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Alcantara JC, Alharbi B, Almotairi Y, Alam MJ, Muddathir ARM, Alshaghdali K. Analysis of preanalytical errors in a clinical chemistry laboratory: A 2-year study. Medicine (Baltimore) 2022; 101:e29853. [PMID: 35801773 PMCID: PMC9259178 DOI: 10.1097/md.0000000000029853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Patient safety and medical diagnosis of patients are mainly influenced by laboratory results. The present study aimed to evaluate the errors in the preanalytical phase of testing in a Clinical Chemistry diagnostic laboratory. A review was conducted at the Clinical Chemistry Laboratory of a hospital in Saudi Arabia from January 2019 to December 2020. Using the laboratory information system, the data of all canceled tests and requests were retrieved and evaluated for preanalytical errors. A total of 55,345 laboratory test requests and samples from different departments were evaluated for preanalytical errors. An overall rate of 12.1% (6705) was determined as preanalytical errors. The occurrence of these errors was found to be highest in the emergency department (21%). The leading preanalytical errors were nonreceived samples (3.7%) and hemolysis (3.5%). The annual preanalytical errors revealed an increasing rate in outpatient and inpatient departments, while a decreasing rate was observed in the emergency department. An increased rate of errors was also noted for the 2-year study period from 11.3% to 12.9%. The preanalytical phase has a significant impact on the quality of laboratory results. The rate of error in the study was high and the leading causes were nonreceived samples and hemolysis. An increased occurrence of hemolyzed samples in the outpatient department was noted. Enhanced educational efforts emphasizing specimen quality issues and training in sample collection among hospital staff must be carried out.
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Affiliation(s)
- Jerold C. Alcantara
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Hail, Saudi Arabia
- *Correspondence: Jerold C. Alcantara, Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Hail, PO Box 2440 Hail, Saudi Arabia (e-mail: )
| | - Bandar Alharbi
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Hail, Saudi Arabia
| | - Yasser Almotairi
- Department of Clinical Laboratory, Maternity and Pediatric Hospital, Hail, Saudi Arabia
| | | | | | - Khalid Alshaghdali
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Hail, Saudi Arabia
- Molecular Diagnostic and Personalized Therapeutic Unit, University of Hail, Hail, Saudi Arabia
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Ying Q, Lv D, Fu X, Shi S, Chen L, He Y, Yang J, Yang S, Mu Q. Resolution of serologic problems due to cold agglutinin mediated autoimmune hemolytic anemia and its transfusion decision. J Clin Lab Anal 2021; 35:e23894. [PMID: 34216510 PMCID: PMC8373330 DOI: 10.1002/jcla.23894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/11/2021] [Accepted: 06/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background Autoimmune hemolytic anemia (AIHA) is a rare disease characterized by hemolysis caused by autoantibodies against erythrocyte surface antigen. These antibodies can be classified as warm, cold, or mixed types. Methods We report two cases of cold agglutinin disease (CAD), which were eventually diagnosed owing to blood group discrepancy. Resolution was achieved after washing the red blood cells (RBCs) with warm saline and absorbing the autoantibodies at 4°C with the washed RBCs. We also assessed the patient's condition and discussed the strategy of blood transfusion. Results The first case occurred after postoperative chemotherapy for rectal cancer, and the other manifested with anemia from the outset. Direct antiglobulin tests were positive and revealed autoantibodies against C3d only. Cold agglutinin titration was performed, and the titers of both were 1:1024. Eventually, the patient's condition stabilized without blood transfusion. Conclusion The serological discrepancies observed in the blood transfusion department can successfully guide blood transfusion decisions in cases of CAD.
