Effects of centrifugation prior to pneumatic tube system transport on routine biochemical and immunological tests of susceptibility to hemolysis.
Author(s): Yang RX, Qiu SJ, Song WJ, Zhang H, Zhang BF, Xu HG
Publication: Clin Chim Acta, 2023, Vol. 541, Page 117242
PubMed ID: 36739074 PubMed Review Paper? No
Purpose of Paper
The purpose of this paper was to compare levels of potassium, glucose, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), insulin, and neuron-specific enolase (NSE) between hand-delivered specimens and specimens transported by pneumatic tube system (PTS) as blood, serum in the original tube, and serum in an Eppendorf tube. The levels of potassium, glucose, AST, LDH, insulin, and NSE were also compared between hand-delivered specimens and those transported by PTS 0, 1, 2, and 3 times.
Conclusion of Paper
Levels of potassium, glucose, and AST were comparable in specimens that were transported by PTS and those that were hand-delivered. LDH and NSE were significantly higher when blood was transported by PTS rather than hand-delivered, and NSE was significantly higher when serum was transported by PTS in the original tube than when blood was hand-delivered. Although significant differences in the percentage bias were observed for potassium, AST, LDH, insulin, and NSE in PTS delivered specimens relative to hand-delivered specimens, only the biases in LDH and NSE were considered clinically relevant. Significant correlations were observed between the number of PTS transport segments (number of trips) and the level of glucose, AST, LDH, insulin, and NSE. Levels of LDH and NSE in blood increased with each PTS segment, while glucose declined and AST increased were in blood transported by PTS 3 times compared to blood that was hand-delivered. The biases in LDH and NSE exceeded the maximum allowable bias and were considered clinically relevant even after a single PTS transport segment of blood. Bias in all remaining analytes was clinically unacceptable in specimens transported 3 times.
Studies
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Study Purpose
The purpose of this study was to compare levels of potassium, glucose, AST, LDH, insulin, and NSE between hand-delivered specimens and specimens transported by PTS as blood or serum in the original tube, and serum in an Eppendorf tube. Levels of potassium, glucose, AST LDH, insulin, and NSE were also compared between hand-delivered specimens and those transported by PTS 0, 1, 2, and 3 times. Blood was collected from 32 donors (diagnosis was not specified) and case-matched tubes that were: 1) hand-delivered, 2) transported by PTS, 3) centrifuged (3000 rpm at 4°C for 10 min) and then transported by PTS in the original tube and 4) centrifuged (3000 rpm at 4°C for 10 min) and the resultant serum was transported by PTS in an Eppendorf tube. The distance that specimens were transported was 200 m and transport occurred within approximately 30 min of venipuncture. To investigate the potential effects of repeated transport by PTS, case-matched blood specimens were transported by PTS 0, 1, 2, and 3 times. Levels of potassium, glucose, AST, and LDH were analyzed using a Beckman Coulter AU5800 machine and levels of insulin and NSE were quantified using a Cobas 602 ECL analyzer.
Summary of Findings:
Levels of potassium, glucose, and AST were comparable between specimens that were transported by PTS and those that were hand-delivered, while levels of LDH and NSE were significantly higher when blood was transported by PTS compared to those that were hand-delivered (P<0.001, both) and NSE levels were significantly higher when serum was transported by PTS in the original tube than when blood was hand-delivered (P<0.05). Relative to specimens that were hand-delivered, the percentage bias in potassium, AST, LDH, insulin, and NSE levels was significantly affected by transport condition (P<0.05 all), with the least bias observed when serum was transported in an Eppendorf tube and the most bias when blood was transported by PTS. However, the authors report that biases were considered clinically irrelevant with the exception of LDH and NSE. When blood was transported by centrifugation, the bias in LDH exceeded the maximum allowed bias in 36 of the 48 specimens evaluated and the maximum absolute bias exceeded the clinical acceptable limits. Similarly, the bias in NSE levels exceeded the clinically allowable error when blood was transported by PTS or when serum was transported in the original tube.
Significant correlations were observed between the number of PTS segments (number of PTS transports) and the level of glucose (R=-0.233, P=0.008), AST (R=0.230, P=0.009), LDH (R=0.614, P<0.001), insulin (R=0.178, P=0.045) and NSE (R=0.753, P<0.001). While LDH and NSE increased with each PTS segment, as significantly higher levels were found in specimens transported ≥1 time versus hand-delivered specimens (P<0.01 and P<0.002, respectively), glucose was significantly lower and AST was significantly higher in specimens transported by PTS 3 times compared to those that were hand-delivered (P<0.05, both). The percentage bias of all six analytes was higher in specimens transported by PTS 3 times compared to those transported once. Importantly, the biases in LDH and NSE exceeded the maximum allowable bias and were considered clinically relevant even after a single PTS transport segment and the bias in all analytes was clinically unacceptable in specimens transported by PTS 3 times.
Biospecimens
Preservative Types
- None (Fresh)
Diagnoses:
- Not specified
Platform:
Analyte Technology Platform Carbohydrate Clinical chemistry/auto analyzer Protein Clinical chemistry/auto analyzer Peptide Clinical chemistry/auto analyzer Electrolyte/Metal Clinical chemistry/auto analyzer Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Storage Specimen transport duration/condition As blood
As serum in original tube
As serum in Eppendorf tube
Transported by PTS once
Transported by PTS twice
Transported by PTS three times
Hand delivered
Storage Within hospital transportation method Hand-delivered
Pneumatic tube system