Does Pneumatic Tube System Transport Contribute to Hemolysis in ED Blood Samples?

Phelan, Michael; Reineks, Edmunds Z.; Hustey, Fredric M.; Berriochoa, J.; Podolsky, S.R.; Meldon, Stephen W.; Schold, Jesse D.; Chamberlin, Janelle; Procop, Gary W.

doi:10.5811/westjem.2016.6.29948

Cited by 16 publications

(7 citation statements)

References 18 publications

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“…Several papers describe how PTS may increase the risk of in vitro hemolysis [2,[8][9][10]. Clinical chemistry analyses are most often discussed in this context; however, blood gas, hematology and coagulation analyses have also been subject to evaluation when assessing the effects of PTS on specimen integrity [4,11,12].…”

Section: Introductionmentioning

confidence: 99%

Use of clinical data and acceleration profiles to validate pneumatic transportation systems

Gils

Broell²,

Vinholt

et al. 2019

Clinical Chemistry and Laboratory Medicine (CCLM)

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BackgroundModern pneumatic transportation systems (PTSs) are widely used in hospitals for rapid blood sample transportation. The use of PTS may affect sample integrity. Impact on sample integrity in relation to hemolysis and platelet assays was investigated and also, we wish to outline a process-based and outcome-based validation model for this preanalytical component.MethodsThe effect of PTS was evaluated by drawing duplicate blood samples from healthy volunteers, one sent by PTS and the other transported manually to the core laboratory. Markers of hemolysis (potassium, lactate dehydrogenase [LD] and hemolysis index [HI]) and platelet function and activation were assessed. Historic laboratory test results of hemolysis markers measured before and after implementation of PTS were compared. Furthermore, acceleration profiles during PTS and manual transportation were obtained from a mini g logger in a sample tube.ResultsHand-carried samples experienced a maximum peak acceleration of 5 g, while peaks at almost 15 g were observed for PTS. No differences were detected in results of potassium, LD, platelet function and activation between PTS and manual transport. Using past laboratory data, differences in potassium and LD significantly differed before and after PTS installation for all three lines evaluated. However, these estimated differences were not clinically significant.ConclusionsIn this study, we found no evidence of PTS-induced hemolysis or impact on platelet function or activation assays. Further, we did not find any clinically significant changes indicating an acceleration-dependent impact on blood sample quality. Quality assurance of PTS can be performed by surveilling outcome markers such as HI, potassium and LD.

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Section: Introductionmentioning

confidence: 99%

Use of clinical data and acceleration profiles to validate pneumatic transportation systems

Gils

Broell²,

Vinholt

et al. 2019

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…This study found that the first primary outcome (the hemolysis rate) did not differ significantly between a PTS and manual transportation. Cakirca and Erdal [10] similarly considered that using a PTS did not significantly affect the hemolysis of blood samples, with hemolysis rates of 8% and 10% in their PTS and manualtransportation groups, respectively; Fernandes et al [21] found corresponding rates of 5.8% and 10%, with no significant difference, as also found by Phelan et al [4]. However, Kara et al [2] found that the hemolysis rate was significantly higher in their PTS group than in their manual-transportation group.…”

Section: Discussionmentioning

confidence: 77%

“…Concerns have been raised that a PTS may cause the hemolysis of blood samples that further results in changes to the levels of potassium (K), lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST), due to factors such as high pressures, fast transportation speeds, and sudden changes in the transportation direction [2,3]. However, other studies found no relationship between using a PTS and hemolysis [4,5]. These discrepancies have prompted debate about whether using a PTS causes hemolysis, and hospital managers are now hesitating to employ PTSs, instead opting for traditional manual transportation that wastes time and energy.…”

Section: Introductionmentioning

confidence: 99%

Effects of a pneumatic tube system on the hemolysis of blood samples: a PRISMA-compliant meta-analysis

