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Daves M.,Laboratorio Of Biochimica Clinica | Salvagno G.L.,University of Verona | Cemin R.,Ospedale Regionale di Bolzano | Gelati M.,University of Verona | And 3 more authors.
Clinical Laboratory | Year: 2012

Background: Reliable information on the potential bias arising from processing in vitro hemolysis specimens referred for conventional cardiac biomarker testing is scarce and controversial as yet. The present investigation was designed to assess the influence of low levels of in vitro hemolysis on cardiac biomarker testing. Methods: Three aliquots, prepared by serial dilutions of homologous hemolysed samples collected from 14 different subjects and containing final concentrations of plasma hemoglobin of 0, 0.3, and 0.6 g/L were tested for the following parameters: cardiac troponin I (cTnI) and T (cTnT), myoglobin (Myo), creatine kinase isoenzyme-MB (CK-MB), brain natriuretic peptide (BNP) and NT-prohormone-brain natriuretic peptide (NT-pro BNP). Results: No statistically significant differences were observed in any of the parameters tested nor did the bias achieve clinical significance. Conclusions: The results of this study show that moderate hemolysis, as low as 0.6 g/L, has no influence on the reliability of cardiac biomarker testing. Source


Lippi G.,U.O. Diagnostica Ematochimica | Caputo M.,Laboratorio Of Patologia Clinica | Banfi G.,University of Milan | Daves M.,Laboratorio Of Biochimica Clinica | And 8 more authors.
Biochimica Clinica | Year: 2011

The presence of hemolysis in a biological blood sample is mainly caused by hemolytic anemia or hemolysis in vitro. The latter is caused by inappropriate collection and processing of biological samples, which may affect the reliability of test results. Hemolysis is assessed by free hemoglobin quantification, whose limit is 0.02 g/L in plasma and 0.05 g/L in serum, and visually observed when the concentration of free hemoglobin exceeds 0.30 g/L. Since hemolysis is the most frequent cause of unsuitable biological samples in clinical laboratories, with a prevalence approaching 3% of all received samples, these recommendations have been drafted specifically to assist laboratory professionals in detection and management of hemolysed specimens. In summary, the recommended approach is based on: (i) systematic detection and quantification of hemolysis, by visual inspection and subsequent quantification of the hemolysis index on all samples with visually detectable hemolysis; (ii) immediate notification to the referring department of the presence of hemolysis in the sample, as locally determined; (iii) suppression of all results affected by the presence and/or degree of hemolysis; and (iv) timely request of a second sample, on which the previously deleted tests can be performed. Source


Lippi G.,U.O. di Diagnostica Ematochimica | Caputo M.,Laboratorio Of Patologia Clinica | Banfi G.,University of Milan | Daves M.,Laboratorio Of Biochimica Clinica | And 8 more authors.
Rivista Italiana della Medicina di Laboratorio | Year: 2011

The presence of haemolysis in a biological blood sample is mainly a result of haemolytic anaemia or haemolysis in vitro. Another cause may be inappropriate handling at the time of collection and processing of the sample, and this may affect the reliability of the test results. Haemolysis is assessed by quantification of free haemoglobin, whose limit is 20 mg/l in plasma and 50 mg/l in serum. Haemolysis can be observed visually when the concentration of free haemoglobin exceeds 300 mg/l. Since haemolysis is the most frequent reason for a biological sample to be considered unsuitable for processing in the clinical laboratory, with a prevalence approaching 3% of all samples received, these consensus recommendations have been drafted specifically to assist laboratory professionals in the detection and management of haemolysed specimens. The recommended approach can be summarized as follows: (1) systematic detection and quantification of haemolysis by visual inspection and subsequent quantification of the haemolysis index in all samples with visually detectable haemolysis; (2) immediate notification to the referring department of the presence of haemolysis in the sample, as locally determined; (3) suspension of all tests affected by the presence and/or the degree of haemolysis detected; and (4) timely request for a second sample to allow the tests previously suspended to be performed. © SIBioC-SIMeL. Source


Lippi G.,U.O. Diagnostica Ematochimica | Mattiuzzi C.,Servizio Governance Clinica | Banfi G.,University of Milan | Buttarello M.,Laboratorio Analisi | And 11 more authors.
Biochimica Clinica | Year: 2013

The collection of venous blood is central in clinical laboratory activity. Although there is widespread perception that this practice is simple and free of complications and side effects, it is undeniable that the vast majority of laboratory errors arises from ignorance, incompetence or negligence during venipuncture. It has hence become advisable to prepare a document in simplified form of checklist, consisting of a concise but comprehensive list of activities to be completed or verified in order to prevent errors during venous blood collection. In the intention of authors, this synthetic checklist is a modular tool, adaptable to different local contexts, it can be easily and gradually implemented, it is supported by scientific evidence and consensus of experts and created with the support of different healthcare professionals and it is adherent to the best practices and requires minimal resources for implementation. It is reasonable to assume that this checklist may be able to withstand system and individual changes, strengthening the standards for safety of both operators and patients, limiting potential failure patterns. We hope that the checklist may be implemented in all healthcare facilities where routine venous blood collection is performed, after adaptation to suit characteristics of local organization. Source


Lippi G.,U.O. Diagnostica Ematochimica | Mattiuzzi C.,Servizio Governance Clinica | Banfi G.,University of Milan | Buttarello M.,Laboratorio Analisi | And 11 more authors.
Rivista Italiana della Medicina di Laboratorio | Year: 2013

Summary: The collection of venous blood is essential to obtain biological samples for performance of laboratory testing. Although there is widespread perception that this practice is simple and free of complications and side effects, it is undeniable that the vast majority of laboratory errors arises from ignorance, incompetence or negligence during venipuncture. It has hence become advisable to edit a document in simplified form of checklist, consisting of a concise but comprehensive list of activities to complete or verify, in order to prevent the onset of errors during venous blood collection. In the intention of authors and of the Italian societies of laboratory medicine, this synthetic checklist is a modular tool, adaptable to different local contexts, it can be easily and gradually implemented, is supported by scientific evidence and consensus of experts, has been created with the support of different healthcare professionals, is adherent to the best practices and requires minimal resources for implementation. It is reasonable to assume that this checklist may be able to withstand system and individual changes, strengthening the standards for safety of both operators and patients, limiting potential failure patterns. We also hope that the checklist may be implemented in all healthcare facilities where routine venous blood collection is performed, after adaptation to suit characteristics of local organization. © 2013 Springer-Verlag Italia. Parole chiave: Emolisi ChecklistCampioni non idoneiVariabilità preanalitica Prelievo venoso Raccomandazioni. Source

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