Preanalytical issues identification and prevention in clinical hematology laboratory: best practice for patient safety

Kuntal Patel


Introduction: Pre-analytical variable includes sample collection, transport, handling, physiological influences and/or interference factors. As the blood collection is the first step, any error in this step will endanger the whole test results, no matter how accurately these are analyzed in the laboratory. Material and Method: In present prospective study, some common issues in blood collection and handling in hospital inpatient and outdoor patient departments of Dhiraj General Hospital (tertiary health care center in Vadodara) have been discussed by giving some expected solutions. Pre-analytics involve the patient, the physician, the resident doctor, the nursing staff, the laboratory technician, the laboratory personnel and the transport service. Result: A total of 13178 received samples, the number of preanalytical issues documented were 185 in OPD and 388 in IPD. Conclusion: All the staff is required to know about preanalytical variables, their possible sources and their effect on the test results and ultimate outcome on patient’s safety. Moreover, since the resident doctors have a direct interaction with the paramedical staff, it is very important for them to understand the preanalytical variables so that they could instruct the paramedical staff accordingly.

Full Text:



Leape, LL. Errors in medicine. Clin Chim Acta 2009; 404 (1):2–5. doi: 10.1016/j.cca.2009.03.020.

Adegoke OA, Idowu A, Jeje O. Incomplete laboratory request forms as a contributory factor to preanalytical errors in a Nigerian teaching hospital. Afr J Biochem Res. 2011;5(3):82-85.

Burnett L. Chesher D, Mudaliar Y. Improving the quality of information on pathology request forms. Ann Clin Biochem.2004;41(1):53-56. doi: 10. 1258/000456304322664708

Lippi G, Blanckaert N, Bonini P, et al. Causes, consequences, detection and prevention of identification errors in laboratory diagnostics. Clin Chem Lab Med. 2009; 47 (2): 143–153. doi: 10. 1515/ CCLM. 2009.045

Plebani M. Errors in clinical laboratories or errors in laboratory medicine? Clin Chem Lab Med. 2006;44 (6) : 750-759. doi: 1515/ CCLM. 2006.123

Lundberg GD. Acting on significant laboratory results. JAMA.1981;245(17):1762-1763.doi:10.1001 / jama. 1981.0331 0420052032

Carraro P. Hemolyzed specimens: A reason for rejection or a clinical challenge? Clin Chem. 2000; 46 (2) : 306-307.

Narayanan S, Hamasaki N. Current concepts of coagulation and fibrinolysis. Adv Clin Chem 1999; 33:133-168.doi: 60207-3

Jones BA, Calam RR, Howanitz PJ. Chemistry specimen acceptability. A College of American Pathologists Q-Probes study of 453 laboratories. Arch Pathol Lab Med. 1997;121(1):19-26.

Kirchner MJ, Funes VA, Adzet CB. Quality indicators and specifications for key processes in clinical laboratories: a preliminary experience. Clin Chem Lab Med 2007; 45(5):672-677.doi: https://doi. org/10. 1515/CCLM.2007.122

Jay DW, Provasek D. Characterization and mathematical correction of hemolysis interference in selected Hitachi 717 assays. Clin Chem. 1993;39(9): 1804-1810.

Fidler JR. Task analysis revisited: Refining the phlebotomy technician scope of practice and assessing longitudinal change in competencies. Eval Health Prof. 2007:30(2):150-169. doi: 01632 78707300631

Plebani M, Laposata M, Lundberg GD. The brain-tobrain loop concept for laboratory testing 40 years after its introduction. Am J Clin Pathol 2011; 136(6):829-833. doi: 10.1309/ AJCPR28 HWH SSD NON.

Boone DJ. Governmental perspectives on evaluating laboratory performance. Clin Chem. 1993;39(7):1461–1467.

Bonini P, Plebani M, Ceriotti F. Errors in laboratory medicine. Clin Chem. 2002;48(6):691-698.

Carraro P, Plebani M. Errors in a stat laboratory: Types and frequencies 10 years later. Clin Chem. 2007; 53(7):1338–1342. doi: 10.1373/clinchem.2007.088344


  • There are currently no refbacks.