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Heparinate but not serum tubes are susceptible to hemolysis by pneumatic tube transportation

  • Sara Pasqualetti EMAIL logo , Dominika Szőke and Mauro Panteghini
Published/Copyright: October 28, 2015
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 54 Issue 5

Abstract

Background:

Pneumatic tube transportation (PTT) may induce hemolysis (H) in blood samples. We aimed to compare the H degree before and after PTT implementation in our hospital.

Methods:

Hemolysis indices (HI) for all lithium-heparin plasma samples (P) drawn by the Emergency Department in 2-month periods were retrospectively collected and pre- (n=3579) and post-PTT (n=3469) results compared. The impact of PTT introduction was investigated on LDH [HI threshold (HIt), 25], conjugated bilirubin (cBIL) (HIt, 30), K (HIt, 100) and ALT (HIt, 125). In addition, HI retrieved for P and paired serum samples collected in silica clot activator tubes (S) from the same venipuncture were compared in pre- (n=501) and post-PTT (n=509) periods.

Results:

Median (5–95th percentile) HI in P was significantly higher in post-PTT period [7 (0–112) vs. 6 (0–82), p<0.001]. Results reported as ‘Hemolysis’ in P increased from 6.6% in pre-PTT to 9.4% in post-PTT (p<0.001). Investigated tests gave the following rejection rates (pre-PTT vs. post-PTT): LDH, 13.4% vs. 18.8%, p<0.001; cBIL, 9.4% vs. 27.0%, p<0.05; K, 3.7% vs. 5.6%, p<0.001; ALT, 2.9% vs. 4.4%, p<0.01. The slightly higher susceptibility to H of S compared to paired P found in the pre-PTT [9 (1–64) vs. 6 (0–85)] was not confirmed in the post-PTT period [7 (0–90) vs. 8 (1–72)], in which median HI in S was significantly lower (p<0.001) than in pre-PTT.

Conclusions:

In our setting PTT promotes H in P, increasing the rate of rejected tests. The use of S appears to protect against the hemolysing effect of PTT.

Keywords: hemolysis; pneumatic tube transportation; sample type

Article Note:

This work was presented in part at the 21st IFCC-EFLM European Congress of Clinical Chemistry and Laboratory Medicine held in Paris, France, 21–25 June 2015 as poster. The abstract has been published in Clin Chem Lab Med 2015;53:S1144.

Corresponding author: Sara Pasqualetti, UOC Patologia Clinica, Azienda Ospedaliera “Luigi Sacco”, Via GB Grassi 74, 20157 Milano, Italy, Phone: +3902390442290, Fax: +390250319835, E-mail:

Acknowledgments

The authors are indebted with the following individuals working at the “Luigi Sacco” University Hospital (Milan): Cristina Valente, for retrieving HI data from the LIS; Giuseppe Sala, for providing technical details of the PTT system; Maria Grazia Piacenza, for recording lot numbers of BD tubes used during the study.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Felder RA. Preanalytical errors introduced by sample-transportation systems: a means to assess them. Clin Chem 2011;57:1349–50.10.1373/clinchem.2011.172452Search in Google Scholar PubMed

2. Fernandes CM, Worster A, Eva K, Hill S, McCallum C. Pneumatic tube delivery system for blood samples reduces turnaround times without affecting sample quality. J Emerg Nurs 2006;32:139–43.10.1016/j.jen.2005.11.013Search in Google Scholar PubMed

3. Tiwari AK, Pandey P, Dixit S, Raina V. Speed of sample transportation by a pneumatic tube system can influence the degree of hemolysis. Clin Chem Lab Med 2011;50:471–4.10.1515/cclm.2011.779Search in Google Scholar

4. Kratz A, Salem RO, Van Cott EM. Effects of a pneumatic tube system on routine and novel hematology and coagulation parameters in healthy volunteers. Arch Pathol Lab Med 2007;131:293–6.10.5858/2007-131-293-EOAPTSSearch in Google Scholar PubMed

5. Plebani M, Zaninotto M. Pneumatic tube delivery systems for patient samples: evidence of quality and quality of evidence. Clin Chem Lab Med 2011;49:1245–6.10.1515/CCLM.2011.216Search in Google Scholar PubMed

6. Evliyaoğlu O, Toprak G, Tekin A, Başarali MK, Kilinç C, Colpan L. Effect of pneumatic tube delivery system rate and distance on hemolysis of blood specimens. J Clin Lab Anal 2012;26:66–9.10.1002/jcla.21484Search in Google Scholar PubMed PubMed Central

