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The incidence rate and influence factors of hemolysis, lipemia, icterus in fasting serum biochemistry specimens. PLoS One 2022; 17:e0262748. [PMID: 35045128 PMCID: PMC8769349 DOI: 10.1371/journal.pone.0262748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Hemolysis, icterus, and lipemia (HIL) of blood samples have been a concern in hospitals because they reflect pre-analytical processes’ quality control. However, very few studies investigate the influence of patients’ gender, age, and department, as well as sample-related turnaround time, on the incidence rate of HIL in fasting serum biochemistry specimens. Methods A retrospective, descriptive study was conducted to investigate the incidence rate of HIL based on the HIL index in 501,612 fasting serum biochemistry specimens from January 2017 to May 2018 in a tertiary university hospital with 4,200 beds in Sichuan, southwest China. A subgroup analysis was conducted to evaluate the differences in the HIL incidence rate by gender, age and department of patients, and turnaround time of specimens. Results The incidence rate of hemolysis, lipemia and icterus was 384, 53, and 612 per 10,000 specimens. The male patients had a significantly elevated incidence of hemolysis (4.13% vs. 3.54%), lipemia (0.67% vs. 0.38%), and icterus (6.95% vs. 5.43%) than female patients. Hemolysis, lipemia, and icterus incidence rate were significantly associated with the male sex with an odds ratio (OR) of 1.174 [95% confidence interval (CI), 1.140–1.208], 1.757 (95%CI: 1.623–1.903), and 1.303 (95%CI: 1.273–1.333), respectively, (P<0.05). The hospitalized patients had a higher incidence of hemolysis (4.03% vs. 3.54%), lipemia (0.63% vs. 0.36%), and icterus (7.10% vs. 4.75%) than outpatients (P<0.001). Specimens with relatively longer transfer time and/or detection time had a higher HIL incidence (P<0.001). The Pediatrics had the highest incidence of hemolysis (16.2%) with an adjusted OR (AOR) of 4.93 (95%CI, 4.59–5.29, P<0.001). The Neonatology department had the highest icterus incidence (30.1%) with an AOR of 4.93 (95%CI: 4.59–5.29, P<0.001). The Neonatology department (2.32%) and Gastrointestinal Surgery (2.05%) had the highest lipemia incidence, with an AOR of 1.17 (95%CI: 0.91–1.51) and 4.76 (95%CI: 4.70–5.53), both P-value <0.001. There was an increasing tendency of hemolysis and icterus incidence for children under one year or adults aged more than 40. Conclusion Evaluation of HIL incidence rate and HIL-related influence factors in fasting serum biochemistry specimens are impartment to interpret the results more accurately and provide better clinical services to patients.
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Soh SX, Loh TP, Sethi SK, Ong L. Methods to reduce lipemic interference in clinical chemistry tests: a systematic review and recommendations. Clin Chem Lab Med 2021; 60:152-161. [PMID: 34773729 DOI: 10.1515/cclm-2021-0979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Lipemia is the presence of abnormally high lipoprotein concentrations in serum or plasma samples that can interfere with laboratory testing. There is little guidance available from manufacturers or professional bodies on processing lipemic samples to produce clinically acceptable results. This systematic review summarizes existing literature on the effectiveness of lipid removal techniques in reducing interference in clinical chemistry tests. METHODS A PubMed search using terms relating to lipid removal from human samples for clinical chemistry tests produced 1,558 studies published between January 2010 and July 2021. 15 articles met the criteria for further analyses. RESULTS A total of 66 analytes were investigated amongst the 15 studies, which showed highly heterogenous study designs. High-speed centrifugation was consistently effective for 13 analytes: albumin, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, creatine kinase (CK), creatinine (Jaffe method), gamma-glutamyl transferase (GGT), glucose (hexokinase-based method), lactate dehydrogenase (LDH), phosphate, potassium, and urea. Lipid-clearing agents were uniformly effective for seven analytes: ALT, AST, total bilirubin, CK, creatinine (Jaffe method), lipase, and urea. Mixed results were reported for the remaining analytes. CONCLUSIONS For some analytes, high-speed centrifugation and/or lipid-clearing agents can be used in place of ultracentrifugation. Harmonized protocols and acceptability criteria are required to allow pooled data analysis and interpretation of different lipemic interference studies.
