Clinical institute of chemistry, clinical unit for medical biochemistry and toxicology, university hospital center sestre milosrdnice faculty of pharmac. Preanalytical phase an overview sciencedirect topics. All collection tubes must be filled with the required volume no short samples. Identification and reduction of preanalytical errors in clinical. Clinical laboratory total testing process is highly complex. Pdf preanalytical workstations as a tool for reducing. In analytical phase common causes are pipetting errors, equipment malfunction, sample mixups, interference. The preanalytical phase is the phase where the laboratory has no direct control on the process.
Compliance of blood sampling procedures with the clsi h3 a6 guidelines. 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. Highthroughput proteomic methods for disease biomarker discovery in human serum are promising, but concerns exist regarding reproducibility of results and variability introduced by sample handling. Preanalytical errors and their impact on tests in clinical. 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. Useful tips to avoid preanalytical errors in blood gas. 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. Best practices are just thatthe best ways to approach and solve a problem. On behalf of the european federation of clinical chemistry and laboratory medicine eflm. Pdf european survey on preanalytical sample handling. 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. The phases before the sample reaches the laboratory preanalytical and the phase after the sample is analyzed postanalytical are equally important.
This may be via direct education sessions, elearning or via direct feedback through sample reports or verbally. At each stage of your blood collection process, we identify and monitor possible causes of. Preanalytical sample handling recommendations for alzheimers. 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. In this lesson, sources of errors for the preanalytic and postanalytic phases of the total testing process are discussed, along with possible solutions. Time between sample collection and centrifugation, and between centrifugation and measurement, impacted the measured concentrations of a. Mix the sample thoroughly immediately after sampling. These factors highlight the importance of seeking laboratory input at the earliest stage of design of a study or. The role of eflm wgpre in standardization and harmonization of the preanalytical phase in europe. Quality assurance of the preanalytical phase complying with iso 15189. Pdf laboratory testing, a highly complex process commonly called the.
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. 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. Minimizing preanalytical errors in capillary blood sample collection and handling. In preanalytical phase the common causes are sorting and routing, pouroff and labeling, centrifugation time andor speed. Pdf preanalytical sample handling and sample stability. Poor sample quality due to haemolysis leads to sample recollection, delayed turnaround time and has cost bearing on the patients, staff and organisation.
Glucose measured in plasma from tubes containing sodium fluoride is recommended but serum from serumgel tubes may be used in research situations. Reducing preanalytical laboratory sample errors through. At each stage of your blood collection process, we identify and monitor possible causes of preanalytical errors to help you understand your current. Preanalytical and postanalytical qc often these papers play a zerosum game, emphasizing pre and postanalytical quality while diminishing the importance of analytical quality. Of those responders who monitored preanalytical errors, 16% n 202 used manual documentation of errors e. Fill lines are indicated by the black and white notches on the side of the label. Specimen collection, handling and transport page 3 of 6 c. Sample has been delivered to the lab in a plastic syringe, on ice. The eflm strongly believes that harmonization of each of these issues may markedly reduce the potential risk of preanalytical errors and substantially improve. It may occur at all stages of the preanalytical phase i. The preanalytical phase is the phase where the laboratory has no direct control. On behalf of the european federation of clinical chemistry and laboratory medicine eflm working group for the preanalytical phase wgpre. Jun 15, 2019 european survey on preanalytical sample handling part 2. Preanalytical, analytical, and postanalytical phases of.
Several studies have investigated preanalytical factors that influence btm measurement. Negligence in any of these steps can lead to erroneous results attributed to pre. Glucose measured in plasma from tubes containing sodium fluoride is recommended but serum from serum. Challenges in preanalytical phase of laboratory medicine. 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. I would thouroughly mix the sample and perform the analysis. Preanalytical errors and their impact on tests in clinical laboratory. Expiration dates can be found on each paper label on the tube e. Pdf reducing preanalytical laboratory sample errors through. Improving the collection and management of human samples. Preanalytical variables and factors that interfere with the. Preanalytical issues in the haemostasis laboratory. The preanalytical phase covers all stages from preparing the patient for specimen collection to introducing the specimen into the analytical process. Methods require thorough evaluation of patientrelated preanalytical factors, and.
Mass spectrometry ms offers a wide range of possibilities for analyzing biological samples containing complex mixtures of proteins and peptides, by generating proteome profiles. Quality control of preanalytical handling of blood samples. Most errors in the venous blood testing orocess jare. How do european laboratories monitor the preanalytical phase. Nowadays, the testing process still requires extensive manual management through the different laboratory procedures pre, intra and postanalytical which. 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. The complex process of laboratory and pointofcare testing of patient blood samples comprises three phases. Glucose measured in plasma from tubes containing sodium fluoride is. Preanalytical factors that can affect results include. Pdf european survey on preanalytical sample handling part 1. Compliance of blood sampling procedures with the clsi h3a6 guidelines. Reducing preanalytical errors whitehat communications.
Business case for preanalytical process improvement. Furthermore, the preanalytical phase includes all those activities centrifugation, pipetting, aliquoting, sorting, etc. 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. Quality assurance of the preanalytical phase complying. Specifically, c31a2 offers guidance in recognizing preanalytical factors that can affect ionized calcium determinations. They are not ways of achieving perfection, but they can go a long way toward the goal of eliminating preanalytical errors.
Useful tips to avoid preanalytical errors in blood gas testing. Lipemic samples lipemic samples are often seen following collection after heavy meals or the due to pre existing metabolic. The topics covered included sample stability, preanalytical challenges in hematology. Aug 14, 2018 minimizing preanalytical errors in capillary blood sample collection and handling. An observational study by the european federation of clinical. Identification of the types of preanalytical errors in the. Specimen handling and storage effect of temperature and light. Measurement of blood glucose is a standard biochemical test requiring optimum preanalytical sample handling. With the increasing num ber in laboratory tests per patients, the burden of phlebotomy increased3. Preanalytical, analytical, and postanalytical phases of testing the preanalytic testing phase occurs first in the laboratory process. Improving the collection and management of human samples used. European survey on preanalytical sample handling part 2.
European survey on preanalytical sample handling part 1. 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. This study investigated the influence of different preanalytic handling methods on surfaceenhanced laser desorptionionization timeofflight mass spectrometry seldi. Sample handling and transport effect of time between sampling and analysis temperature of sample during transport mode of transport. Preanalytical errors related to venous sample collection and. Here is a short discussion on the topic in regards to blood specimens. Advances in automation, sample collection, transportation, and. Preanalytical variables include appropriateness of test request, proper patient identification and preparation, accurate sample collection, handling and transport to the laboratory.
Eflm european federation of clinical chemistry and. Minimizing preanalytical errors in capillary blood sample. Pdf preanalytical stage of blood sample collection. The effect of preanalytical factors on research samples will differ depending on the methodology and analyses used in the. General chemistry technical bulletin centrifugation the role. Pdf european survey on preanalytical sample handling part.
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. Preanalytical phase comprises of test selection, patient identification, collection of the sample, handling of the sample, sorting out, pipetting and centrifugation 2, 3. Preanalytical,analytical and postanalytical errors in. 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. This phase may include specimen handling issues that occur even prior to the time the specimen is received in the laboratory. Type of anticoagulant substantially affected measured levels of. Practices of european laboratories on monitoring and processing haemolytic, icteric and lipemic samples. Preanalytical errors related to venous blood sample collection and handling.