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Affiliation(s)
- Qiming Ying
- School of Medicine, Ningbo University, Ningbo, China.,Department of Blood Transfusion, Ningbo City First Hospital, Ningbo, China
| | - Dingfeng Lv
- School of Medicine, Ningbo University, Ningbo, China.,Department of Blood Transfusion, Ningbo City First Hospital, Ningbo, China
| | - Xiaomei Fu
- Department of Blood Transfusion, Ningbo City First Hospital, Ningbo, China
| | - Shuanglu Shi
- School of Medicine, Ningbo University, Ningbo, China.,Department of Blood Transfusion, Ningbo City First Hospital, Ningbo, China
| | - Luyan Chen
- Department of Blood Transfusion, Ningbo City First Hospital, Ningbo, China
| | - Yiwen He
- Department of Blood Transfusion, Ningbo City First Hospital, Ningbo, China
| | - Jing Yang
- Department of Blood Transfusion, Ningbo City First Hospital, Ningbo, China
| | - Shujun Yang
- The Laboratory of Stem Cell Transplantation, Department of Hematology, Ningbo City First Hospital, Ningbo, China
| | - Qitian Mu
- The Laboratory of Stem Cell Transplantation, Department of Hematology, Ningbo City First Hospital, Ningbo, China
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Establishment of Hematological Reference Values among Healthy Adults in Bamenda, North West Region of Cameroon. Anemia 2021; 2021:6690926. [PMID: 33708443 PMCID: PMC7932772 DOI: 10.1155/2021/6690926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
The use of the reference range of values of a laboratory test is highly significant in diagnostic accuracy. However, race and ethnic variations may affect the safe use of reference ranges from a different setting/population. Because the establishment of reference ranges for the Cameroonian population will possibly improve the quality of health care, this study was designed to establish hematological reference ranges among healthy adults in Bamenda, North West region of Cameroon. This was a cross-sectional study carried out within the period of five months from February 2020 to June 2020, at the Bamenda Regional Hospital. A total of 350 (139 females and 211 males) study participants who met the inclusion criteria were included in the study. The Urit 3300 autoanalyzer (Urit Medical Electronic (Group) Co., Ltd, Guilin, China) was used to analyze the hematological parameters. The general health questionnaire for donors, for verification of reference range study and laboratory tests, was used for data collection. Descriptive statistics were used to calculate reference ranges, means, and medians at 95% confidence intervals. Maximum and minimum reference ranges were computed at 97.5th and 2.5th percentiles. The nonparametric test (Mann–Whitney test) was used to determine the significance of the difference in hematological values between the male and female groups. Three (MID%, LYM#, and MID#) out of the 19 hematological parameters were verified, while sixteen (WBC, LYM%, GRAN%, GRAN#, RBC, HGB, HCT%, MCV, MCH, MCHC, RDW_CV, RDW_SD, PLT, MPV, PDW, and PCT%) were established. The currently used reference intervals do not represent the population of the North West region. Therefore, other regional hospitals in Cameroon should establish reference intervals applicable to their respective regions.
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Ni J, Zhu W, Wang Y, Wei X, Li J, Peng L, Zhang K, Bai B. A Reference chart for clinical biochemical tests of hemolyzed serum samples. J Clin Lab Anal 2020; 35:e23561. [PMID: 32881061 PMCID: PMC7843283 DOI: 10.1002/jcla.23561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background Although the effect of hemolysis has been extensively evaluated on clinical biochemical tests, a practical guidance for laboratory staff to rapidly determine whether a hemolyzed blood sample is acceptable and how to interpret the results is lacking. Here, we introduce a chart as a convenient reference for dealing with such samples. Methods Serum samples with 0.1%, 0.3%, 1%, 3%, and 10% hemolysis were prepared from sonicated endogenous red blood cells and received 35 wet and 22 dry clinical biochemical tests, respectively. The contributing part in the biochemical test result at each hemolysis condition was derived by subtracting the original test result of this sample with no hemolysis. The net results were used for analyses and preparation of the reference chart. Results The reference chart displayed the analytically calculated hemolysis interference and related statistical analyses. The chart also provided the color appearance of serum samples at each hemolysis condition for clinical staffs to determine whether a hemolyzed sample could be accepted. Conclusion In clinical laboratories, preparation of such a reference chart is extremely useful in dealing with hemolyzed blood samples for clinical biochemical tests.
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Affiliation(s)
- Jun Ni
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Wenbo Zhu
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Yanyang Wang
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xuefei Wei
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jingjing Li
- Center for Precision Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lu Peng
- Department of Laboratory Medicine, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Kui Zhang
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Bing Bai
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.,Department of Nuclear Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Center for Precision Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Banday AZ, Tyagi R, Jogu S, Sudhakar M, Patra PK, Pandiarajan V, Sharma P, Ahluwalia J, Bhatia P. Childhood venous thromboembolism-A careful look at complete blood count can reveal the underlying risk factor. Pediatr Blood Cancer 2020; 67:e28472. [PMID: 32525598 DOI: 10.1002/pbc.28472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Aaqib Zaffar Banday
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Reva Tyagi
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suchit Jogu
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Murugan Sudhakar
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pratap Kumar Patra
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vignesh Pandiarajan
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Prashant Sharma
- Department of Hematology, Research Block-A, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jasmina Ahluwalia
- Department of Hematology, Research Block-A, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Prateek Bhatia
- Hematology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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