Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention
-
Karin Bölenius
, Johan Söderberg
, Johan Hultdin , Marie Lindkvist , Christine Brulin und Kjell Grankvist
Abstract
Background: Venous blood specimen collection is a common health care practice that has to follow strict guidelines, non-compliance among sampling staff may compromise patient safety. We evaluated a large-scale 2 h educational intervention that emphasised guideline adherence to assess possible improvements of venous blood specimen collection practices.
Methods: Blood specimen haemolysis is usually caused by inadequate venous blood specimen collection and handling, reflecting overall pre-analytical handling. We monitored haemolysis of serum samples with haemolysis index corresponding to ≥150 mg/L of free haemoglobin for specimens sent from 11 primary health care centres and analysed on a Vitros 5,1 clinical chemistry analyser before (2008, n=6652 samples) and after (2010, n=6121 samples) the intervention.
Results: The total percentage of haemolysed specimens was 11.8% compared to 10.5% (p=0.022) before the intervention. As groups, rural primary health care centres demonstrated a significant reduction [Odds ratios (OR)=0.744] of haemolysed specimens after intervention, whereas urban primary health care centres demonstrated a significant increase (OR=1.451) of haemolysis.
Conclusions: A large-scale 2 h educational intervention to make venous blood specimen collection staff comply with guideline practices had minor effects on collection practices. Educational interventions may be effective in wards/care centres demonstrating venous blood specimen collection practices with larger deviations from guidelines.
This work would not have been possible without Jenny Ekman and Annika Wästerby who retrieved haemolysis data and the laboratory instructors Susanne Hermansson, Ann-Britt Lindström, Marie Backlund and Marie Lundgren who performed the educational intervention. We would like to thank the Faculty of Medicine, Umeå University, Umeå, Sweden, the Swedish National Board of Health and Welfare, Sweden and Västerbotten County Council in Sweden for research funding.
Conflict of interest statement
Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Authors’ contributions: KB, JS, CB and KG proposed the original idea for the study. KB and JH collected the data and executed the statistical analyses together with ML. KB drafted the manuscript and all the authors read the manuscript critically for important intellectual content and approved the final manuscript.
References
1. Gagliardi AR, Brouwers MC, Palda VA, Lemieux-Charles L, Grimshaw JM. An exploration of how guideline developer capacity and guideline implementability influence implementation and adoption: study protocol. Implement Sci 2009;4:36.10.1186/1748-5908-4-36http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000268171900001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar PubMed
2. Swedish National Board of Health and Welfare. (SFS 2010:659). Availablefrom: http://62.95.69.3/SFSdoc/10/100659.PDF. Accessed 2 March, 2012.Suche in Google Scholar
3. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003;362:1225–30.10.1016/S0140-6736(03)14546-1Suche in Google Scholar PubMed
4. Söderberg J, Grankvist K, Brulin C, Wallin O. Incident reporting practices in the pre-analytical phase: low reported frequencies in the primary health care setting. Scand J Clin Lab Invest 2009;69:731–5.10.3109/00365510903007018http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000272492300002&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar
5. Söderberg J, Wallin O, Grankvist K, Brulin C. Is the test result correct? A questionnaire study of blood collection practices in primary health care. J Eval Clin Pract 2010;16:707–11.10.1111/j.1365-2753.2009.01179.xhttp://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000279901700007&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar PubMed
6. Söderberg J, Brulin C, Grankvist K, Wallin O. Pre-analytical errors in primary healthcare: a questionnaire study of information search procedures, test request management and test tube labelling. Clin Chem Lab Med 2009;47:195–201.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000263656400013&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar
7. Wallin O, Söderberg J, Van Guelpen B, Stenlund H, Grankvist K, Brulin C. Pre-analytical venous blood sampling practices demand improvement – a survey of test-request management, test-tube labelling and information search procedures. Clin Chim Acta 2008;391:91–7.10.1016/j.cca.2008.02.016http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000255846000016&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar
8. Wallin O, Söderberg J, Van Guelpen B, Stenlund H, Grankvist K, Brulin C. Blood sample collection and patient identification demand improvement: a questionnaire study of pre-analytical practices in hospital wards and laboratories. Scand J Caring Sci 2010;24:581–91.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000281000800020&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111/j.1471-6712.2009.00753.xSuche in Google Scholar