Ding

Wen

Wang

et al. 2021

Scandinavian Journal of Clinical and Laboratory Investigation

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Many studies have explored how using a pneumatic tube system (PTS) is related to the hemolysis of blood samples, but their conclusions have been inconsistent. This meta-analysis was to clarify whether using a PTS induces the hemolysis of blood samples. The PubMed, Embase, Scopus, CNKI, CqVip, SinoMed and WanFang databases were searched for studies published between January 1970 and August 2019. The primary outcomes were the hemolysis rate and hemolysis index of blood samples after applying a PTS and manual transportation. We estimated the pooled risk ratio (RR) and the standardized mean difference (SMD), using random-effects models. This meta-analysis included 29 studies covering 3121 blood samples. No significant differences were found between the PTS and manual-transportation groups in the hemolysis rate [RR: 0.99, 95% confidence interval (CI): 0.57 to 1.70], hemolysis index (SMD: 0.19, 95% CI: À0.00 to 0.38), or level of potassium (SMD: 0.05, 95% CI: À0.03 to 0.12), alanine aminotransferase (SMD: 0.00, 95% CI: À0.10 to 0.11), or aspartate aminotransferase (SMD: 0.04, 95% CI: À0.08 to 0.17). However, lactate dehydrogenase (LDH) level was significantly higher in the PTS group than in the manual-transportation group (SMD: 0.20, 95% CI: 0.06 to 0.34). Subgroup analysis revealed that the LDH level was clearly higher in the PTS group than in the manual-transportation group only when the PTS speed was !6 m/s or when the PTS distance was !250 m. According to this meta-analysis, PTSs were associated with alterations in LDH measurements, so it is sensible that each hospital validates and monitors their PTSs.

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“…Since fewer medical staff members are on duty in the nights or holidays, it is a hard work for them to come to the department of transfusion and carry RBCs or PCs to each ward. If the transportation of these products using PTS could be expanded, as has been the case with blood specimens for laboratory tests [12][13][14][15], it might be very helpful for medical staff and lighten their workload.…”

Section: Discussionmentioning

confidence: 99%

Quality of red blood cell and platelet concentrates after transportation by a pneumatic tube system

Kobayashi

Ebihara

Asami

et al. 2019

ISBT Science Series

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Background and objectives Pneumatic tube systems (PTSs) are used in some hospitals to transport patients' specimens. We investigated the feasibility of applying PTS for blood products for transfusion in our hospital. Materials and methodsWe transported red blood cells (RBCs) and platelet concentrates (PCs) by the PTS and measured biomarkers such as red cell haemolysis and platelet dysfunction before and after one-way transportation, in addition, after one-way transportation for three consecutive times by PTS.Results Using 25 RBCs, K, free Hb, Hb, LD, AST and pH were compared before and after transportation. There were no significant differences. Haemolysis rates ranging between 0Á13% and 0Á35% were acceptable under the guideline. Using 6 PCs, platelet concentration, aggregation and activation function were examined. There were no significant differences before and after transportation. Positive rates of CD62P ranging between 3Á1% and 11Á4% showed no remarkable changes after the transportation. After the third consecutive transportation, LD and AST were slightly increased. However, haemolysis rate changed from 0Á16% to 0Á21%, again stayed in guideline level. As for platelet products, platelet aggregation activities to collagen (approximately 80%) did not change significantly. ConclusionOur study demonstrated that PTS is feasible for transporting them since one-and three-time transportation by PTS does not appear to influence the important quality of RBCs and PCs. In our hospital, we have applied PTS for the transportation of blood products without major troubles such as loss of products or transfusion-related adverse events.

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Does Pneumatic Tube System Transport Contribute to Hemolysis in ED Blood Samples?

Cited by 16 publications

References 18 publications

Use of clinical data and acceleration profiles to validate pneumatic transportation systems

Use of clinical data and acceleration profiles to validate pneumatic transportation systems

Effects of a pneumatic tube system on the hemolysis of blood samples: a PRISMA-compliant meta-analysis

Quality of red blood cell and platelet concentrates after transportation by a pneumatic tube system

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