Preanalytical Variables in Hemostasis Testing.

Hemostasis testing performed in clinical laboratories are critical for assessing hemorrhagic and thrombotic disorders. The assays performed can be used to provide the information required for diagnosis, risk assessment, efficacy of therapy, and therapeutic monitoring. As such, hemostasis tests should be performed to the highest level of quality, including the standardization, implementation, and monitoring of all phases of the testing, which include the preanalytical, analytical, and post-analytical phases. It is well established that the preanalytical phase is the most critical component of the testing process, being the hands-on activities, including patient preparation for blood collection, as well as the actual blood collection, including sample identification and the post-collection handling to include sample transportation, processing, and storage of samples when testing is not performed immediately. The purpose of this article is to provide an update to the previous edition of coagulation testing-related preanalytical variables (PAV) and, when properly addressed and performed, can reduce the most common causes of errors in the hemostasis laboratory.

Gosselin RC 《-》

Preanalytical Issues in Hemostasis and Thrombosis Testing.

Lippi G ，Favaloro EJ 《-》

Post-analytical Issues in Hemostasis and Thrombosis Testing: An Update.

There are typically three phases identified as contributing to the total testing process. The preanalytical phase starts with the clinician and the patient, when laboratory testing is being considered. This phase also includes decisions about which tests to order (or not), patient identification, blood collection, blood transport, sample processing, and storage to name a few. There are many potential failures that may occur in this preanalytical phase, and these are the topic of another chapter in this book. The second phase, the analytical phase, represents the performance of the test, which is essentially covered in various protocols in this book and the previous edition. The third is the post-analytical phase, which is what occurs after sample testing, and is the topic of the current chapter. Post-analytical issues are generally related to reporting and interpretation of test results. This chapter provides a brief description of these events, as well as guidance for preventing or minimizing post-analytical issues. In particular, there are several strategies for improved post-analytical reporting of hemostasis assays, with this providing the final opportunity to prevent serious clinical errors in patient diagnosis or management.

Favaloro EJ ，Gosselin RC ，Pasalic L ，Lippi G ... -  《-》

Quality standards for sample processing, transportation, and storage in hemostasis testing.

Samples for hemostasis testing drawn into sodium citrate anticoagulant are vulnerable to the effects of preanalytical variables associated with sample processing, transportation, and storage. These variables include the temperature at which samples are transported and stored; the stability of the samples once processed; whether maintained at room temperature, refrigerated, or frozen; methods of centrifugation; as well as the potential impact of using an automated line. Acknowledgment of these variables, as well as understanding their potential impact on assay results, is imperative to the reporting of high quality and accurate results. This article discusses the preanalytical issues associated with sample processing, transportation, and storage and also presents the ideal conditions for sample handling.

Adcock Funk DM ，Lippi G ，Favaloro EJ 《-》

Review of coagulation preanalytical variables with update on the effect of direct oral anticoagulants.

There are many preanalytical variables (PAV) that are known to affect coagulation testing. The more commonly acknowledged PAV addressed by the clinical laboratory tend to start with their influence on blood collection, but realistically coagulation PAV starts with the patient, where the laboratory has less influence or control. Patient selection and appropriate timing for blood collection may be integral for assuring proper diagnosis and management. Laboratory control and assurance for ideal phlebotomy practice would mitigate most PAVs related to blood collection to minimize suboptimal sample collection. Laboratory oversight of sample transportation, processing and storage will assure sample integrity until testing can be facilitated. The purpose of this document is to review common PAV that should be taken into consideration when ordering, performing and interpreting a coagulation test result, with additional attention to the effect of direct oral anticoagulants (DOACs).

Gosselin RC 《-》