Preanalytical Errors in a Hematology Laboratory: An Experience from a Tertiary Care Center

Abstract

Background: Laboratory errors arise at any stage of testing. Detecting these inaccuracies before results are revealed might delay diagnosis and treatment, causing patient distress. Here, we studied the preanalytical errors in a hematology laboratory. Methods: This one-year retrospective analysis was conducted at the laboratory of a tertiary care hospital and included information on blood samples that were taken for hematology tests from both outpatients and inpatients. Laboratory records included sample collection and rejection information. The type and frequency of preanalytical errors were expressed as a proportion of total errors and sample number. Microsoft Excel was utilized to enter data. The results were presented in the form of frequency tables. Results: This research included 67,892 hematology samples. For preanalytical errors, 886 samples (1.3%) were discarded. The most common preanalytical error was insufficient sample (54.17%), and the least common was an empty/damaged tube (0.4%). Erroneous samples in the emergency department were mostly insufficient and clotted, whereas pediatric sample errors were caused by insufficient and diluted samples. Conclusion: Inadequate samples and clotted samples account for the vast majority of preanalytical factors. Insufficiency and dilutional errors were most frequent from pediatric patients. Adherence to best laboratory practices can drastically cut down on preanalytical errors.

Determining the rate and reasons for specimen rejection among specimens referred for HIV viral load determination through referral linkage to Debre Tabor Comprehensive Specialized Hospital, north-central, Ethiopia,2023: Retrospective study

“…In this study, we also discovered another type of preanalytical error (clotted specimen), which accounts for 1.9 % of all errors. This finding is lower than the findings of research conducted in Oromia, Ethiopia, 21.9 % [ 25 ]; Saudi Arabia, 20.09 % [ 20 ]; Cantonal Hospital Zenica in Bosnia and Herzegovina, 39.87 % [ 19 ]; and Libya, 25 % [ 23 ] of specimens were rejected due to the occurrence of the clot. A study conducted in Saudi Arabia [ 14 ], however, found a lower proportion, i.e., 0.08 % specimen rejection rate due to the clotting of specimens.…”

“…Of the total specimens collected the overall specimen rejection rate found in the current study is similar to the overall specimen rejection rates obtained from studies done at the University of Gondar Hospital, Northwest Ethiopia, 3.8 % [ 15 ]; in Zimbabwe, 4 % [ 16 ], and Nepal, 5.5 % [ 17 ]. However, the overall sample rejection at the pre-analytical phase in the current study is higher than the studies conducted at Amhara Public Health Institute in Bahir Dar, Ethiopia, 0.5 % [ 9 ]; St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia, 1.4 % [ 1 ]; Delhi, 1.52 % [ 18 ]; Cantonal Hospital Zenica, 1.7 % [ 19 ]; and Makkah, Saudi Arabia, 1.3 % [ 20 ]. On the other hand, our study's finding indicates a lower rate of overall sample rejection in the pre-analytical phase compared to the rate of overall pre-analytical sample rejection of previous studies conducted at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia,26 % [ 2 ]; St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia,72.3 % [ 21 ], and Saudi Arabia, 12.1 % [ 14 ].…”

“…Blood clotting is most commonly caused by an insufficient anticoagulant-to-blood ratio or a delay in transferring blood from a syringe to a test tube. Clotting damages cells and consumes coagulation factors, rendering the specimen unsuitable for assays that require plasma [ 20 ]. In this study, we also discovered another type of preanalytical error (clotted specimen), which accounts for 1.9 % of all errors.…”

Novel Simple Approach for Differentiating Concentrated or Diluted Blood Samples, Hematological Disorders and Organ Dysfunctions in Acute Care Settings-A Global Perspective

“…Recent studies have shown the relationship of fluid overload with adverse outcomes; hence, manage and optimization of fluid balance becomes a central component of the management of critically ill patients [5,6]. Acute myeloid leukaemia (AML) is a condition in which myeloblast count rapidly increase in bone marrow, so normal functioning erythrocyte precursors are decreased in number resulting in reduced blood cell count.…”

Series of errors leading to life-threatening transfusion-associated circulatory overload

“…Different pre-analytical errors hamper the accuracy of laboratory results: sample clotting, insufficient volume of blood in a test tube, diluted sample, haemolysis, wrong test tube for an intended test, wrong identification label on a test tube, etc. [1,2]. There were no symptoms of acute bleeding.…”