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Effect of different pre-analytical conditions on plasma lactate concentration

Ivana Rako ; Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Croatia
Ana Mlinaric ; Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Croatia
Monika Dozelencic ; Department of Biochemistry and Haematology, General Hospital “Dr. Ivo Pedišić”, Sisak, Croatia
Gordana Fressl Juros ; Department of Clinical Laboratory Diagnostics, Children’s Hospital Srebrnjak, Zagreb, Croatia
Dunja Rogic ; Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Croatia

Puni tekst: engleski pdf 272 Kb

str. 266-275

preuzimanja: 228



Introduction: Plasma lactate is a frequently used and important parameter for medical decision making. To setup a pre-analytical algorithm, we
aimed to investigate the influence of different test tube additives, aliquoting, ice storage and haemolysis on plasma lactate concentrations for possible
sparing critically ill (ICU) patients of additional blood drawing.
Materials and methods: In our study (N = 177), lactate concentration and haemolysis index (HI) were measured in aliquoted (AHP) and unaliquoted
(HP) Li-heparin, NaF/K3EDTA and NaF/KOX plasma, centrifuged within 15 minutes after venipuncture, on Cobas c501 analyzer. Differences
were tested using the Wilcoxon’s test and Passing-Bablok regression. Clinical accuracy of results was assessed in 107 ICU patients based on reference
interval and clinical decision limits.
Results: Lactate concentrations did not differ in NaF/K3EDTA and NaF/KOX plasma (P = 0.855). No clinically significant difference of AHP compared
to NaF/K3EDTA lactate was found (y = 0.13 (0.08 to 0.19) + 1.02 (0.99 to 1.08) x) if samples were aliquoted within 30 minutes after venipuncture. On
contrary, lactate concentrations in HP showed significant proportional difference (y = 0.07 (- 0.12 to 1.24) + 1.37 (1.22 to 1.56) x) and were clinically
incorrect in 14% of patients. Transport in ice bath increases HI in NaF/K3EDTA (P < 0.001), but without influencing lactate results compared to room
temperature (y = 0.03 (- 0.06 to 1.00) + 1.05 (0.99 to 1.11) x).
Conclusions: Lactate determination in HP is unacceptable because of high proportional error and high risk of clinical inaccuracy compared to NaF/
K3EDTA. If pre-analytical conditions are met, AHP, NaF/K3EDTA and NaF/KOX plasma can be used interchangeably. Aliquoted Li-heparin samples alow
measurement of other biochemical tests from a single tube and can spare ICU patients from additional blood drawing. Storage in ice bath provides
no additional stabilization in NaF/K3EDTA tubes.

Ključne riječi

plasma lactate, blood analysis, blood specimen collection, haemolysis, pre-analytical phase

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