Autoverification-based algorithms to detect preanalytical errors: Two examples

• Published in: Clinical biochemistry Vol. 115; pp. 126 - 128
• Main Authors: Wei, Ruhan, Légaré, William, McShane, Adam J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023
• Subjects: Alanine Transaminase; Algorithms; Aspartate Aminotransferases; Autoverification; Bilirubin; Humans; Preanalytical errors; Pseudohyperkalemia; Pseudohypoglycemia; Software; Pseudohyperkalemia; Pseudohypoglycemia; Preanalytical errors; Autoverification
• ISSN: 0009-9120; 1873-2933
• DOI: 10.1016/j.clinbiochem.2022.06.010

•Autoverification-based quality rules can prevent the release of potentially erroneous results.•Turbid specimens may account for the majority of lipemia index alarms.•Some cases of pseudohypoglycemia or pseudohyperkalemia may be identified via autoverification-based quality rules. The preanalytical phase of testing accounts for the majority of the errors. Software-based quality rules, such as autoverification, can assist in preanalytical error detection; therefore, preventing erroneous results from being reported. Two autoverification rules, turbidity/lipemia, and pseudohypoglycemia/pseudohyperkalemia alarms, are highlighted. Increased sample turbidity may arise from several causes outside of lipemia. Typically, this can be resolved by clarifying the sample with standard centrifugation. Truly lipemic specimens typically require higher centrifugation speeds and greater centrifugation time. At our facility, 96% of direct bilirubin (DBIL), 95% of aspartate transaminase (AST), and 98% of alanine transaminase (ALT) turbidity/lipemia alarms were found to be from sample turbidity versus lipemia. Secondly, a pseudohypoglycemia/pseudohyperkalemia rule was employed for specimens with delayed separation from cellular material. Of the total potassium results >6.0 mmol/L or glucose results <40 mg/dL (2.2 mmol/L), 30% and 50% respectively were noted to have delayed sample separation.