PB2425 THE IMPACT OF SPECIMEN VOLUME AND HAEMOLYSIS ON ROUTINE COAGULATION TEST RESULTS: REDUCING THE RECOLLECTION BURDEN IN A HIGH‐THROUGHPUT LABORATORY
Notice bibliographique
Résumé
Background: The inability to process haemolysed and underfilled specimens has been a perennial problem in routine coagulation testing causing delays, inconvenience and increased costs. While there has always been a degree of ambiguity surrounding the true impact of these pre‐analytical variables on test results, the general consensus is that they should not be tested. The controversy has been amplified in recent years with studies suggesting that some test results from haemolysed and underfilled specimens may in fact be reportable. However to date, these findings have not been incorporated into best practice guidelines. Aims: This study evaluated the effect of both haemolysis and inadequate volume on routine coagulation testing to provide laboratories with more scope to reduce the number of recollected specimens than the guidelines currently allow. Methods: From November 2016 to March 2017 at Wellington Hospital New Zealand, the Prothrombin Time (PT), Activated Partial Prothrombin Time (APTT) and Fibrinogen results of the original rejected haemolysed / underfilled specimens were compared with those of the recollected specimens. Specimens were rejected if they were >10% underfilled or contained >0.40 g/L free Haemoglobin (Hb). All testing was performed using photo‐optical measurements on a Sysmex® CS‐2100i coagulation analyser. Statistical analysis was performed using regression analysis and 2‐tailed paired t tests. Results: A total of 83 consecutive paired patient specimens included in the study were either underfilled (n = 41) or haemolysed (n = 42). In volume studies, we showed that accurate results are still achieved for PT if a specimen is >73% filled (R2 = 0.9879, y = 0.9964x; P < 0.05), APTT if a specimen is >79% filled (R2 = 0.9665, y = 0.9752x; P < 0.05) and fibrinogen if the specimen is >59% filled (R2 = 0.9587, y = 0.977x; P < 0.05). It should be noted however that our data was limited below a fill volume of 80%. In haemolysis studies, there was no statistically significant difference in PT results (R2 = 0.9879, y = 0.9637x; P < 0.05) or fibrinogen results (R2 = 0.9607, y = 1.0162x; P < 0.05) at any level of haemolysis. APTTs showed a statistically significant difference overall (R2 = 0.87, y = 0.9684x; P < 0.05), however the only clinically meaningful differences were observed in three paired samples with >1 g/L free Hb. Incorporation of these findings into our processes at Wellington Hospital reduced the number of recollected specimens by approximately 90%. Summary/Conclusion: This study has validated a minimal fill volume of 80% and a maximum haemolysis level of 1 g/L free Hb for PT, APTT and Fibrinogen. Evidence‐based acceptance criteria was developed using these findings resulting in significant cost savings, improved turnaround times and increased satisfaction across clinical and allied health teams. This review offers a clinically appropriate solution to a problem which has always hindered routine coagulation testing.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,027 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».