Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy.
Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy.
Clin Biochem. 2021 Sep;95:49-53. doi: 10.1016/j.clinbiochem.2021.05.013. Epub 2021 May 30.
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.
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.
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.
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.
溶血样本（HS）检测结果的处理存在争议。在妇产科环境中，为了报告受干扰的检测结果，我们提供了检测结果本身、溶血程度（以游离血红蛋白浓度表示）以及建议重新采集样本的警告。我们研究了这种方法对样本质量和临床医生决策的影响。
使用贝克曼库尔特 AU680 测定游离血红蛋白作为溶血指数。通过比较 2017 年 4 月至 12 月（新政策引入后的时期）与 2018 年 4 月至 12 月的数据，我们估计了总 HS 数量、受 HS 影响更大的临床科室、受干扰分析物最多的科室以及受干扰检测的重新检测率。
在新报告引入后的一年，我们发现 HS 显著减少（5.8%比 7.8%，P<0.001），同时受溶血影响的结果频率也降低。受影响最大的科室，即儿科和新生儿重症监护病房，样本质量得到了改善（HS 率分别从 30.6%降至 16.1%，P<0.001 和从 25.2%降至 20.9%，P=0.048）。我们发现，在发出天门冬氨酸氨基转移酶、镁、钾、结合胆红素和乳酸脱氢酶的警报结果后，重新检测的频率显著降低。
我们的方法导致 HS 减少，表明提供的报告可能是提高采血质量的驱动力，也有助于临床医生决定是否需要重新检测。
