PREANALYTIC GUIDELINES OF AMERISPEC DIAGNOSTICS
There are many factors that contribute to accurate test results in the laboratory. One of this factor is preanalytical variables which account for almost 32-75% of laboratory errors, it includes the time of ordering the test by the physician until the sample is ready for analysis.
The goal of this guideline is to prevent all preanalytical errors to accurately give results to every patient of Amerispec Diagnostics.
1 – Request Form
Enter all the demographics of patient on the request form legibly and accurately. Name, Date of birth and patient file number must be filled-up to have at least two unique identifiers for each patient. Enter the facility name on the space provided.
It is crucial to identify a patient properly so that blood is being collected from the correct person, have them provide their full name by asking the patient.
Kindly check the test required on the request form and the appropriate sample, written as “S” for serum and “WB” for whole blood, are indicated next to it.
2 – Patient preparation
Prior to collecting specimens, certain patient variables need to be considered. As for certain analytes, patients need to be fasting (absence of food and liquids).
3 – Specimen Collection Tubes and Materials
Vacutainers and collection materials are provided to all clients, this is done by request. Clients will be provided along with the collection manual and evaluation form. Where they can fill-up the form and their experiences with collection materials and suggestions if any.
4 – Sample volume
It is essential to fill up the vacutainers containing anticoagulant. Most of the anticoagulated tubes has its “Mark” on the tube due to standardized dilution. Please ensure to provide the sample volume needed for each requested analysis. Please refer on the chart “Oder of Draw” below based on international standards for correct sample volume requirements.
5 – Specimen Labelling
Incorrect labelling of specimen accounts to most of the preanalytical errors. Using the verified request form of the patient write all the identifiers on the tubes, unique for specific patient.
6 – Clotted Specimen
Serum specimens, namely red top tubes and serum separator gel tubes, need to clot completely prior to centrifugation and processing. Blood specimens should clot for 20 to 30 minutes in room temperature to ensure complete clot formation. Tubes are then centrifuged and must be spun at the speed of 3500rpm for 5 minutes.
Blood specimens collected in EDTA tubes, for Immunosuppressant Drug Panel, are properly mixed immediately to avoid clot formation. Please refer on the “Oder of Draw” below based on international standards for proper order of draw of blood and proper mixing.
7 – Hemolysis
Hemolysis may be due to improper specimen collection. Prolonged or strong application of tourniquet and difficulty during blood collection are most cases of hemolysis. This will interfere significantly in most analytes in Clinical Chemistry. Suggest that highly skilled phlebotomist and phlebotomy training must be there in each facility. Additional, tourniquet application must be loosened in less than 30 seconds after the needle has inserted and blood flows in the tube and not more than 1 minute.
8 – CBC’s
A manual or automated blood differential is difficult to interpret when the blood sample was kept more than 4 hours. The blood cells deteriorate and show significant different morphology.
9 – Split Samples
Splitting of samples is known to lead to patient sample confusions in the clinics. We highly recommend, sending us the original or mother tubes.
10 – Sample Leak
Please ensure to keep the sample safe from leakage. Securely screw the cap or double seal the container using parafilm. Leaking samples are hazardous for personnel including non-medical staff, like logistics and front office. Kindly use closed systems with appropriate symbol as provided by Amerispec Diagnostics.
11 – Stapling of Bags
Please avoid stapling of bags. Kindly use the sealable ziplock to seal the pouches. Use the rear pocket provided for request form.
12 – Storage and Transport.
Amerispec Diagnostics has provided temperature controlled boxes which are monitored every sample collection. Please ensure to follow the appropriate storage of sample as per requirement of the tests in Directory of Services, that is Ambient, Refrigerate and Freeze.
13 – Order of Draw
Order of draw is based on Clinical and Laboratory Standard Institute.