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Affiliation(s)
- Sheila X Soh
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Sunil K Sethi
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Lizhen Ong
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
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Robbiano C, Birindelli S, Dolci A, Panteghini M. Impact of managing affected results in haemolysed samples of an infant-maternity hospital using an unconventional approach. Clin Biochem 2021; 95:49-53. [PMID: 34077758 DOI: 10.1016/j.clinbiochem.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The management of affected results in haemolysed samples (HS) is debated. In an infant-maternity setting, for reporting interfered test results, we provided the result itself, the degree of haemolysis (as free haemoglobin concentration), and a warning recommending sample recollection. We investigated the impact of this approach on sample quality and clinicians' decision-making. METHODS Free haemoglobin was measured on Beckman Coulter AU680 as haemolytic index. We estimated the total HS number, the clinical wards more affected by HS, the most interfered analytes, and the retesting rate of interfered tests, by comparing data from Apr-Dec 2017, the period just after the introduction of the new policy, vs. Apr-Dec 2018. RESULTS One year after the new report introduction, a significant HS decrease (5.8% vs. 7.8%, P < 0.001) was detected, together with a reduction of the frequency by which haemolysis affected results. The most affected wards, i.e., Paediatric and Neonatal Intensive Care Units, showed an improvement in sample quality (HS rate, 30.6% to 16.1%, P < 0.001, and 25.2% to 20.9%, P = 0.048, respectively). We noted a significant decrease in retesting after an alerted result for aspartate aminotransferase, magnesium, potassium, conjugated bilirubin, and lactate dehydrogenase. CONCLUSIONS Our approach led to a HS decrease, suggesting that the provided report could be a driving force for improvement of phlebotomy quality, also helping clinicians in deciding if retesting is essential or not.
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Affiliation(s)
- Cristina Robbiano
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy.
| | - Sarah Birindelli
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
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Bransky A, Larsson A, Aardal E, Ben-Yosef Y, Christenson RH. A Novel Approach to Hematology Testing at the Point of Care. J Appl Lab Med 2021; 6:532-542. [PMID: 33274357 PMCID: PMC7798949 DOI: 10.1093/jalm/jfaa186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022]
Abstract
Background The need for rapid point-of-care (POC) diagnostics is now becoming more evident due to the increasing need for timely results and improvement in healthcare service. With the recent COVID-19 pandemic outbreak, POC has become critical in managing the spread of disease. Applicable diagnostics should be readily deployable, easy to use, portable, and accurate so that they fit mobile laboratories, pop-up treatment centers, field hospitals, secluded wards within hospitals, or remote regions, and can be operated by staff with minimal training. Complete blood count (CBC), however, has not been available at the POC in a simple-to-use device until recently. The HemoScreen, which was recently cleared by the FDA for POC use, is a miniature, easy-to-use instrument that uses disposable cartridges and may fill this gap. Content The HemoScreen’s analysis method, in contrast to standard laboratory analyzers, is based on machine vision (image-based analysis) and artificial intelligence (AI). We discuss the different methods currently used and compare their results to the vision-based one. The HemoScreen is found to correlate well to laser and impedance-based methods while emphasis is given to mean cell volume (MCV), mean cell hemoglobin (MCH), and platelets (PLT) that demonstrate better correlation when the vision-based method is compared to itself due to the essential differences between the underlying technologies. Summary The HemoScreen analyzer demonstrates lab equivalent performance, tested at different clinical settings and sample characteristics, and might outperform standard techniques in the presence of certain interferences. This new approach to hematology testing has great potential to improve quality of care in a variety of settings.
