Importance of Preanalytical Phase in Laboratory Medicine
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Questions and Answers

What percentage of total errors in diagnostic laboratories are due to preanalytical errors?

  • 50-75% (correct)
  • 20-30%
  • 30-40%
  • 80-90%

    • What is the primary purpose of proper patient identification in the preanalytical phase?

  • To reduce the risk of sample mix-ups (correct)
  • To ensure accurate labeling of samples
  • To obtain a blood sample of adequate quality
  • To prevent sample contamination

    • What is the effect of traumatic venipuncture on the quality of the blood sample?

  • It decreases the risk of clot formation
  • It has no effect on the quality of the sample
  • It increases the risk of hemolysis (correct)
  • It improves the quality of the sample

    • Why is it important to avoid carryover of anticoagulants or other additives when collecting multiple blood tubes from the same patient?

    <p>To prevent interference with the analytical results</p> Signup and view all the answers

    What is the primary reason for the intense focus on the preanalytical phase in the last decade?

    <p>To reduce the risk of errors in laboratory medicine</p> Signup and view all the answers

    Which of the following is an example of an uncontrollable preanalytical variable?

    <p>Age of the patient</p> Signup and view all the answers

    What is the effect of preanalytical errors on the health and safety of patients?

    <p>They can jeopardize the health and safety of patients</p> Signup and view all the answers

    What is the purpose of proper handling and storage of specimens in the preanalytical phase?

    <p>To preserve the quality of the sample</p> Signup and view all the answers

    Which of the following is an example of a preanalytical variable that can be controlled?

    <p>Specimen collection technique</p> Signup and view all the answers

    What is the primary reason for the development of recommendations and standards for the preanalytical phase?

    <p>To reduce the risk of errors in laboratory medicine</p> Signup and view all the answers

    What is the main reason for the importance of the preanalytical phase in laboratory medicine?

    <p>To ensure accurate laboratory results</p> Signup and view all the answers

    The preanalytical phase only includes specimen collection and handling.

    <p>False</p> Signup and view all the answers

    What is the purpose of proper patient identification in the preanalytical phase?

    <p>To ensure that the correct patient's sample is analyzed and to prevent mix-ups</p> Signup and view all the answers

    The label on the tube must match exactly the _________ of the patient.

    <p>identity</p> Signup and view all the answers

    Match the following preanalytical variables with their descriptions:

    <p>Age = Endogenous variable EDTA = Anticoagulant of choice for hematology variables Pregnancy = Physiological variable Traumatic venipuncture = Cause of sample artefacts</p> Signup and view all the answers

    Why is it important to perform venipuncture in the most atraumatic way possible?

    <p>To obtain a blood sample of adequate quality for analysis</p> Signup and view all the answers

    The preanalytical phase is responsible for the majority of errors in diagnostic laboratories.

    <p>True</p> Signup and view all the answers

    What is an example of a specimen variable that can be controlled in the preanalytical phase?

    <p>Choice of anticoagulant and tube</p> Signup and view all the answers

    The preanalytical phase includes all those steps that occur in the practice such as specimen collection, handling, storage, and ____________ to the laboratory.

    <p>shipping</p> Signup and view all the answers

    What is the purpose of knowing uncontrollable preanalytical variables in the preanalytical phase?

    <p>To separate their effects from disease-related changes affecting laboratory results</p> Signup and view all the answers

    What is a common consequence of removing the needle while the tourniquet is still on during venipuncture?

    <p>Vein Damage</p> Signup and view all the answers

    What is the primary concern when collecting blood specimens from a patient with an IV line?

    <p>IV fluid interference with test results</p> Signup and view all the answers

    Which of the following can cause a rapid increase in the ratio of blood cells to plasma?

    <p>Tourniquet application</p> Signup and view all the answers

    What is the consequence of mixing blood specimens too vigorously?

    <p>Hemolysis</p> Signup and view all the answers

    Why is it essential to wipe away the first blood drop in capillary collection?

