Original scientific paper

https://doi.org/10.11613/BM.2018.030711

A collaborative study by the Working Group on Hemostasis and Thrombosis of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) on the interference of haemolysis on five routine blood coagulation tests by evaluation of 269 paired haemolysed/non-haemolysed samples

Chiara Novelli ; Transfusion Center and Haematology Laboratory, Western Milan Area Hospital Consortium, Legnano General Hospital, Legnano, Italy
Matteo Vidali ; Clinical Chemistry Unit, Maggiore della Carità Hospital, Novara, Italy
Bruno Brando ; Transfusion Center and Haematology Laboratory, Western Milan Area Hospital Consortium, Legnano General Hospital, Legnano, Italy
Benedetto Morelli ; Synlab Laboratory, Castenedolo, Italy
Giovanna Andreani ; Clinical Chemistry Laboratory, Apuan Hospital, Massa, Italy
Marina Arini ; Clinical and Microbiological Analysis Laboratory, Dell’Angelo Hospital, Mestre, Italy
Paola Calzoni ; Clinical Pathology, University Hospital of Siena, Siena, Italy
Roberta Giacomello ; Department of Medical Area, University of Udine, Department of Laboratory Medicine, ASUI UD, University Hospital, Udine, Italy
Barbara Montaruli ; Laboratory Analysis, A.O. Ordine Mauriziano, Turin, Italy
Emanuela Muccini ; Clinical Biochemistry Laboratory, Azienda O.U. S. Giovanni Battista, Turin, Italy
Angela Papa ; Laboratory Medicine, G. Monasterio Foundation, CNR-Regione Toscana, Pisa, Italy
Paola Pradella ; Transfusion Medicine, University Hospital “Ospedali Riuniti” of Trieste, Trieste, Italy
Lucia Ruocco ; Clinical Analysis Laboratory, University Hospital of Pisa, Pisa, Italy
Fosca Siviero ; Laboratory Medicine, Bassano del Grappa Hospital, Bassano del Grappa, Italy
Filomena Gemma Viola ; Department of Laboratory Medicine, Tor Vergata University Hospital of Rome, Rome, Italy
Mario Zanchetta ; Laboratory Analysis, Degli Infermi Hospital, Ponderano, Italy
Lorena Zardo ; Laboratory Analysis, San Giacomo Apostolo Hospital, Castelfranco Veneto, Italy
Giuseppe Lippi ; Section of Clinical Biochemistry, University of Verona, Verona, Italy

Abstract

Introduction: Haemolysis is the leading cause of sample rejection in laboratory haemostasis. Most studies focused on artificially haemolysed samples.
The aim of this study was a prospective assessment of spontaneous haemolysis on haemostasis tests, by comparing results of haemolysed (H)
versus new, non-haemolysed (NH) specimens, collected within 4hrs. As new coagulometers can identify interfering substances, visual assessment of
haemolysis was also compared with instrumental haemolysis index and stratified in subclasses.
Materials and methods: Two hundred and sixty nine paired samples were collected and analysed using ACL TOP750-CTS (Instrumentation Laboratory,
Bedford, USA), for prothrombin time (PT), activated partial thromboplastin time (aPTT), D-Dimer (DD), fibrinogen (Fib) and antithrombin
(AT). Bias between H and NH was calculated and compared with the respective critical difference (CD).
Results: Mean bias was - 0.1 s for PT (P = 0.057), - 1.1 s for aPTT (P < 0.001), 1025 ng/mL for DD (P < 0.001), - 0.04 g/L for Fib (P = 0.258) and 1.4%
for AT (P = 0.013). Bias exceeding the CD varied according to the method, with larger differences for aPTT (36.1%) and DD (17.1%) and < 8% for PT,
Fib and AT. No correlation emerged between free haemoglobin values and difference in haemostasis tests in H and NH samples for any tests. Moderate/
severe haemolysis involved > 95% of samples. The agreement between visual assessment and instrumental evaluation of haemolysis was 0.62.
Conclusion: Spurious haemolysis deeply influences aPTT and DD, and to a lesser extent AT and Fib. Prothrombin time seems only slightly influenced,
suggesting that PT can be accepted also in haemolysed samples. Although a good inter-observer correlation of haemolysis evaluation was found,
the instrumental assessment of haemolysis seems recommendable.

Keywords

blood coagulation tests; haemolysis; preanalytical phase

Hrčak ID:

206663

URI

https://hrcak.srce.hr/206663

Publication date:

15.10.2018.

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