7. Streichert T, Otto B, Schnabel C, Nordholt G, Haddad M, Maric M, et al. Determination of hemolysis thresholds by the use of data loggers in pneumatic tube systems. Clin Chem 2011;57:1390–7.10.1373/clinchem.2011.167932Search in Google Scholar PubMed

8. Kara H, Bayir A, Ak A, Degirmenci S, Akinci M, Agacayak A, et al. Hemolysis associated with pneumatic tube system transport for blood samples. Pak J Med Sci 2014;30:50–8.10.12669/pjms.301.4228Search in Google Scholar PubMed PubMed Central

9. Sodi R, Darn SM, Stott A. Pneumatic tube system induced hemolysis: assessing sample type susceptibility to hemolysis. Ann Clin Biochem 2004;41:237–40.10.1258/000456304323019631Search in Google Scholar PubMed

10. Böckel-Frohnhöfer N, Hübner U, Hummel B, Geisel J. Pneumatic tube-transported blood samples in lithium heparinate gel separator tubes may be more susceptible to hemolysis than blood samples in serum tubes. Scand J Clin Lab Invest 2014;74: 599–602.10.3109/00365513.2014.921931Search in Google Scholar PubMed

11. Guiheneuf R, Vuillaume I, Mangalaboyi J, Launay D, Berthon C, Maury JC, et al. Pneumatic transport is critical for leukaemic patients with major leukocytosis: what precautions to measure lactate dehydrogenase, potassium and aspartate aminotransferase? Ann Clin Biochem 2010;47:94–6.10.1258/acb.2009.009044Search in Google Scholar PubMed

12. Gomez-Rioja R, Fernandez-Calle P, Alcaide MJ, Madero R, Oliver P, Iturzaeta JM, et al. Interindividual variability of hemolysis in plasma samples during pneumatic tube system transport. Clin Chem Lab Med 2013;51:e231–3.10.1515/cclm-2013-0171Search in Google Scholar PubMed

13. 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;46:764–72.10.1515/CCLM.2008.170Search in Google Scholar PubMed

14. Lippi G, Banfi G, Buttarello M, Ceriotti F, Daves M, Dolci A, et al. Recommendations for detection and management of unsuitable samples in clinical laboratories. Clin Chem Lab Med 2007;45:728–36.10.1515/CCLM.2007.174Search in Google Scholar PubMed

15. Dolci A, Panteghini M. Harmonization of automated hemolysis index assessment and use: Is it possible? Clin Chim Acta 2014;432:38–43.10.1016/j.cca.2013.10.012Search in Google Scholar PubMed

16. 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;48:143–53.10.3109/10408363.2011.600228Search in Google Scholar PubMed

17. Architect system operations manual PN 201837-111. Sample interference indices (c System), section 3–25. September 2013. Available at Abbott Diagnostics technical library; registration required. https://www.abbottdiagnostics.com/registration-ous/login. Last access: July 2014.Search in Google Scholar

18. Goyal T, Schmotzer CL. Validation of hemolysis index thresholds optimizes detection of clinically significant hemolysis. Am J Clin Pathol 2015;143:579–83.10.1309/AJCPDUDE1HRA0YMRSearch in Google Scholar PubMed

19. Giannitsis E, Kurz K, Hallermayer K, Jarausch J, Jaffe AS, Katus HA. Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem 2010;56:254–61.10.1373/clinchem.2009.132654Search in Google Scholar PubMed

20. Mozzi R, Carnevale A, Valente C, Dolci A, Panteghini M. Rilevazione, monitoraggio e trattamento di non conformità nella fase preanalitica: l’esperienza di un ospedale universitario metropolitano. Biochim Clin 2013;37:95–9.Search in Google Scholar

21. Szőke D, Braga F, Valente C, Panteghini M. Hemoglobin, bilirubin, and lipid interference on Roche Cobas 6000 assays. Clin Chim Acta 2012;413:339–41.10.1016/j.cca.2011.09.044Search in Google Scholar PubMed

22. Clinical and Laboratory Standards Institute (CLSI). Hemolysis, icterus, and lipemia/turbidity indices as indicators of interference in of clinical laboratory analysis; Approved guideline. CLSI document C56-A. Wayne, PA: Clinical and Laboratory Standards Institute, 2012.Search in Google Scholar