    <p>To prevent specimen contamination</p> Signup and view all the answers

    What is the consequence of improper fit of the needle to the syringe during blood collection?

    <p>Hemolysis</p> Signup and view all the answers

    Why is it important to avoid probing during venipuncture?

    <p>To prevent vein damage</p> Signup and view all the answers

    What is the effect of dehydration on certain blood test results?

    <p>Increased RBC, Fe, Na, and coagulation factors</p> Signup and view all the answers

    What is the consequence of squirting blood from a syringe during collection?

    <p>Hemolysis</p> Signup and view all the answers

    Why is it essential to follow proper procedures for transportation and storage of blood specimens?

    <p>To maintain specimen quality and prevent degradation</p> Signup and view all the answers

    Which of the following is affected by a patient's diet?

    <p>Glucose and lipids</p> Signup and view all the answers

    What is the consequence of collecting blood specimens in partially filled tubes?

    <p>Altered blood-to-additive ratio</p> Signup and view all the answers

    What is the effect of crying on WBC in infants?

    <p>Increased WBC</p> Signup and view all the answers

    What is the effect of exercise on certain blood test results?

    <p>Increased glucose and creatinine</p> Signup and view all the answers

    What is the effect of fever on certain hormones?

    <p>Increased insulin and cortisol</p> Signup and view all the answers

    What is the effect of smoking on WBC?

    <p>Increased WBC</p> Signup and view all the answers

    What is the effect of body position on certain blood test results?

    <p>Increased RBC and Ca</p> Signup and view all the answers

    What is the effect of pregnancy on RBC count?

    <p>Decreased RBC count</p> Signup and view all the answers

    What should be done if a patient has a history of fainting?

    <p>Ask the patient to lie down</p> Signup and view all the answers

    What should be avoided when drawing blood from a patient who has had a mastectomy?

    <p>Drawing blood from the arm on the same side of the mastectomy</p> Signup and view all the answers

    What is the ideal time frame for processing and examining hematology samples?

    <p>Within a few hours after collection</p> Signup and view all the answers

    What is the primary purpose of collecting blood samples in the basal state?

    <p>To minimize the effects of diet and exercise on test results</p> Signup and view all the answers

    Which of the following physiological variables can affect RBC counts?

    <p>Age and altitude</p> Signup and view all the answers

    What is the effect of dehydration on blood samples?

    <p>Hemoconcentration and increased enzyme levels</p> Signup and view all the answers

    Which of the following can affect cortisol levels in blood samples?

    <p>Diurnal variation and fever</p> Signup and view all the answers

    What is the purpose of refrigerating serum/plasma samples?

    <p>To slow down biochemical reactions until analysis</p> Signup and view all the answers

    Which of the following is an example of a physiological variable that can affect TSH levels?

    <p>Diurnal variation and smoking</p> Signup and view all the answers

    What is the effect of IM injections on blood samples?

    <p>CK and LDH levels</p> Signup and view all the answers

    Which of the following is a characteristic of the basal state?

    <p>A state of fasting for 12 hours</p> Signup and view all the answers

    What is the effect of altitude on RBC counts?

    <p>Increased RBC counts due to decreased oxygen levels</p> Signup and view all the answers

    What happens to blood results when a patient is dehydrated?

    <p>They are increased</p> Signup and view all the answers

    Circadian variations can affect cortisol levels.

    <p>True</p> Signup and view all the answers

    What is the effect of exercise on glucose levels?

    <p>Increased</p> Signup and view all the answers

    Fever can affect certain ______________, such as insulin levels.

    <p>hormones</p> Signup and view all the answers

    Match the following patient conditions with their effects on blood tests:

    <p>Crying = Increased WBC in infants Exercise = Increased glucose, creatinine, and total protein Fever = Increased insulin levels and cortisol levels Pregnancy = Decreased RBC count</p> Signup and view all the answers

    Smoking can affect cholesterol levels.