9. Wallin O. Pre-analytical errors in hospitals: implications for quality improvement of blood sample collection. [doctoral thesis]. Umeå: Umeå Universitet, 2008.Suche in Google Scholar
10. The Handbook for Healthcare. Available from: http://www.vardhandboken.se/In-English/. Accessed 18 January, 2012.Suche in Google Scholar
11. Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, et al. Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories. Clin Chem Lab Med 2008;46:764–72.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000257542800003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar PubMed
12. Söderberg J, Jonsson PA, Wallin O, Grankvist K, Hultdin J. Haemolysis index – an estimate of pre-analytical quality in primary health care. Clin Chem Lab Med 2009;47:940–4.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000268507800007&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar PubMed
13. Laga A, Cheves T, Maroto S, Coutts M, Sweeney J. The suitability of hemolyzed specimens for compatibility testing using automated technology. Transfusion 2008;48:1713–20.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000258077800027&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111/j.1537-2995.2008.01741.xSuche in Google Scholar PubMed
14. Guder W, da Fonseca-Wollheim F, Heil W, Schmitt Y, Töpfer G, Wisser H, et al. The haemolytic, icteric and lipemic sample recommendations regarding their recognition and prevention of clinically relevant interferences. Lab Med 2000;24:357–64.10.1515/labm.2000.24.8.357Suche in Google Scholar
15. Plebani M, Piva E. Medical errors: pre-analytical issue in patient safety. J Med Biochem 2010;29:310–4.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000282677600011&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.2478/v10011-010-0039-2Suche in Google Scholar
16. Ong ME, Chan YH, Lim CS. Reducing blood sample hemolysis at a tertiary hospital emergency department. Am J Med 2009;122:1054.e1–6.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000271098900018&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1016/j.amjmed.2009.04.024Suche in Google Scholar
17. Kirchner MJ, Funes VA, Adzet CB, Clar MV, Escuer MI, Girona JM, et al. Quality indicators and specifications for key processes in clinical laboratories: a preliminary experience. Clin Chem Lab Med 2007;45:672–7.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000247005900018&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar PubMed
18. Kennedy C, Angermuller S, King R, Noviello S, Walker J, Warden J, et al. A comparison of hemolysis rates using intravenous catheters versus venipuncture tubes for obtaining blood samples. J Emerg Nurs 1996;22:566–9.10.1016/S0099-1767(96)80213-3Suche in Google Scholar PubMed
19. Munnix IC, Schellart M, Gorissen C, Kleinveld H. Factors reducing hemolysis rates in blood samples from the emergency department. Clin Chem Lab Med 2011;49:157–8.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000286418300024&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar PubMed
20. Cox SR, Dages JH, Jarjoura D, Hazelett S. Blood samples drawn from IV catheters have less hemolysis when 5-mL (vs 10-mL) collection tubes are used. J Emerg Nurs 2004;30:529–33.10.1016/j.jen.2004.10.004Suche in Google Scholar PubMed
21. Bölenius K, Brulin C, Grankvist K, Lindkvist M, Söderberg J. A content validated questionnaire for assessment of self-reported venous blood sampling practices. BMC Res Notes 2012;5:39.10.1186/1756-0500-5-39Suche in Google Scholar PubMed PubMed Central
22. Kahn SE, Watkins BF, Bermes EW, Jr. An evaluation of aspectrophotometric scanning technique for measurement of plasma hemoglobin. Ann Clin Lab Sci 1981;11:126–31.Suche in Google Scholar PubMed
23. Västerbottens Läns Landsting. Provtagningsanvisningar Laboratoriemedicin VLL (in Swedish). Available from: https://webappl.vll.se/provtagningsanvisningar. Accessed 2 March, 2012.Suche in Google Scholar
24. Clinical and Laboratory Standards Institute: Procedures for the collection of diagnostic blood specimens by venipuncture. Approved Standard. CLSI document H3-A6 6th ed. Wayne: CLSI, 2007.Suche in Google Scholar
25. Tanabe P, Kyriacou DN, Garland F. Factors affecting the risk of blood bank specimen hemolysis. Acad Emerg Med 2003;10:897–900.10.1111/j.1553-2712.2003.tb00637.xSuche in Google Scholar PubMed
26. Thomas L. Haemolysis as influence and interference factor. Biochim Clin 2002;26:95.Suche in Google Scholar
27. Lippi G, Salvagno GL, Montagnana M, Brocco G, Guidi GC. Influence of hemolysis on routine clinical chemistry testing. Clin Chem Lab Med 2006;44:311–6.10.1515/CCLM.2006.054Suche in Google Scholar PubMed
