Scoring System for Detecting Spurious Hemolysis in Anticoagulated Blood Specimens

BACKGROUND: The identification of in vitro hemolysis (IVH) using a hematology analyzer is challenging because centrifugation of the specimens cannot be performed for cell counts. In the present study, we aimed to develop a scoring system to help identify the presence of hemolysis in anticoagulated blood specimens. METHODS: Thirty-seven potassium EDTA anticoagulated blood specimens were obtained, and each specimen was divided into 3 aliquots (A, B, and C). Aliquots B and C were mechanically hemolyzed by aspirating 2 and 5 times, respectively, using a 27-gauge needle and then tested; aliquot A was analyzed immediately without any hemolysis. After the cells were counted, aliquots B and C were centrifuged and the supernatants were tested for the hemolytic index and lactate dehydrogenase levels. RESULTS: The 4 hematologic parameters were selected and scored from 0 to 3 as follows: or =38.5 for mean cell hemoglobin concentration (MCHC, g/dL); or =0.04 for red blood cell ghosts (10(12)/L); or =1.31 for difference value (g/dL) of measured hemoglobin and calculated hemoglobin; and or =3.35 for difference value (g/dL) of MCHC and cell hemoglobin concentration mean. The hemolysis score was calculated by adding all the scores from the 4 parameters. At the cutoff hemolysis score of 3, the IVH of aliquots B and C were detected as 64.9% and 91.9%, respectively. CONCLUSIONS: The scoring system might provide effective screening for detecting spurious IVH.

Development of an Integrated Reporting System for Verifying Hemolysis, Icterus, and Lipemia in Clinical Chemistry Results

BACKGROUND: Hemolysis, icterus, and lipemia (HIL) cause preanalytical interference and vary unpredictably with different analytical equipments and measurement methods. We developed an integrated reporting system for verifying HIL status in order to identify the extent of interference by HIL on clinical chemistry results. METHODS: HIL interference data from 30 chemical analytes were provided by the manufacturers and were used to generate a table of clinically relevant interference values that indicated the extent of bias at specific index values (alert index values). The HIL results generated by the Vista 1500 system (Siemens Healthcare Diagnostics, USA), Advia 2400 system (Siemens Healthcare Diagnostics), and Modular DPE system (Roche Diagnostics, Switzerland) were analyzed and displayed on physicians' personal computers. RESULTS: Analytes 11 and 29 among the 30 chemical analytes were affected by interference due to hemolysis, when measured using the Vista and Modular systems, respectively. The hemolysis alert indices for the Vista and Modular systems were 0.1-25.8% and 0.1-64.7%, respectively. The alert indices for icterus and lipemia were <1.4% and 0.7% in the Vista system and 0.7% and 1.0% in the Modular system, respectively. CONCLUSIONS: The HIL alert index values for chemical analytes varied depending on the chemistry analyzer. This integrated HIL reporting system provides an effective screening tool for verifying specimen quality with regard to HIL and simplifies the laboratory workflow.

Comparison of Six Clinical Chemistry Test Results According to the Treatment of EDTA Anticoagulant in Body Fluid Specimens / 임상검사와정도관리

BACKGROUND: Specimen requirements such as type of anticoagulant and number of tube for body fluid analysis vary with specimen type and requested laboratory tests. We compared the results of six clinical chemistry tests between EDTA anticoagulated and anticoagulant-free body fluids. METHODS: A total of 191 body fluids (45 pleural, 28 bronchoalveolar lavage, 35 peritoneal, 45 peritosol, and 38 synovial fluids) were aliquoted into EDTA tubes and anticoagulant-free tubes, and were simultaneously tested for total protein, albumin, glucose, lactate dehydrogenase, adenosine deaminase, and amylase. RESULTS: The coefficient of determination (R2) for all six clinical chemistry test results between EDTA anticoagulated and anticoagulant-free body fluids are more than 0.95 with the exception of glucose in bronchoalveolar lavage fluid (R2= 0.78). CONCLUSIONS: EDTA anticoagulated specimen could be used for testing routinely requested clinical chemistry tests in body fluid analysis, that only one tube of specimen is necessary to perform cell count, differential count, and clinical chemistry tests.

Comparison of Three Plastic Tubes (Two Gongdong Vacuum Blood Tubes and Improve Vacuum Blood Collection Tube) with BD Vacutainer Tube for 37 Laboratory Tests / 임상검사와정도관리

BACKGROUND: Recently, three collection tubes manufactured in China (Zhejiang Gongdong Medical Plastic Factory, Guangzhou Improve IVD) were introduced. We compared the performance of the three tubes with the existing BD Vacutainer tube (BD, USA) for common analytes. METHODS: Twenty healthy volunteers were recruited for this study. Routine chemistry, thyroid function test, and hematologic test were analyzed with these tubes, and compared the results by Student paired t-test and Bland-Altman Plot. For stability test, the initial results for each tube were compared with results of 72-hour preserved samples. RESULTS: For Gongdong tube, total bilirubin (T-BIL), glucose (GLU), phosphorus (PHOS), hemoglobin (Hb) and mean corpuscular volume (MCV) were lower, and total protein (TP), AST, direct bilirubin (D-BIL), unsaturated iron binding capacity (UIBC), total iron binding capacity (TIBC) and free thyroxine (FT4) were higher than those of BD tube. For Gongdong2 tube, ALT, T-BIL, PHOS, lactate dehydrogenase and MCV were lower, and D-BIL was higher than that of BD tube. For Improve tube, corpuscular hemoglobin concentration mean (CHCM) was lower, and albumin (Alb), blood urea nitrogen (BUN), creatinine (Cr) and FT4 were higher than those of BD tube. For three tubes, triiodothyronine (T3) was lower, and triglyceride (TG) and magnesium (Mg) were higher than those of BD tube (P<0.05). All statiscally different cases were clinically acceptable by CLIA'88 programs except D-BIL, UIBC, TIBC, Hb, MCV and CHCM those were not considered to be clinically significant. Most of stability tests showed variation within ten percents. CONCLUSIONS: The three tubes showed satisfactory results compared with existing BD Vacutainer tube. We concluded that the tubes are suitable for common laboratory tests.

Immunocytochemical analysis for estrogen receptors in the patients with thyroid disease

No abstract available.