Volume 5, Issue 2, March 2019, Page: 33-40
Impact of Laboratory Diagnostic Preanalytics on Patient Blood Management
Kathrin Schlatterer, Department of Laboratory Medicine, Sankt Gertrauden-Krankenhaus, Berlin, Germany; Institute of Clinical Chemistry and Laboratory Medicine, University Medicine of Greifswald, Greifswald, Germany
Kathrin Schlüter, BD Life Sciences, Becton Dickinson GmbH, Heidelberg, Germany
Received: Mar. 14, 2019;       Accepted: May 15, 2019;       Published: Jun. 29, 2019
DOI: 10.11648/j.ijcems.20190502.12      View  174      Downloads  22
Abstract
This study was designed to investigate the possibility of reducing diagnostic blood loss as a lab-side element of Patient Blood Management. To this end, the nominal blood volume of blood collection tubes was reduced and, additionally, preanalytical processes were optimised to minimise repeated blood collections. These interventions were conducted in conjunction with a change of blood collection system. Auditing the preanalytical phase and observing sample quality before and after the interventions enabled the assessment of changes in preanalytical quality. The occurrence of several blood collection non-compliances had decreased substantially one year after preanalytical training and conversion to the different blood collection system. Improvement of preanalytical quality combined with reduction of tube blood volumes led to a significant decrease in the volume of blood drawn for diagnostic purposes, corresponding to a reduction of 177 L per year for the whole hospital. We also observed a reduction in the total number of blood collection tubes used. An analysis of data for geriatric and Intensive Care Unit (ICU) ward types, where there is a known risk of iatrogenic anaemia, revealed significant blood savings. In conclusion, targeted preanalytical training measures and introduction of blood collection tubes with lower draw volumes enable significant reductions in the volume of patient blood drawn for laboratory diagnostics, and so represent an important contributor to patient blood management.
Keywords
Preanalytical Phase Audit, Sample Quality, Diagnostic Blood Loss, Patient Blood Management
To cite this article
Kathrin Schlatterer, Kathrin Schlüter, Impact of Laboratory Diagnostic Preanalytics on Patient Blood Management, International Journal of Clinical and Experimental Medical Sciences. Vol. 5, No. 2, 2019, pp. 33-40. doi: 10.11648/j.ijcems.20190502.12
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
World Health Organization (2011) Global Forum for Blood Safety: Patient Blood Management. http://www.who.int/bloodsafety/events/gfbs_01_pbm_concept_paper.pdf
[2]
Wisser, D. van Ackern, K. Knoll, E. Wisser, H. and Bertsch T. (2003) Blood loss from laboratory tests. Clinical Chemistry, 49, 1651-1655.
[3]
Ranasinghe, T. and Freeman, W. D. (2014) “ICU vampirism” – time for judicious blood draws in critically ill patients. British Journal of Haematology, 164, 302-303.
[4]
Levi, M. (2014) Twenty-five million litres of blood into the sewer. Journal of Thrombosis and Haemostasis, 12, 1592.
[5]
Spethmann, J. Schlüter, K. and Schlatterer, K. (2018) Laboratory medicine contributions to patient blood management concepts. Journal of Laboratory Medicine, 42, 81–87.
[6]
Dugan, L. Leech, L. Speroni, K. G. and Corriher, J. (2005) Factors affecting hemolysis rates in blood samples drawn from newly placed IV sites in the emergency department. Journal of Emergency Nursing, 31, 338-345.
[7]
Kotter, J. P. (1996) Leading Change. Boston: Harvard Business School Press.
[8]
Clinical and Laboratory Standards Institute (2007) Procedures for the collection of diagnostic blood specimens by venipuncture. PA: CLSI 6th ed. Wayne, H3-A6.
[9]
World Health Organization (2010). WHO guidelines on drawing blood: best practices in phlebotomy. WHO Document Production Services, Geneva.
[10]
Chant, C. Wilson, G. and Friedrich, J. O. (2006) Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study. Critical Care, 10, R140.
