In-vitro hemolysis and its financial impact using different blood collection systems

Abstract

Hemolytic specimens are among the most challenging preanalytical issues in laboratory diagnostics. The type of blood collection tube in use is claimed to influence in vitro hemolysis. We aimed to examine this hypothesis and estimate the respective financial impact, evaluating routine blood samples from the past 4 years.A total of 47,820 hemolysis index (HI) values from five different time intervals (IV1–IV5) were compared against each other, representing the following tubes: IV1-Sarstedt Monovette; IV2-8 mL/16×100 mm Greiner BioOne (GBO) Vacuette; IV3/IV4-5 mL/16×100 mm GBO Vacuette; IV5-4.5 mL/13×75 mm GBO Vacuette. For estimation of the economic impact, material, personnel and analytical costs were calculated.HI mean values in time interval IV2 were significantly higher than in all other intervals, while mean values amongst all other intervals were comparable. The number of moderately and severely hemolyzed samples increased with incrementing vacuum. Overall comparable costs between intervals IV1 and IV5 were €11,370, €14,045, €12,710, €11,213 and €8138 per 10,000 samples, respectively.Aspiration tubes and low vacuum tubes show comparable hemolysis rates. Increasing vacuum levels are associated with higher hemolysis rates. By decreasing in vitro hemolysis, financial savings up to €5907 per 10,000 samples could be gained.

Blood apheresis technologies – a critical review on challenges towards efficient blood separation and treatment

“…In another study however, there is no significant effect in the free haemoglobin (fHb) concentration when the spinning duration was decreased from 7 min (0.07 AE 0.04 g L À1 ) to 5 min (0.07 AE 0.03 g L À1 ) at both 3000 Â g centrifugal force. 53 The same finding was obtained for the free haemoglobin concentration obtained when centrifugal force used was lower at both 900 Â g at 5 and 10 min centrifugation (61 mg L À1 for control and 79 mg L À1 for centrifuged samples at both 5 and 10 min) (Fig. 1d) 21 Although the difference in duration is small, an increase in fHb concentration however small, can have a significant effect if it is above analyte specific haemolysis cut-off.…”

“…1d) 21 Although the difference in duration is small, an increase in fHb concentration however small, can have a significant effect if it is above analyte specific haemolysis cut-off. 53 The adverse effects to cells as associated with the spinning duration and centrifugal force was also explored and correlated to adenosine triphosphate (ATP) (organic compound that drives many metabolic processes in cells) release with haemolysis. 35 An increase in the concentration of ATP was observed (from 1.4-4.7 nM) as the centrifugation time increased from 1 to 5 min (Fig.…”

Errors within the total laboratory testing process, from test selection to medical decision-making – A review of causes, consequences, surveillance and solutions

“…ensuring appropriate transport conditions), and sample preparation (e.g. appropriate force and time of centrifugation) (65,67,72). Monitoring of haemolysed samples by measurement of relative QIs is highly recommended (18).…”

PREDICT: a checklist for preventing preanalytical diagnostic errors in clinical trials

“…delayed diagnoses, underdiagnoses, misdiagnoses, unnecessary follow-up diagnostics or treatment) [5,6], waste of economic resources (e.g. phlebotomist time, new blood collection and blood tubes for recollecting unsuitable specimens) [7,8], as well as organizational issues within (e.g. time lost for identifying and managing preanalytical problems) and outside (e.g.…”