Preanalytical variability: the dark side of the moon in laboratory testing

Abstract

Remarkable advances in instrument technology, automation and computer science have greatly simplified many aspects of previously tedious tasks in laboratory diagnostics, creating a greater volume of routine work, and significantly improving the quality of results of laboratory testing. Following the development and successful implementation of high-quality analytical standards, analytical errors are no longer the main factor influencing the reliability and clinical utilization of laboratory diagnostics. Therefore, additional sources of variation in the entire laboratory testing process should become the focus for further and necessary quality improvements. Errors occurring within the extra-analytical phases are still the prevailing source of concern. Accordingly, lack of standardized procedures for sample collection, including patient preparation, specimen acquisition, handling and storage, account for up to 93% of the errors currently encountered within the entire diagnostic process. The profound awareness that complete elimination of laboratory testing errors is unrealistic, especially those relating to extra-analytical phases that are harder to control, highlights the importance of good laboratory practice and compliance with the new accreditation standards, which encompass the adoption of suitable strategies for error prevention, tracking and reduction, including process redesign, the use of extra-analytical specifications and improved communication among caregivers.

Oxytocin in survivors of childhood-onset craniopharyngioma

“…Some studies suggest that certain stimuli lead to coordinated release of central and peripheral oxytocin, whereas other studies indicate that certain stimuli change central levels while leaving peripheral levels unchanged [40]. In addition, the reliability of oxytocin measurement is still under debate [39], and issues have been raised regarding the importance of preanalytical procedures [41]. In this study, we used saliva samples measured with EIA after extraction.…”

Preanalytical quality improvement: from dream to reality

“…The large amount of knowledge gained over the past decades on the controversial issue of diagnostic errors indicates, however, that most errors do occur in the extra-analytical phases of the total testing process and, especially, in the manuallyintensive processes of the preanalytical phase. As such, and according to reliable data, preanalytical errors still account for nearly 60%-70% of all mistakes occurring in laboratory diagnostics, most of them attributable to mishandling during collection, handling and preparing the specimens for testing (Figures 1, 2 and 3) (3,4). Although most of these errors would be ''intercepted'' by laboratory professional or physicians before inappropriate actions are taken on otherwise unreliable results of laboratory testing, in nearly one-fifth of the cases these errors might be associated with further inappropriate investigations and unjustifiable increase in costs, and -even more notably -in 6.4% of the cases they might be a cause of inappropriate care or inappropriate modifications to therapy (5).…”

Harmonization in laboratory medicine: the complete picture

“…Several lines of evidence attest to the fact that the vast majority of errors in laboratory medicine originate in the ' manually intensive ' activity undertaken in the pre-analytical phase [ 49 ]. The most prevalent pre-analytical errors are those occurring during the collection of blood specimens; so the definition, implementation, and monitoring of suitable sample collection standards are highly conducive to improving the quality of the testing process [ 50 ].…”