PT and fibrinogen was therefore investigated in 19 healthy volunteers after 25  min in supine position, 20  min in sitting position and 20  min stationary standing in upright position. The change from supine to sitting position caused a significant decrease of PT and a significant increase of fibrinogen.

Comparison of genetic and epigenetic alterations of primary tumors and matched plasma samples in patients with colorectal cancer.

Background: Although recent advances in circulating DNA analysis allow the prediction of tumor genomes by noninvasive means, some challenges remain, which limit the widespread introduction of cfDNA in cancer diagnostics. We analyzed the status of the two best characterized colorectal cancer (CRC) genetic and epigenetic alterations in a cohort of CRC patients, and then compared the degree to which the two patterns move from tissue to plasma in order to improve our understanding of biology modulating the concordance between tissues and plasma methylation and mutation profiles.

Methods: Plasma and tumor tissues were collected from 85 patients (69±14 years, 56 males).