Clinical institute of chemistry, clinical unit for medical biochemistry and toxicology, university hospital center sestre milosrdnice faculty of pharmac. Jun 15, 2019 european survey on preanalytical sample handling part 2. Problems may arise during the collection of blood specimens such as misidentification of the sample, use of inadequate devices or needles, incorrect order of draw, prolonged tourniquet placing, unsuccessful at. On behalf of the european federation of clinical chemistry and laboratory medicine eflm. Aug 14, 2018 minimizing preanalytical errors in capillary blood sample collection and handling. An observational study by the european federation of clinical. Preanalytical quality check using our expertise, we examine your institutions preanalytical phase quality and processes from device storage, sample collection up to sample analysis. Pdf preanalytical sample handling and sample stability. At each stage of your blood collection process, we identify and monitor possible causes of preanalytical errors to help you understand your current. Specifically, c31a2 offers guidance in recognizing preanalytical factors that can affect ionized calcium determinations. Preanalytical variables and factors that interfere with the.
This may be via direct education sessions, elearning or via direct feedback through sample reports or verbally. The preanalytical phase covers all stages from preparing the patient for specimen collection to introducing the specimen into the analytical process. Practices of european laboratories on monitoring and processing haemolytic, icteric and lipemic samples. Pdf reducing preanalytical laboratory sample errors through. Expiration dates can be found on each paper label on the tube e. In preanalytical phase the common causes are sorting and routing, pouroff and labeling, centrifugation time andor speed. Minimizing preanalytical errors in capillary blood sample collection and handling. Clinical laboratory total testing process is highly complex. Glucose measured in plasma from tubes containing sodium fluoride is recommended but serum from serum. Preanalytical errors and their impact on tests in clinical. Preanalytical sample handling and storage procedures play an extremely important role in reliably measuring neurochemical dementia diagnostics ndd biomarkers. They are not ways of achieving perfection, but they can go a long way toward the goal of eliminating preanalytical errors.
Preanalytical factors that can affect results include. Type of anticoagulant substantially affected measured levels of total tau. Thus, assessment and control of the preanalytical handling of the samples intended for use in research projects are essential to ensure the quality of these specimens, sample integrity, and correct future use 4, 5. With the increasing num ber in laboratory tests per patients, the burden of phlebotomy increased3. The complex process of laboratory and pointofcare testing of patient blood samples comprises three phases. Preanalytical and postanalytical qc often these papers play a zerosum game, emphasizing pre and postanalytical quality while diminishing the importance of analytical quality. Preanalytical sample handling recommendations for alzheimers. Establishing a standardized, robust process for sample collection and preanalytical sample handling is crucial for the assessment of bloodbased biomarkers for ad to become a part of clinical trial methodology and routine clinical practice. Preanalytical sample handling is a neglected consideration in many clinical tests. Nowadays, the testing process still requires extensive manual management through the different laboratory procedures pre, intra and postanalytical which. The preanalytical phase is the phase where the laboratory has no direct control. Requirements for the labelling of samples will also vary between laboratories, with transfusion laboratories an example where minor errors will result in rejection, and where the ifccwg. Preanalytical issues in the haemostasis laboratory.
Useful tips to avoid preanalytical errors in blood gas testing. Preanalytical errors related to venous blood sample collection and handling. Preanalytical variables include appropriateness of test request, proper patient identification and preparation, accurate sample collection, handling and transport to the laboratory. Glucose measured in plasma from tubes containing sodium fluoride is recommended but serum from serumgel tubes may be used in research situations. Sample has been delivered to the lab in a plastic syringe, on ice. In analytical phase common causes are pipetting errors, equipment malfunction, sample mixups, interference. Most errors in the venous blood testing orocess jare. General chemistry technical bulletin centrifugation the role. Preanalytical errors there is consolidated evidence that lack of standardization and monitoring of pre analytic variables, including procedures for patient identification, sample collection, handling and processing has an adverse influence on the reliability of test results, consuming valuable healthcare resources and compromising the patient.
Pdf preanalytical workstations as a tool for reducing. Manual weighting appears more accurate, but less prac. This phase may include specimen handling issues that occur even prior to the time the specimen is received in the laboratory. Several studies have investigated preanalytical factors that influence btm measurement. Preanalytical errors and their impact on tests in clinical laboratory. Identification and reduction of preanalytical errors in clinical. Improving the collection and management of human samples used. The eflm strongly believes that harmonization of each of these issues may markedly reduce the potential risk of preanalytical errors and substantially improve. The topics covered included sample stability, preanalytical challenges in hematology. Preanalytical errors and their impact on tests in clinical laboratory practice pakistan journal of medical research, 2012 january march 29 phlebotomy practices should be adopted by all health care workers. European survey on preanalytical sample handling part 2. Negligence in any of these steps can lead to erroneous results attributed to pre.
