Evaluation of Blood Sample Rejection in a Clinical Laboratory of an Oncology Institute

Main Article Content

Siti Salmah Noordin
Salbiah Isa

Abstract

Introduction: Error in blood sampling is of one the commonest causes of laboratory sample rejection and poses a great challenge particularly amongst oncology patients due to difficult venous access. This study aims to identify the main causes of blood sample rejection in the haematology and chemical pathology (CP) laboratories of an oncology institute. Method: All blood samples received and rejected in the CP and haematology laboratory from 2017 to 2019 were obtained from the laboratory information system (LIS) and sample rejection logbook. The rejection cause for each of the rejected samples was recorded and analysed. Results: Out of the total 39 495 blood samples received, 244 (0.6%) were rejected. The rejection rate in the CP was higher compared with that in the haematology laboratory (51.2% vs. 48.8%). The most frequent cause of rejection was haemolysis (49.6%), clotted sample (32.8%), and insufficient sample volume (6.1%). Conclusion: Haemolysis, clotted blood and insufficient sample were the main causes of sample rejection in our oncology centre. Effective and multidisciplinary targeted interventions to reduce blood sampling error are important to improve pre-analytical handling of blood samples from oncology patients.

Downloads

Download data is not yet available.

Article Details

How to Cite
Noordin, S. S., & Isa, S. (2021). Evaluation of Blood Sample Rejection in a Clinical Laboratory of an Oncology Institute. Malaysian Journal of Medicine and Health Sciences, 17(4), 49–54. Retrieved from http://mjmhsojs.upm.edu.my/index.php/mjmhs/article/view/462
Section
Original Articles

References

Badrick T. Evidence-based laboratory medicine. Clin Biochem Rev. 2013;34(2):43–6.

Hammerling JA. A Review of Medical Errors in Laboratory Diagnostics and Where We Are Today. Lab Med. 2012;43(2):41–4.

Lippi G, Chance JJ, Church S, Dazzi P, Fontana R, Giavarina D, et al. Preanalytical quality improvement: from dream to reality. Clin Chem Lab Med. 2011;49(7):1113–26.

Arul P, Pushparaj M, Pandian K, Chennimalai L, Rajendran K, Selvaraj E, et al. Prevalence and types of preanalytical error in hematology laboratory of a tertiary care hospital in South India. J Lab Physicians. 2018;10(02):237–40.

Plebani M, Sciacovelli L, Aita A, Padoan A, Chiozza ML. Quality indicators to detect pre- analytical errors in laboratory testing. Clin Chim Acta. 2014;15;432:44–8.

Green SF. The cost of poor blood specimen quality and errors in preanalytical processes. Clin Biochem. 2013;46(13–14):1175—1179.

Sait MK, Aguam AP, Mohidin S, Al Eidraous S, Al Tabsh L, Anfinan NM, et al. Intravenous Site Complications for Patients Receiving Chemotherapy: An Observational Stud. Ann Short Reports. 2019;2:1032

Cakirca G. The evaluation of error types and turnaround time of preanalytical phase in biochemistry and hematology laboratories. Iran J Pathol. 2018;13(2):173–8.

Jacobsz LA, Zemlin AE, Roos J, Erasmus RT. Chemistry and haematology sample rejection and clinical impact in a tertiary laboratory in Cape Town. 2011;49(12):2047–50.

Bhat V, Tiwari M, Chavan P, Kelkar R. Clinica Chimica Acta Analysis of laboratory sample rejections in the pre-analytical stage at an oncology center. Clin Chim Acta. 2012;413(15–16):1203–6.

Lee NY. Reduction of pre-analytical errors in the clinical laboratory at the University Hospital of Korea through quality improvement activities. Clin Biochem. 2019;70:24–9.

Guimarães AC, Wolfart M, Brisolara MLL, Dani C. Causes of rejection of blood samples handled in the clinical laboratory of a University Hospital in Porto Alegre. Clin Biochem. 2012;45(1-2):123-6.

Rooper L, Carter J, Hargrove J, Hoffmann S, Riedel S. Targeting Rejection: Analysis of Specimen Acceptability and Rejection, and Framework for Identifying Interventions in a Single Tertiary Healthcare Facility. J Clin Lab Anal. 2017;31(3):e22060.

Koseoglu M, Hur A, Atay A, Çuhadar S. Effects of hemolysis interferences on routine biochemistry parameters. Biochem Medica. 2011;21(1):79–85.

Carraro P, Servidio G, Plebani M. Hemolyzed Specimens: A Reason for Rejection or a Clinical Challenge? Clin Chem. 2020;46(2):306–7.

de Jonge G, dos Santos TL, Cruz BR, Simionatto M, Bittencourt JIM, Krum EA, et al. Interference of in vitro hemolysis complete blood count. J Clin Lab Anal. 2018;32(5).

Woolley A, Golmard J-L, Kitchen S. Effects of haemolysis, icterus and lipaemia on coagulation tests as performed on Stago STA-Compact-Max analyser. Int J Lab Hematol. 2016;38(4):375–88.

Lippi G, Musa R, Avanzini P, Aloe R, Pipitone S, Sandei F. Influence of in vitro hemolysis on hematological testing on Advia 2120. Int J Lab Hematol. 2012;34(2):179–84.

Getahun T, Alemu A, Mulugeta F, Sileshi M, Ayalkebet A, Habtu W, et al. Evaluation of Visual Serum Indices Measurements and Potential False Result Risks in Routine Clinical Chemistry Tests in Addis Ababa, Ethiopia. EJIFCC. 2019;30(3):276– 87.

Goswami AP, Roy SS, Goswami NN. Evaluation of Specimen Rejection Rate in Hematology Laboratory. IOSR J Dent Med Sci. 2014;13(9):01– 4.

Maxwell H. Updated phlebotomy procedures: Procedures for the collection of diagnostic blood specimens by venipuncture. 2010 [cited on 20 July 2020]. Available from: https://phlebotomycoach.com/downloads/clsi-guidelines-blood-drawing.pdf

Yahaya DG and O. Clots in EDTA ‘lavender top’’ blood samples. Institute of Biomedical Science’. 2019 [cited on 27 July 2020]. Available from: https://www.ibms.org/resources/news/clots-in-edta-lavender-top-blood-samples/

Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Phlebotomy issues and quality improvement in results of laboratory testing. Clinical Laboratory. 2006;52(5-6):217–30.

Lima-Oliveira G, Lippi G, Salvagno GL, Picheth G, Guidi GC. Laboratory Diagnostics and Quality of Blood Collection. J Med Biochem. 2015;34(3):288– 94.

Arslan FD, Karakoyun I, Basok BI, Aksit MZ, Celik E, Dogan K, et al. The Effects of Education and Training Given to Phlebotomists for Reducing Preanalytical Errors. J Med Biochem. 2018:37(2):172–80.

Schoenfeld E, Shokoohi H, Boniface K. Ultrasound- guided peripheral intravenous access in the emergency department: Patient-centered survey. West J Emerg Med. 2011;12(4):475–7.

Kara H, Bayir A, Ak A, Degirmenci S, Akinci M, Agacayak A, et al. Hemolysis associated with pneumatic tube system transport for blood samples. Pakistan J Med Sci. 2014;30(1):50–3.

Cakirca G, Erdal H. The Effect of Pneumatic Tube Systems on the Hemolysis of Biochemistry Blood Samples. J Emerg Nurs. 2017;43(3):255–8.