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Affiliation(s)
| | - Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Elisabeth Aardal
- Department of Clinical Chemistry, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Cadamuro J, Lippi G, von Meyer A, Ibarz M, van Dongen E, Cornes M, Nybo M, Vermeersch P, Grankvist K, Guimaraes JT, Kristensen GBB, de la Salle B, Simundic AM. European survey on preanalytical sample handling - Part 2: Practices of European laboratories on monitoring and processing haemolytic, icteric and lipemic samples. On behalf of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase (WG-PRE). Biochem Med (Zagreb) 2019; 29:020705. [PMID: 31223259 PMCID: PMC6559623 DOI: 10.11613/bm.2019.020705] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/12/2019] [Indexed: 12/31/2022] Open
Abstract
Introduction No guideline currently exists on how to detect or document haemolysis, icterus or lipemia (HIL) in blood samples, nor on subsequent use of this information. The EFLM WG-PRE has performed a survey for assessing current practices of European laboratories in HIL monitoring. This second part of two coherent articles is focused on HIL. Materials and methods An online survey, containing 39 questions on preanalytical issues, was disseminated among EFLM member countries. Seventeen questions exclusively focused on assessment, management and follow-up actions of HIL in routine blood samples. Results Overall, 1405 valid responses from 37 countries were received. A total of 1160 (86%) of all responders stating to analyse blood samples - monitored HIL. HIL was mostly checked in clinical chemistry samples and less frequently in those received for coagulation, therapeutic drug monitoring and serology/infectious disease testing. HIL detection by automatic HIL indices or visual inspection, along with haemolysis cut-offs definition, varied widely among responders. A quarter of responders performing automated HIL checks used internal quality controls. In haemolytic/icteric/lipemic samples, most responders (70%) only rejected HIL-sensitive parameters, whilst about 20% released all test results with general comments. Other responders did not analysed but rejected the entire sample, while some released all tests, without comments. Overall, 26% responders who monitored HIL were using this information for monitoring phlebotomy or sample transport quality. Conclusion Strategies for monitoring and treating haemolytic, icteric or lipemic samples are quite heterogeneous in Europe. The WG-PRE will use these insights for developing and providing recommendations aimed at harmonizing strategies across Europe.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
| | - Alexander von Meyer
- Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany
| | - Mercedes Ibarz
- Department of Laboratory Medicine, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain
| | - Edmee van Dongen
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria.,Section of Clinical Chemistry, University of Verona, Verona, Italy.,Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany.,Department of Laboratory Medicine, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain.,Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Clinical Chemistry Department, Worcestershire Acute Hospitals NHS Trust, Worcester, UK.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Medical Biosciences, Clinical Chemistry, Umea University, Umea, Sweden.,Department of Clinical Pathology, São João Hospital Center, Department of Biomedicine, Faculty of Medicine, and EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal.,Norwegian Quality Improvement of laboratory examinations (Noklus), Bergen, Norway.,UK NEQAS Haematology, West Hertfordshire Hospitals NHS Trust, operating UK NEQAS for Haematology and Transfusion, Watford, UK.,Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
| | | | - Michael Cornes
- Clinical Chemistry Department, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Pieter Vermeersch
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umea University, Umea, Sweden
| | - Joao Tiago Guimaraes
- Department of Clinical Pathology, São João Hospital Center, Department of Biomedicine, Faculty of Medicine, and EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Gunn B B Kristensen
- Norwegian Quality Improvement of laboratory examinations (Noklus), Bergen, Norway
| | - Barbara de la Salle
- UK NEQAS Haematology, West Hertfordshire Hospitals NHS Trust, operating UK NEQAS for Haematology and Transfusion, Watford, UK
| | - Ana-Maria Simundic
- Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia
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Du Z, Liu J, Zhang H, Bao B, Zhao R, Jin Y. Determination of hemolysis index thresholds for biochemical tests on Siemens Advia 2400 chemistry analyzer. J Clin Lab Anal 2019; 33:e22856. [PMID: 30779463 PMCID: PMC6589729 DOI: 10.1002/jcla.22856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/15/2018] [Accepted: 12/19/2018] [Indexed: 11/23/2022] Open
Abstract
Background In vitro hemolysis is still the most common source of pre‐analytical nonconformities. This study aimed to investigate the hemolytic effects on commonly used biochemical tests as well as to determine the hemolysis index (HI) thresholds on Siemens Advia 2400 chemistry analyzer. Methods Peripheral blood samples were collected from forty healthy volunteers. Hemolysis was achieved using syringes. Five hemolysis levels were produced including the no hemolysis group, slight hemolysis group, mild hemolysis group, moderate hemolysis group, and heavy hemolysis group. We then used the bias from baseline (no hemolysis) and HI to construct regression functions. The HI corresponding to the bias limits was considered as HI thresholds. We chose the total allowable error (TAE) as the bias limit. Results Of the twenty‐eight analytes, ten analytes had clinical significance. Creatine kinase‐MB, creatine kinase, potassium, aspartate aminotransferase, and hydroxybutyrate dehydrogenase were all positively affected; the corresponding HI threshold was 45.2, 99.96, 4.07, 10.16, and 7.94, respectively. Lactate dehydrogenase was also positively interfered, but we failed to calculate the HI threshold. Total bile acid, uric acid, and sodium were all negatively affected, and the HI threshold was 42.23, 500 and 501.8, respectively. Glucose was also negatively interfered, but it failed to achieve the HI threshold. Conclusions When the HI value was higher than its threshold, the corresponding analyte was considered inappropriate for reporting. The implementation of the assay‐specific HI thresholds could provide an accurate method to identify analytes interfered by hemolysis, which would improve clinical interpretations and further boost laboratory quality by reducing errors associated with hemolysis.
