Influence of <i>in vitro</i> hemolysis on hematological testing on Advia 2120

Lippi, Giuseppe; Musa, Ramli; Avanzini, Paola; Aloe, Rosalia; Pipitone, Silvia; Sandei, Franca

doi:10.1111/j.1751-553x.2011.01378.x

Cited by 33 publications

(48 citation statements)

References 31 publications

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“…The second (hemolyzed aliquot A), third (hemolyzed aliquot B) and fourth (hemolyzed aliquot C) aliquots were mechanically hemolyzed by aspirating whole blood one (hemolyzed aliquot A), two (hemolyzed aliquot B) and three times (hemolyzed aliquot C) with an insulin syringe equipped with a fine needle (30 gauge, 0.3 Â 8 mm) (Picindolor; Artsana S.p.A., Grandate, Italy). This technique has been proved to reliably mimic a traumatic blood collection and produce concomitant breakdown of red blood cells, platelets and leukocytes [10]. The plasma was subsequently separated by centrifugation at 2000 Â g for 10 min at room temperature and also tested for hemolysis index and D-dimer.…”

Section: Methodsmentioning

confidence: 99%

“…Among the various potential errors in the preanalytical phase, invitro hemolysis still represents the first cause of specimens rejection in laboratory diagnostics [7,8], including the coagulation laboratory where their prevalence is $1% of all samples and $20% of those considered unsuitable [9]. Although there is vast information about the influence of spurious hemolysis on clinical chemistry [7], immunochemistry [7], hematology [10], arterial blood gas [11], as well as conventional coagulation testing [4][5][6], less is known about the potential bias produced by in-vitro hemolysis on D-dimer testing to the best of our knowledge. Moreover, in none of the previous studies, the influence of spurious hemolysis has been assessed by producing a mechanical injury of blood to reproduce the effects of a troublesome venipuncture, as well as comparing simultaneously the effect on two different immunoassay techniques.…”

Section: Introductionmentioning

confidence: 99%

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Influence of mechanical hemolysis of blood on two D-dimer immunoassays

Lippi

Avanzini

Zobbi

et al. 2012

Blood Coagulation &Amp; Fibrinolysis

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Although there is broad information about the influence of spurious hemolysis on several laboratory tests, less is known on the bias produced on D-dimer testing. Four different pools were obtained from primary blood tubes, and each of them was divided into four aliquots. The first nonhemolyzed was centrifuged, the plasma was separated and then tested for hemolysis index and D-dimer. The second (hemolyzed aliquot A), third (hemolyzed aliquot B) and fourth (hemolyzed aliquot C) aliquots were mechanically hemolyzed by aspirating whole blood one, two and three times through a fine needle. The plasma was then separated and tested for hemolysis index and D-dimer. D-dimer was quantified by HemosIL AcuStar D-dimer and HemosIL D-dimer HS for ACL TOP. Undetectable hemolysis was present in aliquot nonhemolyzed (<0.5 g/l), whereas the concentration of cell-free hemoglobin significantly increased from hemolyzed aliquot A (5.5-7.0 g/l hemoglobin) to hemolyzed aliquot B (11.5 and 15.0 g/l hemoglobin) and hemolyzed aliquot C (20-22 g/l hemoglobin). The plasma concentration of D-dimer decreased from aliquots nonhemolyzed to hemolyzed aliquot C, achieving clinical significance fromhemolyzed aliquot A and hemolyzed aliquot B when measured with D-dimer HS for ACL TOP and AcuStar D-dimer, respectively. The decrease with AcuStar D-dimer was -5 ± 3% in hemolyzed aliquot A, -7 ± 3% in hemolyzed aliquot B, and -9 ± 3% in hemolyzed aliquot C, whereas the decrease with D-dimer HS for ACL TOP was -5 ± 3% in hemolyzed aliquot A, -8 ± 3% in hemolyzed aliquot B and -9 ± 3% in hemolyzed aliquot C. The similar trend towards decreasing values observed when measuring D-dimer with chemiluminescent and turbidimetric immmunoassays on four heterogeneous plasma pools suggest that the hemolysis interference is more likely to be biological than analytical. The modest bias observed in samples with frank hemolysis (i.e. cell-free hemoglobin of 11.5 g/l) confirms that both methods are robust against this type of interference, so that test results might be released in the majority of mildly hemolyzed samples.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of mechanical hemolysis of blood on two D-dimer immunoassays

Lippi

Avanzini

Zobbi

et al. 2012

Blood Coagulation &Amp; Fibrinolysis

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“…One important preanalytical variable affecting some clotting tests as well as platelets is hemolysis [52] . Some coagulation analyzers are already available with automated preanalytical checks.…”

Section: Preanalytical Phase For Hemostasis and Platelet Function Tesmentioning

confidence: 99%

Preanalytical quality improvement: in quality we trust

Lippi

Becan-McBride

Behúlová

et al. 2012

Clinical Chemistry and Laboratory Medicine (CCLM)

189

123

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Total quality in laboratory medicine should be defined as the guarantee that each activity throughout the total testing process is correctly performed, providing valuable medical decision-making and effective patient care. In the past decades, a 10-fold reduction in the analytical error rate has been achieved thanks to improvements in both reliability and standardization of analytical techniques, reagents, and instrumentation. Notable advances in information technology, quality control and quality assurance methods have also assured a valuable contribution for reducing diagnostic errors. Nevertheless, several lines of evidence still suggest that most errors in laboratory diagnostics fall outside the analytical phase, and the pre-and postanalytical steps have been found to be much more vulnerable. This collective paper, which is the logical continuum of the former already published in this journal 2 years ago, provides additional contribution to risk management in the preanalytical phase and is a synopsis of the lectures of the 2nd European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)-Becton Dickinson (BD) European Conference on Preanalytical Phase meeting entitled " Preanalytical quality improvement: in quality we trust " (Zagreb, Croatia, 1 -2 March 2013). The leading topics that will be discussed include quality indicators for preanalytical phase, phlebotomy practices for collection of blood gas analysis and pediatric samples, lipemia and blood collection tube interferences, preanalytical requirements of urinalysis, molecular biology hemostasis and platelet testing, as well as indications on best practices for safe blood collection. Auditing of the preanalytical phase by ISO assessors and external quality assessment for preanalytical phase are also discussed.

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“…The literature presents a restricted number of studies about the influence of hemolysis on the complete blood count (CBC); moreover as far as we know, no data have been reported in using the impedance‐based hematology analyzers. Therefore, the objective of this study was to evaluate the interference of in vitro hemolysis on the blood cell‐counting parameters interpretation performed by the impedance method.…”

Section: Introductionmentioning

confidence: 99%