28. Grant MS. The effect of blood drawing techniques and equipment on the hemolysis of ED laboratory blood samples. J Emerg Nurs 2003;29:116–21.10.1067/men.2003.66Suche in Google Scholar PubMed
29. Fang L, Fang SH, Chung YH, Chien ST. Collecting factors related to the haemolysis of blood specimens. J Clin Nurs 2008;17:2343–51.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000258405800014&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111/j.1365-2702.2006.02057.xSuche in Google Scholar PubMed
30. Carraro P, Servidio G, Plebani M. Hemolyzed specimens: a reason for rejection or a clinical challenge? Clin Chem 2000;46:306.10.1093/clinchem/46.2.306Suche in Google Scholar PubMed
31. Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000259.pub2/pdf. Accessed 2 March, 2012.10.1002/14651858.CD000259.pub2/pdf.Accessed2Suche in Google Scholar
32. Lippi G, Plebani M, Di Somma S, Cervellin G. Hemolyzed specimens: a major challenge for emergency departments and clinical laboratories. Crit Rev Clin Lab Sci 2011;48:143–53.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000294492400003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.3109/10408363.2011.600228Suche in Google Scholar PubMed
33. Lippi G, Salvagno GL, Montagnana GB, Guidi GC. Influence of short-term venous stasis on clinical chemistry testing. Clin Chem Lab Med 2005;43:869–75.10.1515/CCLM.2005.146Suche in Google Scholar PubMed
34. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Scartezini M, Guidi GC, et al. Transillumination: a new tool to eliminate the impact of venous stasis during the procedure for the collection of diagnostic blood specimens for routine haematological testing. Int J Lab Hematol 2011;33:457–62.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000294131200005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111/j.1751-553X.2011.01305.xSuche in Google Scholar
35. Ernst DJ. Flawless phlebotomy: becoming a great collector. Nursing 1995;25:54.10.1097/00152193-199510000-00022Suche in Google Scholar PubMed
36. Ovretveit J, Gustafson D. Evaluation of quality improvement programmes. Qual Saf Health Care 2002;11:270–5.10.1136/qhc.11.3.270Suche in Google Scholar PubMed
37. Ovretveit J, Gustafson D. Improving the quality of health care – using research to inform quality programmes. Brit Med J 2003;326:759–61.10.1136/bmj.326.7392.759Suche in Google Scholar
38. Landefeld CS, Shojania KG, Auerbach AD. Should we use large scale healthcare interventions without clear evidence that benefits outweigh costs and harms? No. BMJ 2008;336:1277.10.1136/bmj.a144http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000256705900028&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar PubMed
39. What are Large Scale Intervention? Available from: http://www.largescaleinterventions.com/english%20version/intro%20What%20is%20LSI.htm. Accessed 18 January, 2012.Suche in Google Scholar
40. Mittman BS, Tonesk X, Jacobson PD. Implementing clinical practice guidelines: social influence strategies and practitioner behavior change. Qual Rev Bull 1992;18:413.10.1016/S0097-5990(16)30567-XSuche in Google Scholar
41. Gagliardi AR, Brouwers MC, Palda VA, Lemieux-Charles L, Grimshaw JM. How can we improve guideline use? A conceptual framework of implementability. Implement Sci 2011;6:26.10.1186/1748-5908-6-26http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000289293800001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar PubMed PubMed Central
42. Fink R, Thompson CJ, Bonnes D. Overcoming barriers and promoting the use of research in practice. J Nurs Admin 2005;35:121–9.10.1097/00005110-200503000-00005Suche in Google Scholar PubMed
43. Franke AL, Smit MC, de Veer AJ, Mistiaen P. Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. Med Inform Decis Mak 2008;8:38.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000259819400001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1186/1472-6947-8-38Suche in Google Scholar PubMed PubMed Central
44. Lippi G, Sonntag O, Plebani M. Appropriate labelling of blood collection tubes: a step ahead towards patient’s safety. Clin Chem Lab Med 2011;49:1921–3.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000299856700001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Suche in Google Scholar
45. Grol RP, Bosch MC, Hulscher ME, Eccles MP, Wensing M. Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q 2007;85:93–138.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000244341800005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111/j.1468-0009.2007.00478.xSuche in Google Scholar PubMed PubMed Central
©2013 by Walter de Gruyter Berlin Boston
Artikel in diesem Heft
- Letters to the Editor
- Performance evaluation of three different immunoassays for detection of antibodies to hepatitis B core
- Serum homocysteine concentrations in Chinese children with autism
- Interchangeability of venous and capillary HbA1c results is affected by oxidative stress
- Interference of hemoglobin (Hb) N-Baltimore on measurement of HbA1c using the HA-8160 HPLC method
