Background: The pre and post analytical phase in a testing cycle contributes up to 93% of total laboratory errors. Hence, it is of utter importance for the laboratory to study error occurrence rates during the testing cycle and implement a quality improvement plan to release an accurate result.
Methods: The present study was conducted during the period 2008 - 2009 in the clinical biochemistry lab in Lady Hardinge Medical College and associated hospitals. During a 6 month period 32,589 samples were monitored for major preanalytical problems at the receiving counter of the laboratory.
Results: Out of all laboratory problems, up to 61% are associated with the preanalytical phase in the lab. Out of this, 33% of the errors are associated with the test request forms, 18% errors with sample collection in glass vials, and 3% errors associated with sample processing in the laboratory. As per Quality Improvement policy of the lab, a closed blood evacuation system (vacutainers) has been implemented for sample collection. Post implementation, preanalytical error rate has been reduced to 48%, however, tube filling errors still remain the major problem noted.
Conclusions: Based on these observations, transcription errors related to test request forms is of great concern and needs corrective measures via proper educational programs. If this area is compromised it can lead to adverse patient outcome. However, with the use of vacutainers a better specimen quality and health care worker safety is achieved. It also decreases inconvenience to the patient.
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Kidney Int Rep
January 2025
La Isla Network, Washington DC, USA.
Clin Chem Lab Med
January 2025
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
Objectives: Careful consideration of the pre-analytical process for urine examination is essential to avoid errors and support accurate results and decision-making. Our objective was to assess the impact of various pre-analytical factors on urine test strip and quantitative chemistry results, including stability, tube type, fill volume, and centrifugation.
Methods: Residual random urine specimens were identified.
J Appl Lab Med
December 2024
HealthPartners Medical Laboratory, Pathology Lab, Bloomington, MN, United States.
Introduction: Specimens suspected of errors related to low hemoglobin or changes in hemoglobin beyond that of clinically explained variations during hospital stays are frequently redrawn under the auspices that they are contaminated. When lack of an indwelling IV eliminates contamination as a possibility, evaluation of the specimen between the time of collection and testing should occur.
Methods: As part of a quality improvement project, we investigated the impact of sedimentation on collected blood specimens not immediately transferred to their respective tubes from a syringe.
Adv Lab Med
December 2024
Section of Clinical Biochemistry and School of Medicine, University of Verona, Verona, Italy.
Objectives: Urinalysis is widely used and is also frequently requested in emergency situations for screening hypovolemia, urinary tract infections, diabetes, ketoacidosis and hematuria. Our aim was to evaluate the impact of reporting urinary sediment in emergency department specimens with the Sysmex UN system.
Methods: We evaluated urinalyses requested by the emergency department over a three-month period and examined red blood cell count interference, compared leukocyte esterase dipsticks to cytofluorimetric leukocyte count and nitrites to cytofluorimetric bacterial count.
Biochem Med (Zagreb)
February 2025
Department of Medical Biochemistry and Hematology, Children's Hospital Zagreb, Zagreb, Croatia.
Ceftriaxone, a widely used antibiotic, is one of the most common drugs to cause drug-induced immune hemolytic anemia. In this report, we describe the effect of ceftriaxone on red blood cell parameters (low red blood cell count, low hematocrit, and high erythrocyte index values) in two pediatric patients without clinical symptoms of hemolytic anemia. Although automated hematology analyzers have helped to detect incorrect results, a peripheral blood smear examination was necessary for recognizing the erythrocyte agglutinins caused by ceftriaxone.
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