An Overview of Complete Blood Count Sample Rejection Rates in a Clinical Hematology Laboratory Due to Various Preanalytical Errors

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Abstract

Introduction

The Chughtai Laboratory collects blood samples for complete blood counts from various hospitals, emergency departments, ICUs, and through home sampling services all across the country. The preanalytical phase is an integral component of laboratory medicine. A laboratory report has a key role in patient treatment and the clinician's decision in the management of the disease. Preanalytical errors are most frequently caused by the absence of a sample and/or inappropriate understanding of a test request, mislabeling, contamination from the sampling site, hemolyzed, clotted, insufficient samples, storage issues, and inappropriate blood to anticoagulant proportion or inappropriate choice of anticoagulant.

Objective

To identify the cause of rejection rates of the complete blood count samples and reduce the rejection rates by improving the accuracy of the results and lowering pre-analytical errors.

Methods

This cross-sectional study was done in the Hematology Department of Chughtai Laboratory's head office in Lahore between 19-06-2021 and 19-10-2021. Simple random sampling was applied to collect the data. About 3 ml of each blood sample was received in an ethylenediaminetetraacetic acid (EDTA) vial, inspected visually, run on Sysmex XN-9000 (Sysmex Corporation, Kobe, Hyogo, Japan), and was reviewed on peripheral smears.

Results

Out of 231,008 blood samples, 11,897 (5.15%) samples were rejected. The most common pre-analytical mistake was storage issues due to transportation delay (19.45%) followed by wrong medical records (19.16%), diluted samples (16.35%), incorrect tubes (16.01%), hemolyzed samples (15.13%), unlabeled samples (10.01%), and clotted sample (3.88%).

Conclusion

In the hematology department, the total rejection rate observed during the study period was 5.15%. Recognition of preanalytical errors and avoiding them will help us lower the sample rejection rate and raise the overall quality of laboratory management.

Related collections

Most cited references 24

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Joint EFLM-COLABIOCLI Recommendation for venous blood sampling

Ana-Maria Šimundić, Karin Bölenius, Janne Cadamuro … (2018)

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. This recommendation applies to the use of a closed blood collection system and does not provide guidance for the blood collection with an open needle and syringe and catheter collections. Moreover, this document neither addresses patient consent, test ordering, sample handling and transport nor collection from children and unconscious patients. The recommended procedure is based on the best available evidence. Each step was graded using a system that scores the quality of the evidence and the strength of the recommendation. The process of grading was done at several face-to-face meetings involving the same mixture of stakeholders stated previously. The main parts of this recommendation are: 1) Pre-sampling procedures, 2) Sampling procedure, 3) Post-sampling procedures and 4) Implementation. A first draft of the recommendation was circulated to EFLM members for public consultation. WG-PRE-LATAM was also invited to comment the document. A revised version has been sent for voting on to all EFLM and COLABIOCLI members and has been officially endorsed by 33/40 EFLM and 21/21 COLABIOCLI members. We encourage professionals throughout Europe and Latin America to adopt and implement this recommendation to improve the quality of blood collection practices and increase patient and workers safety.

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The cost of poor blood specimen quality and errors in preanalytical processes.

Ann Green (2013)

The increase in the prevalence of medical errors represents a disturbing trend; hospital-based errors are the eighth leading cause of death in the United States. For the clinical laboratory, errors that occur in the preanalytical phase of testing may account for up to 75% of total laboratory errors; 26% of these may have detrimental effects on patient care, which contribute to unnecessary investigations or inappropriate treatment, increase in lengths of hospital stay, as well as dissatisfaction with healthcare services. This review focuses on these errors, particularly those observed in the preanalytical phase, and how they may affect clinical and financial outcomes. Financial ramifications are also demonstrated through a model that estimates the costs of preanalytical errors for the hospital and laboratory as well as patient care. Copyright © 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

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Laboratory Diagnostics and Quality of Blood Collection

Gabriel Lima-Oliveira, Giuseppe Lippi, Gian Salvagno … (2015)

Summary 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. We have read with interest a recent article where the authors addressed important aspects of venous blood collection for laboratory medicine analysis. The authors conducted a phlebotomy survey based on the Clinical and Laboratory Standard Institute (CLSI) H03-A6 document (presently replaced by the GP41-A6 document) in three government hospitals in Ethiopia to evaluate 120 professionals (101 non-laboratory professionals vs. 19 laboratory professionals) as regards the venous blood collection practice. The aim of this mini (non-systematic) review is to both take a cue from the above article and from current practices we had already observed in other laboratory settings, and discuss four questionable activities performed by health care professionals during venous blood collection. We refer to: i) diet restriction assessment; ii) puncture site cleansing; iii) timing of tourniquet removal and; iv) mixing specimen with additives.

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 31 January 2023

Publication date (Electronic, collection): January 2023

Volume: 15

Issue: 1

Electronic Location Identifier: e34444

Affiliations

[1 ] Haematology, Chughtai Lab, Lahore, PAK

[2 ] Hematopathology, Chughtai Lab, Lahore, PAK

[3 ] Histopathology, Chughtai Lab, Lahore, PAK

Author notes

Tayyab Noor noortayyab1988@ 123456gmail.com

Article

DOI: 10.7759/cureus.34444

PMC ID: 9979861

PubMed ID: 36874705

SO-VID: ca05e1b1-2493-4fdf-9e75-f537dc45a7d4

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date accepted : 31 January 2023

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