Faculty of Medical Technology

Clinical Biochemistry

Laboratory errors
Collected and prepared by:

ESAM ALFAGIEH
4th year of medical technology
2013-2014

Laboratory errors
What are lab errors?
Can we stop them?
How do we stop them?

REPORTING

ORDERING

Error
s
INTERPRETING

Lab Errors
Laboratory errors may be defined as any

defect from ordering tests to reporting

results and interpreting
Repeat sample?
Costs Money & Time

:Phases of Lab Analysis

Pre analytical phase
Analytical phase
Post analytical phase

65%
20%
15%

80% of errors are unrelated to analysis

Pre-analytical phase
o Test Ordering.
o Sample collection.
o Sample transport to the lab.
o Sample processing or preparation for

testing.

Test Ordering
Unsuitable tests.
Patient Preparation.
Handwriting.
Patient misidentification.
Orders Test on incorrect Patient.
Written Orders are not Correctly

Transcribed (LFT, RFT).

Written Orders are not Legible.

Patient Preparation
Fasting
Postprandial
Before or After Medication Dosage
At specific time in a hormonal cycle
(Patient not obey the instructions)

Sample collection
- Phlebotomy errors
- Site selection
- Choice of Collection Area:
- Hematoma.
- Indwelling IV.
- Tube selection

Sample collection
- Phlebotomy errors

- Tourniquet Application
(No > 1 Minute).
- Allow for Complete Drying of Alcohol.
- Selection of Correct Needle Size
(18 to 23 Gauge May Be Used).
- Complete Fill of Tubes
(Over or under filling).

:Coagulation Tube Filling

Handling of Tubes Post Collection

Invert as per Manufacturers Instructions

3 -10 times (Additive Driven).

Effects of Improper Inversion (Clotted Samples).

Do NOT SHAKE (Hemolysis).

Handling of Tubes Post Collection

Avoid Excessive Heat or Cold (Hemolysis).
Never Expose Whole Blood to Dry Ice

(Hemolysis).
Protect from Light if Necessary Amber

Tubes.

Sample transport to the lab

- Transport All Samples to the Laboratory as

Efficiently as Possible
- Light exposure

50% drop of bilirubin

- Excessive heat
Hemolysis
- Unspun samples K, LDH, ALT, AST, Ammonia.
Glucose, Ca++.

Sample processing or preparation for

testing
- Delivery to Departments
- Temporary Specimen Storage
- Specimen Separation
- Centrifuging

Other pre-analytical
Variables
Controllable variables
Non controllable variables

Controllable variables
- Diet
- Life style (smoking, alcohol ingestion, drug

administration)
- Drugs
- Physiological variables (prolonged bed rest,

exercise)

Non controllable variables

- Biological variables (Age, sex & race)
- Environmental variables (seasonal

influences)
- Obesity
- Pregnancy
- Stress

Analytical errors: (testing)

-Equipment:
Automation versus manual Inadequate Q/A
-Reagents:
Quality, Storage conditions, Expiry
-Technique:
Specificity & Sensitivity
-Personal (technologist)
Tech fail to follow procedure.

:Post-analytical
- Reporting.
- Typing errors.

Pre-analytical Issues
Associated with Specimen
Processing
Hemolysis
Allow complete clot formation to occur
Centrifuge promptly
- speed (high speed lead to hemolysis)

Hemolysis
The presence of hemolysis

in the serum or plasma of

a sample appears as
a pink or red color to the
liquid.
See the sample to the right.

Causes of Hemolysis
Prolonged tourniquet application
Incomplete alcohol drying following site

preparation.
Rupture of red cells when collected with
small bore needle
Tissue trauma during collection.

Causes of Hemolysis
Vigorous shaking of collection tubes.
Freezing of red blood cells during storage

or transportation.
Exposure of cells to excessive heat during
storage or transportation.

Hemolysis

K, CK, LDH, Mg.

Glucose, Bilirubin.

Most frequent causes of

pre-analytical errors
Open tube (container).
Tube not signed.
Tube not correctly identified.
Clotted sample.
Wrong tube.
Quantity Not Sufficient (QNS).
Broken tube.
Hemolyzed sample.
Lack of signature.

Suggested quality
indicators for
preanalytical phase
Standard operating procedures (SOP)

for specimen acceptance/rejection.

Identification of reasons for specimen

rejection.

Miss-concept
Lab staff alone are responsible for

lab errors.
WRONG !!!
Labs, Physicians and Patients are
All RESPONSIBLE.

Controlling Laboratory errors

- Continuous education.
- Automation.
- Quality control(QC).
- Internal QC:
- daily monitoring of precision & accuracy of a

particular lab (calibrators & controls).

- External QC:
- long term accuracy of different labs.

Thanks for your Attention.

We can only be as good as the

samples we receive!