Specimen Processing and Pre-Analytical Errors

Derived from "Chapter Nine: Specimen Processing and Pre-Analytical Errors"

Test Directory

A directory that phlebotomists and lab personnel are expected to be able to use to great efficiency, containing all apt information for a test including test tube, alternates, processing instructions, storage instructions and rejection criteria

Timing Requirements

Requires collection at a specific time of day; Time of redraw after (a potential) baseline draw are outlined per institution and per medicaiton

Peak and Trough Levels of Medication in the Bloodstream

Peak Levels: reflect the highest concentration of medication in the blood, taken just after administration

Trough Levels: reflect the lowest medication level in the blood, taken around 15 minutes before the next administration of medication in sequence

STAT Specimens

A specimen that must be collected immediately and processed as soon as possible

Pre-Analytical Errors Before Collection

Lack of fasting with NPO order (for tests such as glucose and lipid panels), and failing to pre-warm vials (Used for cold agglutinin and cryoglobulin tests)

Pre-Analytical Errors During Collection

Failing to draw “without stasis” (For tests like Lactic Acid, a tourniquet cannot be used

Pre-Analytical Errors After Collection

Failing to refrigerate or centrifuge (red and gold tubes must be centrifuged), or perform any necessary preservation procedures

Icteric Serum

Serum colored yellow, orange, or even green due to elevated bilirubin

Lipemic Serum

Milky white turbid serum due to high levels of lipids in the blood

Hemolyzed Serum

Will appear red or pink from red blood cells rupturing due to excessive shaking

Aliquoted Specimens

Specimens where the serum or plasma has been removed from the initial draw tube and placed into a transport tube (for tests such as Angiotensin II, B-Type Natriuretic Peptide, or Calcitonin)

Light sensitive specimens

Must be moved to protective casings (amber containers) or wrapped in protective material (aluminum foil) (for tests such as Bilirubin, Vitamin B6, B12 and K

Warmed Specimens

Some specimens must be kept warm after collection for tests such as Cold agglutinin, cryofibrinogen, or cryoglobulin tests

Chilled Specimens

Must be put on ice immediately after collection (ammonia)

Frozen Specimens

Specimens must be frozen directly after the blood draw (for ACTH, Calcitonin, Factor IX, Gastrin, and Hepatitis C Tests)