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Affiliation(s)
- Zhenhua Du
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
| | - JiQin Liu
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
| | - Hua Zhang
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
| | - BuHe Bao
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
| | - RuiQi Zhao
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
| | - Ying Jin
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
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Nicolay A, Lorec AM, Gomez G, Portugal H. Icteric human samples: Icterus index and method of estimating an interference-free value for 16 biochemical analyses. J Clin Lab Anal 2017; 32. [PMID: 28397988 DOI: 10.1002/jcla.22229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/11/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hemolysis, Icterus, and Lipemia constituting the HIL index, are the most common causes of interference with accurate measurement in biochemistry. This study focuses on bilirubin interference, aiming to identify the analyses impacted and proposing a way to predict nominal interference-free analyte concentrations, based on both analyte level and Icterus Index (Iict ). METHODS Sixteen common analytes were studied: alanine aminotransferase (ALT), albumin (ALB), alkaline phosphatase (ALP), amylase (AMY), aspartate aminotransferase (AST), total cholesterol (CHOLT), creatinine (CREA, enzymatic method), fructosamine (FRUC), gamma-glutamyl transferase (GGT), HDL cholesterol (HDLc), total iron (Iron), lipase (LIP), inorganic phosphorus (Phos), total protein (PROT), triglycerides (TG), and uric acid (UA). Both the traditional 10% change in concentrations from baseline and the Total Change Level (TCL) were taken as acceptance limits. Nineteen pools of sera covering a wide range of values were tested on the Cobas® 6000 (Roche Diagnostics). Iict ranged from 0 to 60. RESULTS Eight analytes increased (FRUC and Phos) or decreased (CHOLT, CREA, HDLc, PROT, TG, and UA) significantly when Iict increased. FRUC, HDLc, PROT, and UA showed a linear relationship when Iict increased. A non-linear relationship was found for TG, CREA, and for CHOLT; this also depended on analyte levels. Others were not impacted, even at high Iict . CONCLUSIONS A method of estimating an interference-free value for FRUC, HDLc, PROT, Phos, UA, TG, and CREA, and for CHOLT in cases of cholestasis, is proposed. Iict levels are identified based on analytical performance goals, and equations to recalculate interference-free values are also proposed.
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Affiliation(s)
- Alain Nicolay
- Faculté de Pharmacie, Aix Marseille Univ, APHM, Hôpital de la Conception, Service de Biochimie, UMR NORT INSERM 1062, INRA 1260, Marseille, France
| | - Anne-Marie Lorec
- Faculté de Pharmacie, Aix Marseille Univ, APHM, Hôpital de la Conception, Service de Biochimie, Marseille, France
| | - Guy Gomez
- APHM, Hôpital de la Conception, Service de Biochimie, Marseille, France
| | - Henri Portugal
- Faculté de Pharmacie, Aix Marseille Univ, APHM, Hôpital de la Conception, Service de Biochimie, Marseille, France
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Pasqualetti S, Szőke D, Panteghini M. Heparinate but not serum tubes are susceptible to hemolysis by pneumatic tube transportation. ACTA ACUST UNITED AC 2016; 54:785-9. [DOI: 10.1515/cclm-2015-0751] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/24/2015] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Pneumatic tube transportation (PTT) may induce hemolysis (H) in blood samples. We aimed to compare the H degree before and after PTT implementation in our hospital.Methods:Hemolysis indices (HI) for all lithium-heparin plasma samples (P) drawn by the Emergency Department in 2-month periods were retrospectively collected and pre- (n=3579) and post-PTT (n=3469) results compared. The impact of PTT introduction was investigated on LDH [HI threshold (HIt), 25], conjugated bilirubin (cBIL) (HIt, 30), K (HIt, 100) and ALT (HIt, 125). In addition, HI retrieved for P and paired serum samples collected in silica clot activator tubes (S) from the same venipuncture were compared in pre- (n=501) and post-PTT (n=509) periods.Results:Median (5–95th percentile) HI in P was significantly higher in post-PTT period [7 (0–112) vs. 6 (0–82), p<0.001]. Results reported as ‘Hemolysis’ in P increased from 6.6% in pre-PTT to 9.4% in post-PTT (p<0.001). Investigated tests gave the following rejection rates (pre-PTT vs. post-PTT): LDH, 13.4% vs. 18.8%, p<0.001; cBIL, 9.4% vs. 27.0%, p<0.05; K, 3.7% vs. 5.6%, p<0.001; ALT, 2.9% vs. 4.4%, p<0.01. The slightly higher susceptibility to H of S compared to paired P found in the pre-PTT [9 (1–64) vs. 6 (0–85)] was not confirmed in the post-PTT period [7 (0–90) vs. 8 (1–72)], in which median HI in S was significantly lower (p<0.001) than in pre-PTT.Conclusions:In our setting PTT promotes H in P, increasing the rate of rejected tests. The use of S appears to protect against the hemolysing effect of PTT.