    <p>True</p> Signup and view all the answers

    What should be done if a patient has a history of fainting?

    <p>Ask the patient to lie down</p> Signup and view all the answers

    What should be avoided when drawing blood from a patient who has had a mastectomy?

    <p>Drawing blood from the arm on the same side of the mastectomy</p> Signup and view all the answers

    Body position can affect certain blood tests, such as __________________ and Fe.

    <p>RBC and Na</p> Signup and view all the answers

    Seizures can occur during blood collection.

    <p>True</p> Signup and view all the answers

    What is the consequence of removing the needle while the tourniquet is still on during venipuncture?

    <p>Hemoconcentration</p> Signup and view all the answers

    Drawing blood through a hematoma can cause hemolysis.

    <p>True</p> Signup and view all the answers

    What is the primary concern when collecting blood specimens from a patient with an IV line?

    <p>Contamination of the specimen with IV fluids or medications.</p> Signup and view all the answers

    The ratio of blood cells to plasma can increase rapidly due to ________ application.

    <p>tourniquet</p> Signup and view all the answers

    Match the following errors with their consequences:

    <p>Probing = Nerve damage Failure to mix properly = Clotted anticoagulated specimens Using large volume tubes with a small diameter butterfly needle = Hemolysis</p> Signup and view all the answers

    What can cause a false high potassium and low calcium levels in blood samples?

    <p>EDTA contamination</p> Signup and view all the answers

    Partially filled tubes can affect the accuracy of coagulation tests only.

    <p>False</p> Signup and view all the answers

    Specimens should be stored according to the recommended ________ and duration to preserve their integrity until analysis.

    <p>temperature</p> Signup and view all the answers

    What can happen if the tourniquet is left on for more than 1 minute during venipuncture?

    <p>Hemoconcentration can occur.</p> Signup and view all the answers

    What can prevent reflux of additive in blood collection?

    <p>Keeping the arm in a downward position</p> Signup and view all the answers

    What is the ideal time frame for processing and examining hematology samples?

    <p>Within a few hours of collection</p> Signup and view all the answers

    The basal state is influenced by gender.

    <p>True</p> Signup and view all the answers

    What is the effect of dehydration on blood samples?

    <p>Hemoconcentration, RBC, enzymes, Fe, Ca, Na</p> Signup and view all the answers

    The primary purpose of collecting blood samples in the _______________ state is to establish reference ranges on inpatients.

    <p>basal</p> Signup and view all the answers

    Match the following physiological variables with their effects on blood tests:

    <p>Age = RBC, WBC, creatinine clearance Altitude = RBC Dehydration = Hemoconcentration, RBC, enzymes, Fe, Ca, Na Diet = Glucose, lipids, electrolytes</p> Signup and view all the answers

    Smoking can affect cortisol levels in blood samples.

    <p>True</p> Signup and view all the answers

    Which of the following physiological variables can affect TSH levels?

    <p>Diurnal variation</p> Signup and view all the answers

    What is the purpose of refrigerating serum/plasma samples?

    <p>To preserve the sample until analysis</p> Signup and view all the answers

    The basal state is defined as the resting state of the body early in the morning after _______________ hours of fasting.

    <p>12</p> Signup and view all the answers

    IM injections can affect CK and LDH levels in blood samples.

    <p>True</p> Signup and view all the answers

    Study Notes

    Importance of Preanalytical Phase

    • The preanalytical phase is crucial in laboratory medicine, as errors in this phase can affect the analytical phase, jeopardizing patient health and safety, and increasing medical care costs.
    • The preanalytical phase includes steps such as specimen collection, handling, storage, and shipping to the laboratory.
    • Physiological variables (e.g., age, gender, pregnancy) and endogenous variables (e.g., medication, recent meals) can also impact laboratory results.

    Preanalytical Errors

    • Preanalytical errors account for 50% to 75% of total errors in diagnostic laboratories.
    • The last decade has seen an increased focus on the preanalytical phase, leading to the development of recommendations and standards.

