Controle da qualidade na coleta do espécime diagnóstico sanguíneo: iluminando uma fase escura de erros pré-analíticos

The use of indicators in the pre-analytical phase as a laboratory management tool

“…The relative error frequency in our study is in accordance with the international literature: 0.25%. It contrasts with 1.52% of Chawla et al (4) , 0.74% of Stark et al (12) , and 1.4% of Goswami et al (6) . The College of American Pathologists Quality Assurance Program (Q-Probe) (5) has xreported xsample/specimen rejection ranging from 0.3% to 0.83% ( Figure 2).…”

“…According to Jacobs et al (10) , the estimated cost of repeating hemolyzed specimens is approximately €4355 per month, plus additional time and use of equipment, based on an average of 60 admissions/day. Factors related to the collection of diagnostic blood specimens, such as maximum time for tourniquet application, inadequate constriction of the forearm muscles, adequate selection of the needle gauge for venipuncture, may increase the incidence of hemolysis, and, consequently, sample rejection (12) .…”

“…Laboratory processing consists of a sequence of procedures that begins with the ordering of tests by physicians, and ends with the interpretation -also by physicians -of the test results. The three phases of this cycle -pre-analytical, analytical and post-analytical -are subject to innumerable possibilities of error that affect quality and reliability of results (12) . According to ISO/ TS 22367:2008, laboratory error may be defined as any defect during the laboratory cycle, resulting from a badly-planned action or a non-achieved aim, which may occur from ordering tests to interpreting their results (9,14) .…”

“…Errors in this phase generally occur from high personnel turnover rates, negligence, lack of understanding about good laboratory practices, and ineffective training (8,12) . They include inappropriate test request, inadequate samples, delays in transport or inappropriate storage, illegible requisitions, improper venipuncture, inadequate instructions to patients (as to previous fasting, special diet, medicine use, etc.…”

Principais parâmetros biológicos avaliados em erros na fase pré-analítica de laboratórios clínicos: revisão sistemática

“…Um fator importante e discutido de forma breve nos estudos que fizeram parte dessa revisão foi o efeito dos medicamentos nas dosagens analíticas, sendo que as interações medicamentosas são citadas como causas de diversas variações nos parâmetros bioquímicos avaliados. Não encontramos estudos experimentais e nem revisões que abordassem, especificamente, a medicação como indutor de erros na fase pré-analítica, analítica ou pós-analítica (17,18,22,32) .…”