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Monneret D, Mestari F, Atlan G, Corlouer C, Ramani Z, Jaffre J, Dever S, Fressart V, Alkouri R, Lamari F, Devilliers C, Imbert-Bismut F, Bonnefont-Rousselot D. Hemolysis indexes for biochemical tests and immunoassays on Roche analyzers: determination of allowable interference limits according to different calculation methods. Scandinavian Journal of Clinical and Laboratory Investigation 2015; 75:162-9. [PMID: 25608598 DOI: 10.3109/00365513.2014.993691] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine the hemolysis interference on biochemical tests and immunoassays performed on Roche Diagnostics analyzers, according to different maximum allowable limits. DESIGN AND METHODS Heparinized plasma and serum pools, free of interferences, were overloaded by increasing amounts of a hemoglobin-titrated hemolysate. This interference was evaluated for 45 analytes using Modular(®) and Cobas(®) analyzers. For each parameter, the hemolysis index (HI) corresponding to the traditional ± 10% change of concentrations from baseline (± 10%Δ) was determined, as well as those corresponding to the analytical change limit (ACL), and to the reference change value (RCV). Then, the relative frequencies distribution (% RFD) of hemolyzed tests performed in a hospital laboratory over a 25-day period were established for each HI as allowable limit. RESULTS Considering the ± 10%Δ, the analyte concentrations enhanced by hemolysis were: Lactate dehydrogenase (LDH), aspartate aminotransferase (AST), folate, potassium, creatine kinase, phosphorus, iron, alanine aminotransferase, lipase, magnesium and triglycerides, decreasingly. The analyte concentrations decreased by hemolysis were: Haptoglobin, high-sensitive troponin T and alkaline phosphatase. Over the 25-day period, the % RFD of tests impacted more than 10%Δ by hemolysis were < 7% for LDH; < 5% for AST, folates and iron; and < 1% for the other analytes. Considering the ACL, HI were lower, giving % RFD substantially increased for many analytes, whereas only four analytes remain sensitive to hemolysis when considering RCV. CONCLUSION This study proposes new HI based on different allowable limits, and can therefore serve as a starting point for future harmonization of hemolysis interference evaluation needed in routine laboratory practice.
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Affiliation(s)
- Denis Monneret
- Department of Metabolic Biochemistry, La Pitié Salpêtrière-Charles Foix University Hospital (AP-HP) , Paris
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Shin DH, Kim J, Uh Y, Lee SI, Seo DM, Kim KS, Jang JY, Lee MH, Yoon KR, Yoon KJ. Development of an integrated reporting system for verifying hemolysis, icterus, and lipemia in clinical chemistry results. Ann Lab Med 2014; 34:307-12. [PMID: 24982836 PMCID: PMC4071188 DOI: 10.3343/alm.2014.34.4.307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/18/2013] [Accepted: 06/03/2014] [Indexed: 12/02/2022] Open
Abstract
Background Hemolysis, icterus, and lipemia (HIL) cause preanalytical interference and vary unpredictably with different analytical equipments and measurement methods. We developed an integrated reporting system for verifying HIL status in order to identify the extent of interference by HIL on clinical chemistry results. Methods HIL interference data from 30 chemical analytes were provided by the manufacturers and were used to generate a table of clinically relevant interference values that indicated the extent of bias at specific index values (alert index values). The HIL results generated by the Vista 1500 system (Siemens Healthcare Diagnostics, USA), Advia 2400 system (Siemens Healthcare Diagnostics), and Modular DPE system (Roche Diagnostics, Switzerland) were analyzed and displayed on physicians' personal computers. Results Analytes 11 and 29 among the 30 chemical analytes were affected by interference due to hemolysis, when measured using the Vista and Modular systems, respectively. The hemolysis alert indices for the Vista and Modular systems were 0.1-25.8% and 0.1-64.7%, respectively. The alert indices for icterus and lipemia were <1.4% and 0.7% in the Vista system and 0.7% and 1.0% in the Modular system, respectively. Conclusions The HIL alert index values for chemical analytes varied depending on the chemistry analyzer. This integrated HIL reporting system provides an effective screening tool for verifying specimen quality with regard to HIL and simplifies the laboratory workflow.
