Tóth Judit, Oláh Anna V, Petercsák Tamás, Kovács Tamás, Kappelmayer János
Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Hungary.
Partner of Pan-Inform Ltd, T-Systems Hungary, Debrecen, Hungary.
EJIFCC. 2020 Mar 20;31(1):6-14. eCollection 2020 Mar.
Preanalytical problems can be more frequent in case of preterm and term newborns as compared to the general patient population. Here we present the leading preanalytical errors in our laboratory, the prevalence of haemolysis and its impact on laboratory test results, and our efforts to improve the diagnostic workup of newborns' samples.
Preanalytical quality indicators were analysed in all samples in 2018. The haemolysis index was measured spectrophotometrically in serum samples in the period of 2012-2018, and the ratio of haemolysed samples and the test rejection rates were analysed. The data of newborns and other patients were analysed separately.
During the tested year, the leading preanalytical errors were haemolysis in serum samples, inadequate sample identification and clotting of anticoagulated blood regarding all samples or newborns. In this seven-year period the ratio of haemolysed serum samples was 4.00% in all patients and 46.4% in newborns, while the test rejection rates due to haemolysis were 0.57% and 3.71%, respectively. Haemolysis indices were significantly higher in case of newborns than in patients with documented severe intravascular haemolysis which suggests that the major reason of elevated haemolysis indices in newborns was haemolysis. Accordingly, all C-reactive protein (CRP) results which were rejected by severe haemolysis became reliable after repeating blood sampling.
Haemolysis is the leading preanalytical problem not only in newborns but also in the general patient population. Our study highlights the importance of automated assessment of serum indices and continuous monitoring of the preanalytical quality indicators and suggests the need for education and blood collection trainings.
与普通患者群体相比，早产和足月新生儿的分析前问题可能更为常见。在此，我们介绍我们实验室中主要的分析前误差、溶血的发生率及其对实验室检测结果的影响，以及我们为改进新生儿样本诊断检查所做的努力。
对2018年所有样本的分析前质量指标进行了分析。在2012 - 2018年期间，采用分光光度法测定血清样本中的溶血指数，并分析溶血样本的比例和检测拒收率。分别分析了新生儿和其他患者的数据。
在测试年份，所有样本或新生儿的主要分析前误差是血清样本溶血、样本识别不足以及抗凝血液凝固。在这七年期间，所有患者溶血血清样本的比例为4.00%，新生儿为46.4%，而因溶血导致的检测拒收率分别为0.57%和3.71%。新生儿的溶血指数显著高于有记录的严重血管内溶血患者，这表明新生儿溶血指数升高的主要原因是溶血。因此，所有因严重溶血而被拒收的C反应蛋白（CRP）结果在重新采血后变得可靠。
溶血不仅是新生儿，也是普通患者群体中主要的分析前问题。我们的研究强调了血清指标自动评估以及分析前质量指标持续监测的重要性，并表明需要进行教育和采血培训。
