Preanalytical Flow Chart - Factors Affecting Hemolysis
The flow chart summarizes sources of potential preanalytical errors that may occur in the specimen workflow, which may lead to hemolysis and variability in analytical accuracy.
Also included is a pdf of the preanalytical factors that may cause hemolysis, their possible consequences, corrective actions and references to literature relative to the corrective actions.
Factors Affecting Hemolysis Preanalytical Specimen Workflow (PDF, opens in a new browser tab)
Patient
- In Vivo Hemolysis due to patient factors (PDF, opens in a new browser tab)
- Metabolic Disorders (eg. Liver disease)
- Chemical Agents (eg. Medication)
- Physical Agents (eg. Mechanical heart valves)
- Infectious Agents (eg. Bacteria)
Phlebotomy
- Catheter, IV Collection (PDF, opens in a new browser tab)
- Capillary Collection (PDF, opens in a new browser tab)
- Needle Gauge (PDF, opens in a new browser tab)
- Position of Arm
- Location of Venipuncture (PDF, opens in a new browser tab)
- Antiseptic Used for Phlebotomy (PDF, opens in a new browser tab)
- Tourniquet Time (PDF, opens in a new browser tab)
- Traumatic Draw (PDF, opens in a new browser tab)
- Fist Clenching
- Tube Type Collected (PDF, opens in a new browser tab)
- Tube Under Filled (PDF, opens in a new browser tab)
- Order of Draw
- Vigorous Mixing (PDF, opens in a new browser tab)
- No Mixing (PDF, opens in a new browser tab)
- Syringe transfer (PDF, opens in a new browser tab)
Specimen Transport
- Origin of Specimen Maternity, Emergency & Intensive Care
- Origin of Specimen In-patient
- Origin of Specimen Physician Office Lab
- Origin of Specimen Outpatient
- Tubes Transported Vertical or Horizontal
- Transport by Pneumatic Tube (PDF, opens in a new browser tab)
- Courier Transport (PDF, opens in a new browser tab)
- Transport Duration (PDF, opens in a new browser tab)
- Pre-Centrifugation & Transport Temperature (PDF, opens in a new browser tab)
Processing
- Verify Tube with Request
- Generate Laboratory Barcode
- Time between Collection & Centrifugation (PDF, opens in a new browser tab)
- Type of Centrifuge
- Centrifuge Calibrated
- Centrifuge Temperature Extremes (PDF, opens in a new browser tab)
- Speed of Centrifuge (PDF, opens in a new browser tab)
- Duration of Centrifugation
- Poor Separator Barrier Integrity (PDF, opens in a new browser tab)
- Cells on Stopper
- Automated Decapping
- Specimen Re-Centrifugation (PDF, opens in a new browser tab)
- Aliquot Labeling
- Specimen Aliquoted
Analysis
- Long Time after Centrifugation
- Serum vs. Plasma vs. Whole Blood
- Tube Mixed Prior to Analysis
- Re-Run Specimen (Same Day)
- Verify Instrument Call & Controls
- Identify Instrument Used for Testing
- Identify Tech Performing Testing
- Verify Report Value
Specimen Storage
- Re-Centrifugation Add-On (PDF, opens in a new browser tab)
- Post-Analysis Storage Temperature (PDF, opens in a new browser tab)
- Duration of Storage (PDF, opens in a new browser tab)
- Red- Steps that may cause hemolysis
- Black- Steps not likely the cause of hemolysis
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The information contained in these documents is not a substitute for informed judgement and the reader shall be solely responsible for decisions that may arise in whole or in part from the use or reliance upon information contained in these documents. To the extent permitted by applicable law, neither BD nor the author(s) shall be liable for any decisions made, action taken or inaction in reliance on the information, statements, evaluations or recommendations set forth in these documents.