    Controlling Preanalytical Variables

    • Some preanalytical variables, such as specimen variables, can be controlled.
    • A thorough knowledge of uncontrollable variables is necessary to separate their effects from disease-related changes affecting laboratory results.

    Avoiding Errors

    Patient Identification

    • Proper patient identification is essential, requiring 100% accuracy.
    • The label on the tube must match the patient's identification exactly.

    Sample Collection

    • Venipuncture should be performed in the most atraumatic way possible to obtain a blood sample of adequate quality.
    • Traumatic venipuncture can cause sample artefacts, such as spurious hemolysis and formation of macro/micro clots.

    Choice of Anticoagulant and Tube

    • EDTA whole blood is the specimen of choice for most hematology variables.
    • When collecting multiple blood tubes, carryover of anticoagulants or additives should be avoided.
    • Follow the correct order of collection to avoid contamination by EDTA, which can cause false elevations of potassium and false decreases of calcium.
    • Serum gel separator tubes can be used for most biochemical analysis, but should be avoided for hormones and drugs measurements.

    Importance of Preanalytical Phase

    • The preanalytical phase is crucial in laboratory medicine, as errors in this phase can affect the analytical phase, jeopardizing patient health and safety, and increasing medical care costs.
    • The preanalytical phase includes steps such as specimen collection, handling, storage, and shipping to the laboratory.
    • Physiological variables (e.g., age, gender, pregnancy) and endogenous variables (e.g., medication, recent meals) can also impact laboratory results.

    Preanalytical Errors

    • Preanalytical errors account for 50% to 75% of total errors in diagnostic laboratories.
    • The last decade has seen an increased focus on the preanalytical phase, leading to the development of recommendations and standards.

    Controlling Preanalytical Variables

    • Some preanalytical variables, such as specimen variables, can be controlled.
    • A thorough knowledge of uncontrollable variables is necessary to separate their effects from disease-related changes affecting laboratory results.

    Avoiding Errors

    Patient Identification

    • Proper patient identification is essential, requiring 100% accuracy.
    • The label on the tube must match the patient's identification exactly.

    Sample Collection

    • Venipuncture should be performed in the most atraumatic way possible to obtain a blood sample of adequate quality.
    • Traumatic venipuncture can cause sample artefacts, such as spurious hemolysis and formation of macro/micro clots.

    Choice of Anticoagulant and Tube

    • EDTA whole blood is the specimen of choice for most hematology variables.
    • When collecting multiple blood tubes, carryover of anticoagulants or additives should be avoided.
    • Follow the correct order of collection to avoid contamination by EDTA, which can cause false elevations of potassium and false decreases of calcium.
    • Serum gel separator tubes can be used for most biochemical analysis, but should be avoided for hormones and drugs measurements.

    Hematology Samples

    • Hematology samples should be processed and examined immediately, ideally within a few hours of collection.
    • Samples sent to an external laboratory should be refrigerated.

    Biochemistry Testing

    • Serum/plasma should be separated and transferred into a plain tube and kept at refrigeration temperature until analysis.
    • For longer storage, freezing is recommended.

    Normal Range

    • A range of normal values for healthy individuals.
    • Influenced by age, gender, and body conditions.

    Basal State

    • Defines the resting state of the body early in the morning after fasting for 12 hours.
    • Ideal for establishing reference ranges on inpatients.
    • Minimizes effects of diet, exercise, etc. on test results.

