Effects of Long Distance Transportation of Specimens on Test Results

Hwan Sub Lim; You Kyung Lee; Won Ki Min

doi:10.3343/lmo.2011.1.2.2

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Lim, Lee, and Min: Effects of Long Distance Transportation of Specimens on Test Results

Original Article

Clinical Chemistry

Laboratory Medicine Online

Laboratory Medicine Online 2011; 1(2): 72-80.

Published online: 1 April 2011

DOI: https://doi.org/10.3343/lmo.2011.1.2.2

Effects of Long Distance Transportation of Specimens on Test Results

Hwan Sub Lim¹, You Kyung Lee², Won Ki Min³

¹Department of Laboratory Medicine, Kwandong University College of Medicine, Goyang, Korea.

²Laboratory Medicine and Genetics, Soonchunhyang University Bucheon Hospital and Soonchunhyang University College of Medicine, Bucheon, Korea.

³Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

Corresponding author: Hwan Sub Lim. Depatment of Laboratory Medicine, Myongji Hospital, Kwandong University College of Medicine, 697-24 Hwajeong-dong, Deogyang-gu, Goyang 412-270, Korea. TEL: +82-31-810-7081, FAX: +82-31-962-1352, capt95@kd.ac.kr/capt95@hitel.net

Received 10 July 2010 Revised 14 October 2010 Accepted 2 November 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Accuracy of laboratory test results is an important issue. New guidelines for specimen delivery systems are needed for appropriate pretreatment of specimens and accuracy of results.

Methods

We evaluated various laboratory profiles, comparing the effects of specimen rack holders and coolants within transport containers. The hematology profiles (complete blood cell count [CBC], erythrocyte sedimentation rate [ESR]), chemistry profiles (aspartate aminotransaminase [AST], alanine aminotransaminase [ALT], gamma-glutamyl transferase [γ-GT], electrolytes [Na, K, Cl], glucose, lactate dehydrogenase [LD], creatinine kinase [CK]), and coagulation profiles (prothrombin time [PT], activated partial thromboplastin time [aPTT], fibrinogen level). We also investigated the effects of transportation time including the presence or absence of hemolyzation. We received from 9 different university hospital laboratories using conventional transporation methods.

Results

Hemolytic features were seen in short drawn specimens. Fewer result variations were observed in specimens transported with coolants. Average specimen transportation time was 11.3 hours, and average temperatures of container was 10.9℃ with coolant and 25.0℃ without coolants. Non-centrifuged specimens transported with coolants showed increased serum K levels than centrifuged specimens. Coagulation tests showed less than a 10% differences. Centrifuged specimen prior to transportation showed no hemolyzation and no differences in results.

Conclusions

Appropriate temperatures for each analyte should be defined to ensure the accuracy of results. To reduce hemolyzation, appropriate temperature and rack holder should be used. Temperature of the transport container should be monitored in objectively. Coagulation tests should be added as referral tests, if appropriate specimen transport monitoring system for time and temperature could be adopted.

Keywords: Specimen delivery, Container, Hemolysis

Figures and Tables

Fig. 1

Serum K Levels (mmol/L) changed according to transportation time elapsed

Table 1

Complete blood cell count results according to transportation time (hours)

Abbreviations: WBC, white blood cell Count; Hb, hemoglobin; Hct, hematocrit; PLT, platelet.

Table 2

Chemistry test results according to transportation time (hour)

^*NT= Not tested.

Abbreviations: AST, aspartate aminotransaminase; ALT, alanine aminotransaminase; γ-GT, gamma-glutamyl transaminase; Na, sodium; K, potassium; Cl, chloride; LD, lactate dehydrogenase; CK, creatine kinase.

Table 3

Coagulation test results according to transportation time (hours)

Abbreviations: PT, prothrombin time; INR, international normalized ratio; aPTT, activated partial thromboplastin time.

Table 4

Temperature changes (℃) observed according to transportation time and external temperature of the transport vehicle

Table 5

Average transport time (hours) between participating laboratories and the central laboratory of reference laboratory

^*Time elapsed between collection of blood sample from patient and transfer to the transporter; ^†Time elapsed between hospital laboratory and regional office of reference laboratory; ^‡Time elapsed between regional office and central laboratory of reference laboratory.

Table 6

Average temperature (℃) of sample transport container

^*Average temperature measured from sample drawn through whole transportation process.

Table 7

Average CBC & ESR result differences (%) of between participants' and reference laboratories

Abbreviations: WBC white blood cell count; Hb, hemoglobin; Hct, hematocrit; PLT, platelet; ESR, erythrocyte sedimentation rate.

Table 8

Average blood chemistry (SST) test result differences (%) between participants' and reference laboratories

Table 9

Average blood chemistry (plain tube) test result differences (%) between participants' and reference laboratories

Table 10

Average coagulation test result differences (%) between participants' and reference laboratories

Abbreviations: PT, prothrombin time; INR, international normalized ratio; aPTT, activated partial thromboplastin time.

Notes

This article is available from http://www.labmedonline.org

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