[11]
Tosiri, P. Kanitsap, N. and Kanitsap, A. (2010) Approximate iatrogenic blood loss in medical intensiv care patients and the causes of anemia. Journal of the Medical Association of Thailand, 93, 271-276.
[12]
Lippi, G. Blanckaert, N. Bonini, P. Green, S. Kitchen, S. Palicka, V. et al. (2008) Haemolysis: an overview of the leading cause of unsuitable specimens in clinical laboratories. Clinical Chemistry and Laboratory Medicine, 46, 764-772.
[13]
Lippi, G. Plebani, M. Di Somma, S. and Cervellin, G. (2011) Hemolyzed specimens: a major challenge for emergency departments and clinical laboratories. Critical Reviews in Clinical Laboratory Sciences, 48, 143-153.
[14]
Tate, J. and Ward, G. (2004) Interferences in Immunoassay. The Clinical Biochemist Reviews, 25, 105-120.
[15]
Hintereder, G. (2017) Patient blood management – Labormedizinische Unterstützung und POCT. Journal of Laboratory Medicine, 41, 219–227.
[16]
McCall, S. J. Souers, R. J. Blond, B. and Massie, L. (2016) Physician Satisfaction With Clinical Laboratory Services: A College of American Pathologists Q-Probes Study of 81 Institutions. Archives of Pathology and Laboratory Medicine, 140, 1098-1103.
[17]
Jones, B. A. Walsh, M. K. and Ruby, S. G. (2006) Hospital nursing satisfaction with clinical laboratory services: a College of American Pathologists Q-Probes study of 162 institutions. Archives of Pathology and Laboratory Medicine, 130, 1756-1761.
[18]
Quaseem, A. Alguire, P. Dallas, P. Feinberg, L. E. Fitzgerald, F. T. Horwitch, C. et al. (2012) Appropriate use of screening and diagnostic tests for foster high-value, cost-conscious care. Annals of Internal Medicine, 156, 47-49.
[19]
Farmer, S. L. Towler, S. C. Leahy, M. F. and Hofmann, A. (2013) Drivers for change: Western Australia Patient Blood Management Program (WA PBMP), World Health Assembly (WHA) and Advisory Committee on Blood Safety and Availability (ACBSA). Best Practice & Research: Clinical Anaesthesiology, 27, 43-58.
[20]
Meybohm, P. Fischer, D. P. Geisen, C. Müller, M. M. Weber, C. F. Herrmann, E. et al. (2014) Safety and effectiveness of a Patient Blood Management (PBM) program in surgical patients--the study design for a multi-centre prospective epidemiologic non-inferiority trial. BMC Health Services Research, 14, 576.
[21]
Meybohm P. Herrmann E. Steinbicker A. U. Wittmann M. Gruenewald M. Fischer D. et al. (2016) Patient Blood Management is Associated With a Substantial Reduction of Red Blood Cell Utilization and Safe for Patient's Outcome: A Prospective, Multicenter Cohort Study With a Noninferiority Design. Annals of Surgery, 264, 203-211.
[22]
Zacharowski K. and Spahn D. R. (2016) Patient Blood Management equals patient safety. Best Practice & Research: Clinical Anaesthesiology, 30, 159-169.
[23]
Fischer D. P. Zacharowski K. Müller M. M. Geisen C. Seifried E. Müller H. et al. (2015) Patient Blood Management implementation strategies and their effect on physicians' risk perception, clinical knowledge and perioperative practice - the Frankfurt experience. Transfusion Medicine and Hemotherapy, 42, 91-97.
[24]
Müller M. M. Fischer D. Stock U. Geisen C. Steffen B. Nussbaumer J. et al. (2014) Patient Blood Management-The preoperative patient. Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, 49, 246-253.
[25]
Fischer D. Geisen C. Steffen B, Meybohm P. Schmitz-Rixen T. (2014) Patient Blood Management-The inpatient care. Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, 49, 256-264.
[26]
Fischer D. P. Zacharowski K. Meybohm P. (2014) Savoring every drop - vampire or mosquito? Critical Care, 18, 306.
Browse journals by subject