Effect of acceleration forces during transport through a pneumatic tube system on ROTEM® analysis

Abstract

Background: ROTEM ® is considered a helpful point-of-care device to monitor blood coagulation in emergency situations. Centrally performed analysis is desirable but rapid transport of blood samples is an important prerequisite. The effect of acceleration forces on sample transport through a pneumatic tube system on ROTEM ® should be tested at each institution to exclude a pre-analytical infl uence. The aims of the present work were: (i) to investigate the effect of pneumatic tube transport on ROTEM ® parameters; (ii) to compare blood sample transport via pneumatic tube vs. manual transportation; and (iii) to determine the effect of acceleration forces on ROTEM ® parameters. Methods: This is a single centre study with 20 healthy volunteers. Five whole blood samples were transferred to the central haematology laboratory by either normal transport or pneumatic delivery with different speed and acceleration forces. EXTEM, INTEM, FIBTEM and APTEM were analysed in parallel with two ROTEM ® devices and compared. Acceleration forces were measured during transport with two different instruments. Results: Increment of transport time, speed and distance resulted in an augmentation of acceleration forces and peaks. All results of the ROTEM ® analysis after manual transport or pneumatic delivery were within normal range. However, increase in acceleration forces resulted in minimally but statistically signifi cant changes in multiple ROTEM ® parameters. The higher the acceleration forces, the more ROTEM ® parameters are infl uenced. Conclusions: Acceleration forces during transport through a pneumatic tube system have an infl uence on ROTEM ® parameters. Prior to transfer blood samples via pneumatic tube system these infl uences should be tested to exclude clinically relevant blood coagulation activation in vitro.

Pneumatic tube system transport does not alter platelet function in optical and whole blood aggregometry, prothrombin time, activated partial thromboplastin time, platelet count and fibrinogen in patients on anti-platelet drug therapy

“…A study by Amann et al including 20 healthy volunteers reported statistically significant changes (P values < 0.001) in multiple ROTEM ® parameters transported by PTS ( 14 ). In contrast, Colucci et al observed no statistically significant differences (P values from 0.381 – 0.978) between pneumatic delivery and hand carried transport in 30 whole blood samples of healthy volunteers ( 15 ).…”

Comparison of pneumatic tube system with manual transport for routine chemistry, hematology, coagulation and blood gas tests

“…Furthermore, only binary data concerning the hemolysis of samples was included compared with our qualitative measurement of hemolysis index. Using paired sample design and novel data logger monitoring, the PTS at different acceleration forces have been found to generate clinical acceptable results on all ROTEM ® blood coagulation parameters in four different settings [17]. However, people should note that the higher the acceleration forces, the more ROTEM ® parameters are influenced [17].…”

“…Using paired sample design and novel data logger monitoring, the PTS at different acceleration forces have been found to generate clinical acceptable results on all ROTEM ® blood coagulation parameters in four different settings [17]. However, people should note that the higher the acceleration forces, the more ROTEM ® parameters are influenced [17]. In the present study, very low and very similar hemolysis indices associated with PTS and manual transport were found: 4.0 (4.00) and 3.0 (4.00), respectively [median (IR), p = 0.43].…”

“…Different acceleration forces increased with the increment of transport time, speed and distance and led to more ROTEM ® blood coagulation parameters affected, although all results were found clinically acceptable [17]. In the present study, we used the split-sample testing to investigate the impact of PTS on final testing values and sample integrity such as hemolysis indices as well as intra-erythrocytic compounds (potassium, lactate dehydrogenase and aspartate aminotransferase) as has been analyzed by these studies [15,16].…”

The clinical significance of pneumatic tube transport system on platelet indices: EDTA or citrate anticoagulant?

“…Specimen transport time for delivery to a central core laboratory is a significant variable of total turnaround time. The effect of pneumatic tube transport system (PTS) on quality of samples is controversial [1,2].…”