    Physiological Variables

    • Factors that affect blood test results, including:
      • Age: RBC, WBC, creatinine clearance
      • Altitude: RBC
      • Dehydration: Hemoconcentration, RBC, enzymes, Fe, Ca, Na
      • Diet: Glucose, lipids, electrolytes
      • Diurnal/circadian variation: TSH, cortisol, Fe
      • Drug therapy: Enzymes, hormones
      • Exercise: pH, PCO2, CK, LDH, glucose
      • Fever: Hormones, cortisol
      • Sex: RBC, Hgb, Hct
      • IM injection: CK, LDH
      • Jaundice: Yellow color interferes
      • Position: Protein, K
      • Pregnancy: RBC
      • Smoking: Chol, cortisol, glucose, GH, triglyceride, WBC
      • Stress: WBC, Fe, ACTH, catecholamine, cortisol
      • Environmental factors: Hemoconcentration

    Patient Complications and Conditions

    • Factors that impact blood collection and test results, including:
      • Adhesive allergy
      • Excessive bleeding
      • Fainting
      • Pain
      • Seizures
      • Mastectomy
      • Paralysis

    Procedural Errors

    • Mistakes during blood collection that can compromise sample quality, including:
      • Hematoma
      • Iatrogenic anemia
      • Nerve damage
      • Reflux of additive
      • Vein damage

    Specimen Quality Concerns

    • Issues that affect the integrity and reliability of blood samples, including:
      • Hemoconcentration
      • Hemolysis
      • Partially filled tubes
      • Specimen contamination
      • Wrong order
      • Clotted anticoagulated specimens
      • IV lines
      • Wrong or expired collection tube
      • Transportation delays
      • Storage conditions

    Importance of Education

    • Educational programs can reduce sample errors and improve patient safety and health system outcomes.

    Hematology Samples

    • Hematology samples should be processed and examined immediately, ideally within a few hours of collection.
    • Samples sent to an external laboratory should be refrigerated.

    Biochemistry Testing

    • Serum/plasma should be separated and transferred into a plain tube and kept at refrigeration temperature until analysis.
    • For longer storage, freezing is recommended.

    Normal Range

    • A range of normal values for healthy individuals.
    • Influenced by age, gender, and body conditions.

    Basal State

    • Defines the resting state of the body early in the morning after fasting for 12 hours.
    • Ideal for establishing reference ranges on inpatients.
    • Minimizes effects of diet, exercise, etc. on test results.

    Physiological Variables

    • Factors that affect blood test results, including:
      • Age: RBC, WBC, creatinine clearance
      • Altitude: RBC
      • Dehydration: Hemoconcentration, RBC, enzymes, Fe, Ca, Na
      • Diet: Glucose, lipids, electrolytes
      • Diurnal/circadian variation: TSH, cortisol, Fe
      • Drug therapy: Enzymes, hormones
      • Exercise: pH, PCO2, CK, LDH, glucose
      • Fever: Hormones, cortisol
      • Sex: RBC, Hgb, Hct
      • IM injection: CK, LDH
      • Jaundice: Yellow color interferes
      • Position: Protein, K
      • Pregnancy: RBC
      • Smoking: Chol, cortisol, glucose, GH, triglyceride, WBC
      • Stress: WBC, Fe, ACTH, catecholamine, cortisol
      • Environmental factors: Hemoconcentration

    Patient Complications and Conditions

    • Factors that impact blood collection and test results, including:
      • Adhesive allergy
      • Excessive bleeding
      • Fainting
      • Pain
      • Seizures
      • Mastectomy
      • Paralysis

    Procedural Errors

    • Mistakes during blood collection that can compromise sample quality, including:
      • Hematoma
      • Iatrogenic anemia
      • Nerve damage
      • Reflux of additive
      • Vein damage

    Specimen Quality Concerns

    • Issues that affect the integrity and reliability of blood samples, including:
      • Hemoconcentration
      • Hemolysis
      • Partially filled tubes
      • Specimen contamination
      • Wrong order
      • Clotted anticoagulated specimens
      • IV lines
      • Wrong or expired collection tube
      • Transportation delays
      • Storage conditions

    Importance of Education

    • Educational programs can reduce sample errors and improve patient safety and health system outcomes.

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    Learn about the preanalytical phase in laboratory medicine, its impact on patient health and safety, and the variables that can affect laboratory results.

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