Pre-analytical errors in coagulation testing: a case series.

IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL
Diagnosis Pub Date : 2024-01-01 eCollection Date: 2024-02-01 DOI:10.1515/dx-2023-0110
Mala Mahto, Visesh Kumar, Ayan Banerjee, Sushil Kumar, Anurag Kumar
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引用次数: 0

Abstract

Objectives: Prevention of pre-analytical issues in coagulation testing is of paramount importance for good laboratory performance. In addition to common issues like hemolysed, icteric, or lipemic samples, some specific pre-analytical errors of coagulation testing include clotted specimens, improper blood-to-anticoagulant ratio, contamination with other anticoagulants, etc. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are very commonly affected tests due to pre-analytical variables. The impact these parameters possess on surgical decision-making and various life-saving interventions are substantial therefore we cannot afford laxity and casual mistakes in carrying out these critical investigations at all.

Case presentation: In this case series, a total of 4 cases of unexpectedly deranged coagulation profiles have been described which were reported incorrectly due to the overall casual approach towards these critical investigations. We have also mentioned how the treating clinician and lab physician retrospectively accessed relevant information in the nick of time to bring back reassurance.

Conclusions: Like every other critical investigation, analytical errors can occur in coagulation parameters due to various avoidable pre-analytical variables. The release of spurious results for coagulation parameters sets alarm bells ringing causing much agony to the treating doctor and patient. Only a disciplined and careful approach taken by hospital and lab staff towards each sample regardless of its criticality can negate these stressful errors to a large extent.

凝血检测中的分析前误差:病例系列。
目的:预防凝血检测中的分析前问题对实验室的良好表现至关重要。除了溶血、黄疸或脂血样本等常见问题外,凝血检测中一些特殊的分析前错误还包括样本凝结、血液与抗凝剂比例不当、受其他抗凝剂污染等。凝血酶原时间(PT)和活化部分凝血活酶时间(aPTT)是非常常见的因分析前变量而受影响的检测项目。这些参数对手术决策和各种挽救生命的干预措施具有重大影响,因此我们在进行这些关键检查时绝不能松懈和随意出错:在本病例系列中,共描述了 4 例意外凝血功能失常的病例,由于对这些关键检查的整体随意性,这些病例被错误报告。我们还提到了主治临床医生和实验室医生是如何在关键时刻回顾性地获取相关信息,从而使患者恢复信心的:与其他所有关键检查一样,凝血参数也会因各种可避免的分析前变量而出现分析错误。虚假的凝血参数结果一经公布,就会给医生和患者敲响警钟,造成极大的痛苦。只有医院和实验室工作人员对每个样本(无论其关键性如何)都采取严谨细致的态度,才能在很大程度上避免这些令人紧张的错误。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Diagnosis
Diagnosis MEDICINE, GENERAL & INTERNAL-
CiteScore
7.20
自引率
5.70%
发文量
41
期刊介绍: Diagnosis focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.  Topics: -Factors that promote diagnostic quality and safety -Clinical reasoning -Diagnostic errors in medicine -The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns -Improving the value of diagnosis – eliminating waste and unnecessary testing -How culture and removing blame promote awareness of diagnostic errors -Training and education related to clinical reasoning and diagnostic skills -Advances in laboratory testing and imaging that improve diagnostic capability -Local, national and international initiatives to reduce diagnostic error
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