Continuous-Flow Automation and Hemolysis Index

A paradigm shift has occurred in the role and organization of laboratory diagnostics over the past decades, wherein consolidation or networking of small laboratories into larger factories and point-of-care testing have simultaneously evolved and now seem to favorably coexist. There is now evidence, however, that the growing implementation of continuous-flow automation, especially in closed systems, has not eased the identification of hemolyzed specimens since the integration of preanalytical and analytical workstations would hide them from visual scrutiny, with an inherent risk that unreliable test results may be released to the stakeholders. Along with other technical breakthroughs, the new generation of laboratory instrumentation is increasingly equipped with systems that can systematically and automatically be tested for a broad series of interferences, the so-called serum indices, which also include the hemolysis index. The routine implementation of these technical tools in clinical laboratories equipped with continuous-flow automation carries several advantages and some drawbacks that are discussed in this article.

[1]  M. Harboe,et al.  A method for determination of hemoglobin in plasma by near-ultraviolet spectrophotometry. , 1959, Scandinavian journal of clinical and laboratory investigation.

[2]  G. Lippi,et al.  Darwinian evolution or regression? The fate of laboratory professionals , 2010, Clinical chemistry and laboratory medicine.

[3]  A. Šimundić,et al.  Comparison of visual vs. automated detection of lipemic, icteric and hemolyzed specimens: can we rely on a human eye? , 2009, Clinical chemistry and laboratory medicine.

[4]  Mario Plebani,et al.  Errors in a stat laboratory: types and frequencies 10 years later. , 2007, Clinical chemistry.

[5]  Mario Plebani,et al.  Hemolyzed specimens: a major challenge for emergency departments and clinical laboratories , 2011, Critical reviews in clinical laboratory sciences.

[6]  Giuseppe Lippi,et al.  Risk management in the preanalytical phase of laboratory testing , 2007, Clinical chemistry and laboratory medicine.

[7]  G. Lippi,et al.  Appropriate labelling of blood collection tubes: a step ahead towards patient’s safety , 2011, Clinical chemistry and laboratory medicine.

[8]  G. Lippi,et al.  Laboratory testing in pharmacies , 2010, Clinical chemistry and laboratory medicine.

[9]  G. Lippi,et al.  Erythrocyte mechanical fragility is increased in patients with type 2 diabetes. , 2012, European journal of internal medicine.

[10]  G. Lippi,et al.  Improving the post-analytical phase , 2010, Clinical chemistry and laboratory medicine.

[11]  Mario Plebani,et al.  Is laboratory medicine a dying profession? Blessed are those who have not seen and yet have believed. , 2010, Clinical biochemistry.

[12]  G. Lippi,et al.  Preanalytical variability: the dark side of the moon in laboratory testing / Präanalytische Variabilität: die Schattenseite klinischer Laboruntersuchungen , 2006, Clinical chemistry and laboratory medicine.

[13]  A. Šimundić,et al.  Preanalytical quality improvement: from dream to reality , 2011, Clinical chemistry and laboratory medicine.

[14]  G. Lippi,et al.  Reduction of unsuitable specimens: a more radical and comprehensive approach is needed. , 2011, Clinica chimica acta; international journal of clinical chemistry.

[15]  A. Šimundić,et al.  Hemolysis detection and management of hemolyzed specimens , 2010 .

[16]  G. Lippi,et al.  Influence of mechanical trauma of blood and hemolysis on PFA-100 testing , 2012, Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.

[17]  Choong Weng Lam,et al.  Implementing a Laboratory Automation System , 2010, Journal of laboratory automation.

[18]  W Greg Miller,et al.  Commutability limitations influence quality control results with different reagent lots. , 2011, Clinical chemistry.

[19]  G. Lippi,et al.  Studies on in vitro hemolysis and utility of corrective formulas for reporting results on hemolyzed specimens. , 2011, Biochemia medica.

[20]  H. Schünemann,et al.  Economic evidence in decision-making process in laboratory medicine , 2011, Clinical chemistry and laboratory medicine.

[21]  Carole-Rae Reed,et al.  Hemolysis of coagulation specimens: a comparative study of intravenous draw methods. , 2012, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[22]  Mario Plebani,et al.  The “hospital central laboratory”: automation, integration and clinical usefulness , 2010, Clinical chemistry and laboratory medicine.

[23]  Mario Plebani,et al.  Closing the brain-to-brain loop in laboratory testing , 2011, Clinical chemistry and laboratory medicine.

[24]  M Plebani,et al.  Mistakes in a stat laboratory: types and frequency. , 1997, Clinical chemistry.

[25]  G. Lippi,et al.  Preanalytical variability: the dark side of the moon in laboratory testing , 2006, Clinical chemistry and laboratory medicine.

[26]  Mario Plebani,et al.  Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories , 2008, Clinical chemistry and laboratory medicine.

[27]  Mario Plebani,et al.  Multicenter evaluation of the hemolysis index in automated clinical chemistry systems , 2009, Clinical chemistry and laboratory medicine.

[28]  G. Lippi,et al.  Hemolysis index: quality indicator or criterion for sample rejection? , 2009, Clinical chemistry and laboratory medicine.

[29]  G. Lippi,et al.  Influence of hemolysis on troponin testing: studies on Beckman Coulter UniCel Dxl 800 Accu-TnI and overview of the literature , 2011, Clinical chemistry and laboratory medicine.

[30]  K. Ryder,et al.  Unreliable visual estimation of the incidence and amount of turbidity, hemolysis, and icterus in serum from hospitalized patients. , 1989, Clinical chemistry.