Pre-analytical errors in coagulation testing: a case series

Mala Mahto; Visesh Kumar; Ayan Banerjee; Sushil Kumar; Anurag Kumar

doi:10.1515/dx-2023-0110

Article

Pre-analytical errors in coagulation testing: a case series

Mala Mahto , Visesh Kumar , Ayan Banerjee , Sushil Kumar and Anurag Kumar

Published/Copyright: January 1, 2024

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From the journal Diagnosis Volume 11 Issue 1

Abstract

Objectives

Prevention of pre-analytical issues in coagulation testing is of paramount importance for good laboratory performance. In addition to common issues like hemolysed, icteric, or lipemic samples, some specific pre-analytical errors of coagulation testing include clotted specimens, improper blood-to-anticoagulant ratio, contamination with other anticoagulants, etc. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are very commonly affected tests due to pre-analytical variables. The impact these parameters possess on surgical decision-making and various life-saving interventions are substantial therefore we cannot afford laxity and casual mistakes in carrying out these critical investigations at all.

Case presentation

In this case series, a total of 4 cases of unexpectedly deranged coagulation profiles have been described which were reported incorrectly due to the overall casual approach towards these critical investigations. We have also mentioned how the treating clinician and lab physician retrospectively accessed relevant information in the nick of time to bring back reassurance.

Conclusions

Like every other critical investigation, analytical errors can occur in coagulation parameters due to various avoidable pre-analytical variables. The release of spurious results for coagulation parameters sets alarm bells ringing causing much agony to the treating doctor and patient. Only a disciplined and careful approach taken by hospital and lab staff towards each sample regardless of its criticality can negate these stressful errors to a large extent.

Keywords: coagulation profile; PT/INR; preanalytical errors; activated partial thromboplastin time (aPTT)

Corresponding author: Dr. Anurag Kumar, Assistant Professor, Department of Biochemistry, All India Institute of Medical Sciences, Patna, India, Phone: 91 9811332395, E-mail: dr.anurag11458@aiimspatna.org

Acknowledgments

The authors wish to thank the doctors, technical staff of the laboratory, and the treating physicians, nursing officers, and patients for their role in bringing to light the small errors that go a big way in improvising diagnostic services. We are also thankful for the dedicated efforts of all healthcare workers during the difficult times brought on by the COVID-19 pandemic.

Research ethics: The local Institutional Review Board deemed the study exempt from review. Only spuriously reported laboratory reports are dealt with in this case series with no involvement of human or animal subjects, approval of the institute’s ethical committee was not required.
Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards. The authors have complied with the World Medical Association Declaration of Helsinki regarding ethical conduct of research involving human subjects and/or animals.
Author contributions: V.K. ran the samples identified the problem and collected the data. S.K., A.B., A.K., and MM conceived the idea behind the case study, analyzed the data, and wrote the first draft. All authors reviewed the final draft and approved the final manuscript.
Competing interests: The authors declare that they have no competing interests.
Research funding: No funding was received for the above-submitted work.
Data availability: Not applicable.

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Received: 2023-08-24

Accepted: 2023-12-11

Published Online: 2024-01-01

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https://doi.org/10.1515/dx-2023-0110

Keywords for this article

coagulation profile; PT/INR; preanalytical errors; activated partial thromboplastin time (aPTT)