Useful tips to avoid preanalytical errors in blood gas. Advances in automation, sample collection, transportation, and. The effect of preanalytical factors on research samples will differ depending on the methodology and analyses used in the. Business case for preanalytical process improvement. These factors highlight the importance of seeking laboratory input at the earliest stage of design of a study or. The aim of most profiling experiments is identification of changes in protein patterns that are related to a certain disease or clinical status and might therefore be used to improve diagnosis, staging, and. Preanalytical, analytical, and postanalytical phases of. General and testspecific considerations are included in this document for key components of sample handling including required materials, sample collection and processing, storage, and transport. Methods require thorough evaluation of patientrelated preanalytical factors, and. In this lesson, sources of errors for the preanalytic and postanalytic phases of the total testing process are discussed, along with possible solutions. Pdf laboratory testing, a highly complex process commonly called the. The phases before the sample reaches the laboratory preanalytical and the phase after the sample is analyzed postanalytical are equally important.
Poor sample quality due to haemolysis leads to sample recollection, delayed turnaround time and has cost bearing on the patients, staff and organisation. Measurement of blood glucose is a standard biochemical test requiring optimum preanalytical sample handling. Preanalytical, analytical, and postanalytical phases of testing the preanalytic testing phase occurs first in the laboratory process. Time between sample collection and centrifugation, and between centrifugation and measurement, impacted the measured concentrations of a. Specimen collection, handling and transport page 3 of 6 c.
I would thouroughly mix the sample and perform the analysis. Specimen handling and storage effect of temperature and light. Glucose measured in plasma from tubes containing sodium fluoride is. Fill lines are indicated by the black and white notches on the side of the label. Best practices are just thatthe best ways to approach and solve a problem. The role of eflm wgpre in standardization and harmonization of the preanalytical phase in europe. Aug 08, 20 preanalytical sample handling is a neglected consideration in many clinical tests.
Preanalytical phase an overview sciencedirect topics. Sample handling and transport effect of time between sampling and analysis temperature of sample during transport mode of transport. Pdf european survey on preanalytical sample handling part 1. Any air bubbles in the sample must be expelled as soon as possible after the sample has been drawn before mixing the sample with heparin even small air bubbles may seriously affect the p o 2 value of the sample an air bubble whose relative volume is 0.
At each stage of your blood collection process, we identify and monitor possible causes of. Improving the collection and management of human samples. It may occur at all stages of the preanalytical phase i. According to reliable data, preanalytical errors still account for nearly 60 70% of all problems occurring in laboratory, most of them attributable to mishandling procedures during collection, handling, preparing or.
Reducing preanalytical laboratory sample errors through. Preanalytical errors related to venous sample collection and. Quality assurance of the preanalytical phase complying. European survey on preanalytical sample handling similar to the traditional approach to improve the quality of the analytical phase, the preanalytical phase requires monitoring of the quality and. How do european laboratories monitor the preanalytical phase. Before determining the appropriate steps that will lead to the reduction of preanalytical variability in urine specimen collection and handling, an institution must understand what factors impact the preanalytical phase of urine testing the most, in. Pdf preanalytical stage of blood sample collection. Identification of the types of preanalytical errors in the. This study investigated the influence of different preanalytic handling methods on surfaceenhanced laser desorptionionization timeofflight mass spectrometry seldi. European survey on preanalytical sample handling part 1.
Type of anticoagulant substantially affected measured levels of. The preanalytical phase is the phase where the laboratory has no direct control on the process. Quality assurance of the preanalytical phase complying with iso 15189. Furthermore, the preanalytical phase includes all those activities centrifugation, pipetting, aliquoting, sorting, etc. Feb 15, 2014 preanalytical errors there is consolidated evidence that lack of standardization and monitoring of pre analytic variables, including procedures for patient identification, sample collection, handling and processing has an adverse influence on the reliability of test results, consuming valuable healthcare resources and compromising the patient. Eflm european federation of clinical chemistry and.
Reducing preanalytical errors whitehat communications. Mix the sample thoroughly immediately after sampling. Pdf european survey on preanalytical sample handling. Lipemic samples lipemic samples are often seen following collection after heavy meals or the due to pre existing metabolic. Compliance of blood sampling procedures with the clsi h3 a6 guidelines. On behalf of the european federation of clinical chemistry and laboratory medicine eflm working group for the preanalytical phase wgpre. Quality assurance of the preanalytical phase complying with. Bd diagnostics preanalytical systems the bd vacutainer range offers a complete system of tubes, needles, needle holders and safety devices, which are optimally designed and tested for controlling preanalytical variability throughout the specimen collection and handling process. Preanalytical,analytical and postanalytical errors in. Quality control of preanalytical handling of blood samples. All collection tubes must be filled with the required volume no short samples. Minimizing preanalytical errors in capillary blood sample. Preanalytical phase comprises of test selection, patient identification, collection of the sample, handling of the sample, sorting out, pipetting and centrifugation 2, 3.
Similar to the traditional approach to improve the quality of the analytical phase, the preanalytical phase requires monitoring of the quality and continuous improvement continual improvement. Challenges in preanalytical phase of laboratory medicine. Of those responders who monitored preanalytical errors, 16% n 202 used manual documentation of errors e. Pdf european survey on preanalytical sample handling part. Mass spectrometry ms offers a wide range of possibilities for analyzing biological samples containing complex mixtures of proteins and peptides, by generating proteome profiles.
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