- First human isolate of Mycobacterium madagascariense in the sputum of a patient with tracheobronchitis
- Protein S and protein C measurements should not be undertaken during vitamin K antagonist therapy
- α2-HS glycoprotein is an essential component of cryoglobulin associated with chronic hepatitis C
- An unusual interference in CK MB assay caused by a macro enzyme creatine phosphokinase (CK) type 2 in HIV-infected patients
- An automated technique for the measurement of the plasma glutathione reductase activity and determination of reference limits for a healthy population
- Is osteopontin stable in plasma and serum?
- Evidence-based approach to reducing perceived wasteful practices in laboratory medicine
- Masthead
- Masthead
- Editorials
- Testing volume is not synonymous of cost, value and efficacy in laboratory diagnostics
- Lessons from controversy: biomarkers evaluation
- Commercial immunoassays in biomarkers studies: researchers beware!1)
- Trials and tribulations in lupus anticoagulant testing
- Reviews
- Mass spectrometry: a revolution in clinical microbiology?
- Chronic Chagas disease: from basics to laboratory medicine
- General Clinical Chemistry and Laboratory Medicine
- Shop for quality or quantity? Volumes and costs in clinical laboratories
- Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention
- Evaluation of high resolution gel β2-transferrin for detection of cerebrospinal fluid leak
- Serum kallikrein-8 correlates with skin activity, but not psoriatic arthritis, in patients with psoriatic disease
- Soluble urokinase plasminogen activator receptor (suPAR) in the assessment of inflammatory activity of rheumatoid arthritis patients in remission
- Bone mass density selectively correlates with serum markers of oxidative damage in post-menopausal women
- Validation of a fast and reliable liquid chromatography-tandem mass spectrometry (LC-MS/MS) with atmospheric pressure chemical ionization method for simultaneous quantitation of voriconazole, itraconazole and its active metabolite hydroxyitraconazole in human plasma
- Performance of different screening methods for the determination of urinary glycosaminoclycans
- Intestinal permeability and fecal eosinophil-derived neurotoxin are the best diagnosis tools for digestive non-IgE-mediated cow’s milk allergy in toddlers
- An internal validation approach and quality control on hematopoietic chimerism testing after allogeneic hematopoietic cell transplantation
- Serum levels of IgG antibodies against oxidized LDL and atherogenic indices in HIV-1-infected patients treated with protease inhibitors
- Cooperation experience in a multicentre study to define the upper limits in a normal population for the diagnostic assessment of the functional lupus anticoagulant assays
- Contribution of procoagulant phospholipids, thrombomodulin activity and thrombin generation assays as prognostic factors in intensive care patients with septic and non-septic organ failure
- Suitability of POC lactate methods for fetal and perinatal lactate testing: considerations for accuracy, specificity and decision making criteria
- Point-of-care testing on admission to the intensive care unit: lactate and glucose independently predict mortality
- Reference Values and Biological Variations
- CA125 reference values change in male and postmenopausal female subjects
- Distributions and ranges of values of blood and urinary biomarker of inflammation and oxidative stress in the workers engaged in office machine manufactures: evaluation of reference values
- Cancer Diagnostics
- Association of acute phase protein-haptoglobin, and epithelial-mesenchymal transition in buccal cancer: a preliminary report
- Comparison of diagnostic and prognostic performance of two assays measuring thymidine kinase 1 activity in serum of breast cancer patients
- Evaluation of the BRAHMS Kryptor® Thyroglobulin Minirecovery Test in patients with differentiated thyroid carcinoma
Artikel in diesem Heft
- Letters to the Editor
- Performance evaluation of three different immunoassays for detection of antibodies to hepatitis B core
- Serum homocysteine concentrations in Chinese children with autism
- Interchangeability of venous and capillary HbA1c results is affected by oxidative stress
- Interference of hemoglobin (Hb) N-Baltimore on measurement of HbA1c using the HA-8160 HPLC method
- First human isolate of Mycobacterium madagascariense in the sputum of a patient with tracheobronchitis
- Protein S and protein C measurements should not be undertaken during vitamin K antagonist therapy
- α2-HS glycoprotein is an essential component of cryoglobulin associated with chronic hepatitis C
- An unusual interference in CK MB assay caused by a macro enzyme creatine phosphokinase (CK) type 2 in HIV-infected patients
- An automated technique for the measurement of the plasma glutathione reductase activity and determination of reference limits for a healthy population
- Is osteopontin stable in plasma and serum?