23. Da Rin G, Lippi G. The quality of diagnostic testing may be impaired during shipment of lithium-heparin gel tubes. Clin Chem Lab Med 2014;52:1633–7.10.1515/cclm-2014-0527Search in Google Scholar PubMed

24. Simundic AM, Nikolac N, Ivankovic V, Ferenec-Ruzic D, Magdic B, Kvaternik M, et al. Comparison of visual vs. automated detection of lipemic, icteric and hemolyzed specimens: can we rely on a human eye? Clin Chem Lab Med 2009;47:1361–5.Search in Google Scholar

Received: 2015-8-3
Accepted: 2015-9-24
Published Online: 2015-10-28
Published in Print: 2016-5-1

©2016 Walter de Gruyter GmbH, Berlin/Boston

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  2. Editorial
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https://doi.org/10.1515/cclm-2015-0751
Keywords for this article
hemolysis; pneumatic tube transportation; sample type

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Protein S100B: from cancer diagnostics to the evaluation of mild traumatic brain injury
  4. Reviews
  5. Capillary electrophoresis based on nucleic acid detection for diagnosing human infectious disease
  6. Oxidative damage and the pathogenesis of menopause related disturbances and diseases
  7. Opinion Paper
  8. EFLM WG-Preanalytical phase opinion paper: local validation of blood collection tubes in clinical laboratories
  9. Genetics and Molecular Diagnostics
  10. Effective quality management practices in routine clinical next-generation sequencing
  11. Analysis of PMP22 duplication and deletion using a panel of six dinucleotide tandem repeats
  12. A novel exonuclease (TaqMan) assay for rapid haptoglobin genotyping
  13. General Clinical Chemistry and Laboratory Medicine
  14. Heparinate but not serum tubes are susceptible to hemolysis by pneumatic tube transportation
  15. Criteria of adequacy for vitamin D testing and prevalence of deficiency in clinical practice
  16. A simple clot based assay for detection of procoagulant cell-derived microparticles
  17. Measurement of factor XIII (FXIII) activity by an automatic ammonia release assay using iodoacetamide blank-procedure: no more overestimation in the low activity range and better detection of severe FXIII deficiencies
  18. Immunoassay or LC-MS/MS for the measurement of salivary cortisol in children?
  19. Head to head evaluation of the analytical performance of two commercial methotrexate immunoassays and comparison with liquid chromatography-mass spectrometry and the former fluorescence polarization immunoassay
  20. Reference Values and Biological Variations
  21. Preanalytical, analytical, gestational and pediatric aspects of the S100B immuno-assays
  22. Establishment of reference intervals of clinical chemistry analytes for the adult population in Saudi Arabia: a study conducted as a part of the IFCC global study on reference values
  23. First data on the biological variation and quality specifications for plasma ammonia concentrations in healthy subjects
  24. Cancer Diagnostics
  25. Hypermethylation of DLX4 predicts poor clinical outcome in patients with myelodysplastic syndrome
  26. Cardiovascular Diseases
  27. Galectin-3, osteopontin and successful aging
  28. Platelet volume is associated with the Framingham risk score for cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
  29. Infectious Diseases
  30. Diagnostic values of CD64, C-reactive protein and procalcitonin in ventilator-associated pneumonia in adult trauma patients: a pilot study
  31. Corrigendum
  32. Corrigendum to: Accuracy of GFR estimating equations combining standardized cystatin C and creatinine assays: a cross-sectional study in Sweden
  33. Letters to the Editor
  34. Theranos phenomenon – part 3
  35. Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice
  36. Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice
  37. Impact of specimen mixing methods on presepsin point-of-care test results using whole blood
  38. Clinical laboratories have a critical role in test strip lot management in glucose point-of-care testing
  39. Hemoglobin A2-Leuven (α2δ2 143(H21) His>Asp): a novel delta-chain variant potentially interfering in hemoglobin A1c measurement using cation exchange HPLC
  40. Eryptosis is induced by hyperthermia in hereditary spherocytosis red blood cells
  41. Investigation of sensitivity for coagulation factor deficiency in APTT and PT: how to perform it?
  42. Underestimation of hepcidin concentration by time of flight mass spectrometry and competitive ELISA in hepcidin p.Gly71Asp heterozygotes
  43. Congress Abstracts
  44. ISMD2016 Eleventh International Symposium on Molecular Diagnostics
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