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Impact of Pneumatic Transport System on Preanalytical Phase Affecting Clinical Biochemistry Results.

Author(s): Kumari S, Kumar S, Bharti N, Shekhar R

Publication: J Lab Physicians, 2023, Vol. 15, Page 48-55

PubMed ID: 37064988 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study compared levels of 25 biochemistry analytes and hemolysis indices in paired blood specimens transported by pneumatic tube system (PTS) with those that were hand-delivered; comparisons were drawn both before and after corrective action to reduce hemolysis during transport in the PTS system. Blood was collected from 100 healthy volunteers (age 18-60 years) into two clot activator and two potassium fluoride tubes using a 21-gauge needle before and after alteration of the PTS system. PTS system alterations included adding cushioning in the carrier and below the station, reprogramming to the shortest possible path, and decreasing the blower pressure applied to the carrier from ±160 mbar to ±105 mbar, resulting in an increase in transit time from 61 (±10) seconds to 106 (±7) seconds.  One tube of each type was transported by PTS while the other was hand-delivered. After arrival, tubes were placed in an ATRAS machine for sorting, and analytes were quantified using Beckman Coulter AU 5800 and DxC 700 AU analyzers. Specimens with >0.3 g/L of hemoglobin were considered hemolyzed. Clinical significance was set at a change > 10% or changes of ≥0.075 mmol/L for calcium, ≥3.0 mmol/L for sodium, and ≥0.3 mmol/L for potassium.

   Summary of Findings:

   In the initial analysis, a total of 9% of PTS transported samples and 2.5% of hand-delivered specimens were classified as hemolyzed (>0.3 g/L of hemoglobin).  Levels of potassium, LDH, AST, and phosphorus were higher in specimens transported by PTS compared to matched hand-delivered specimens (p=0.000, p=0.001, p=0.025, and p=0.047, respectively), and levels of bilirubin and direct bilirubin were lower in PTS transported specimens (p=0.032 and p=0.47, respectively). The increases in LDH and potassium were considered clinically significant (>10%), and, according to the authors, were likely the result of hemolysis. Levels of sodium, potassium, and AST were still significantly higher in PTS transported after corrective action than hand-delivered specimens (p=0.045, p=0.012, and p=0.042, respectively), but the differences were smaller and no longer clinically significant. Further, only 2.5% of PTS transported and 2% of hand-delivered samples were hemolyzed after corrective action. Levels of calcium, chloride, creatinine, high-density lipoprotein, sodium, urea, alanine aminotransferase, albumin, alkaline phosphatase, amylase, glucose, iron, low-density lipoproteins, magnesium, protein, total cholesterol, triglycerides, and uric acid were unaffected by PTS transport.

    

   Biospecimens

   • Bodily Fluid - Blood

   Preservative Types

   • None (Fresh)

   Diagnoses:

   • Not specified

   Platform:

   Analyte	Technology Platform
   Carbohydrate	Clinical chemistry/auto analyzer
   Electrolyte/Metal	Clinical chemistry/auto analyzer
   Steroid	Clinical chemistry/auto analyzer
   Protein	Clinical chemistry/auto analyzer
   Small molecule	Clinical chemistry/auto analyzer
   Lipid	Clinical chemistry/auto analyzer

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Storage	Specimen transport duration/condition	Pre-corrective action to PTS system After corrective action (additional cushioning, lowering blower speed, and reducing transport distance)
   Storage	Within hospital transportation method	Hand-delivered Pneumatic tube system

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