- Evidence-based approach to reducing perceived wasteful practices in laboratory medicine
- Masthead
- Masthead
- Editorials
- Testing volume is not synonymous of cost, value and efficacy in laboratory diagnostics
- Lessons from controversy: biomarkers evaluation
- Commercial immunoassays in biomarkers studies: researchers beware!1)
- Trials and tribulations in lupus anticoagulant testing
- Reviews
- Mass spectrometry: a revolution in clinical microbiology?
- Chronic Chagas disease: from basics to laboratory medicine
- General Clinical Chemistry and Laboratory Medicine
- Shop for quality or quantity? Volumes and costs in clinical laboratories
- Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention
- Evaluation of high resolution gel β2-transferrin for detection of cerebrospinal fluid leak
- Serum kallikrein-8 correlates with skin activity, but not psoriatic arthritis, in patients with psoriatic disease
- Soluble urokinase plasminogen activator receptor (suPAR) in the assessment of inflammatory activity of rheumatoid arthritis patients in remission
- Bone mass density selectively correlates with serum markers of oxidative damage in post-menopausal women
- Validation of a fast and reliable liquid chromatography-tandem mass spectrometry (LC-MS/MS) with atmospheric pressure chemical ionization method for simultaneous quantitation of voriconazole, itraconazole and its active metabolite hydroxyitraconazole in human plasma
- Performance of different screening methods for the determination of urinary glycosaminoclycans
- Intestinal permeability and fecal eosinophil-derived neurotoxin are the best diagnosis tools for digestive non-IgE-mediated cow’s milk allergy in toddlers
- An internal validation approach and quality control on hematopoietic chimerism testing after allogeneic hematopoietic cell transplantation
- Serum levels of IgG antibodies against oxidized LDL and atherogenic indices in HIV-1-infected patients treated with protease inhibitors
- Cooperation experience in a multicentre study to define the upper limits in a normal population for the diagnostic assessment of the functional lupus anticoagulant assays
- Contribution of procoagulant phospholipids, thrombomodulin activity and thrombin generation assays as prognostic factors in intensive care patients with septic and non-septic organ failure
- Suitability of POC lactate methods for fetal and perinatal lactate testing: considerations for accuracy, specificity and decision making criteria
- Point-of-care testing on admission to the intensive care unit: lactate and glucose independently predict mortality
- Reference Values and Biological Variations
- CA125 reference values change in male and postmenopausal female subjects
- Distributions and ranges of values of blood and urinary biomarker of inflammation and oxidative stress in the workers engaged in office machine manufactures: evaluation of reference values
- Cancer Diagnostics
- Association of acute phase protein-haptoglobin, and epithelial-mesenchymal transition in buccal cancer: a preliminary report
- Comparison of diagnostic and prognostic performance of two assays measuring thymidine kinase 1 activity in serum of breast cancer patients
- Evaluation of the BRAHMS Kryptor® Thyroglobulin Minirecovery Test in patients with differentiated thyroid carcinoma