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Affiliation(s)
- Dong Hoon Shin
- Department of Laboratory Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Juwon Kim
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. ; Department of Medical Information Development, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Se Il Lee
- Department of Medical Information Development, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong Min Seo
- Department of Medical Information Development, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kab Seung Kim
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Yun Jang
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Man Hee Lee
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kwang Ro Yoon
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kap Jun Yoon
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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11
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Nikolac N. Lipemia: causes, interference mechanisms, detection and management. Biochem Med (Zagreb) 2014; 24:57-67. [PMID: 24627715 PMCID: PMC3936974 DOI: 10.11613/bm.2014.008] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/10/2013] [Indexed: 11/05/2022] Open
Abstract
In the clinical laboratory setting, interferences can be a significant source of laboratory errors with potential to cause serious harm for the patient. After hemolysis, lipemia is the most frequent endogenous interference that can influence results of various laboratory methods by several mechanisms. The most common preanalytical cause of lipemic samples is inadequate time of blood sampling after the meal or parenteral administration of synthetic lipid emulsions. Although the best way of detecting the degree of lipemia is measuring lipemic index on analytical platforms, laboratory experts should be aware of its problems, like false positive results and lack of standardization between manufacturers. Unlike for other interferences, lipemia can be removed and measurement can be done in a clear sample. However, a protocol for removing lipids from the sample has to be chosen carefully, since it is dependent on the analytes that have to be determined. Investigation of lipemia interference is an obligation of manufacturers of laboratory reagents; however, several literature findings report lack of verification of the declared data. Moreover, the acceptance criteria currently used by the most manufacturers are not based on biological variation and need to be revised. Written procedures for detection of lipemia, removing lipemia interference and reporting results from lipemic samples should be available to laboratory staff in order to standardize the procedure, reduce errors and increase patient safety.
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Affiliation(s)
- Nora Nikolac
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Zagreb, Croatia
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Nikolac N, Simundic AM, Miksa M, Lima-Oliveira G, Salvagno GL, Caruso B, Guidi GC. Heterogeneity of manufacturers' declarations for lipemia interference--an urgent call for standardization. Clin Chim Acta 2013; 426:33-40. [PMID: 23981842 DOI: 10.1016/j.cca.2013.08.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/16/2013] [Accepted: 08/16/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Due to the budget limitations, laboratories mostly rely on the manufacturers' information about the influence of interfering substances on laboratory results. However, some manufacturers do not follow the recommended procedures for testing interferences (CLSI standard) and there is a great variability in the presentation of data regarding lipemia interference. MATERIALS AND METHODS We aimed to verify the manufacturers' specifications for lipemia interference for clinical chemistry reagents provided by Beckman Coulter, Roche and Siemens. Bias was determined using the Intralipid® simulated lipemic samples. Furthermore, we aimed to compare obtained data with the manufacturers' claims and desirable specification for imprecision derived from biological variation. RESULTS i) Manufacturers' declarations were not confirmed for all three manufacturers; ii) the magnitude and direction of the effect of lipemia on laboratory results differ substantially between the three tested analytical systems; and iii) manufacturers are using arbitrary limits in declaring the expected effect of interference on laboratory results. CONCLUSIONS There is an urgent need to standardize the way manufacturers test and report their data on the lipemia interference. We propose that, instead of arbitrary limits, manufacturers use evidence based quality specifications for assessing the allowable biases. Moreover, laboratories should be aware of the possible lack of replicability of manufacturers' declarations.
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Affiliation(s)
- Nora Nikolac
- University Department of Chemistry, Medical School University Hospital Sestre Milosrdnice, Vinogradska 29, 10000 Zagreb, Croatia.
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