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Clinical Chemistry and Laboratory Medicine (CCLM)

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In This Section
Volume 47, Issue 12 (Dec 2009)


Preanalytical mistakes in samples from primary care patients

Adolfo Romero
  • Clinical Laboratory, University Hospital Virgen de la Victoria, Málaga, Spain
/ Andrés Cobos
  • Clinical Laboratory, University Hospital Virgen de la Victoria, Málaga, Spain
/ Ana López-León
  • Guadalhorce Primary Health Care District, Málaga, Spain
/ Germán Ortega
  • Málaga Primary Health Care District, Málaga, Spain
/ Manuel Muñoz
  • GIEMSA, School of Medicine, Málaga, Spain


Background: Preanalytical mistakes (PAMs) in samples usually led to rejection upon arrival to the clinical laboratory. However, PAMs might not always be detected and result in clinical problems. Thus, PAMs should be minimized. We detected PAMs in samples from Primary Health Care Centres (PHCC) served by our central laboratory. Thus, the goal of this study was to describe the number and types of PAMs, and to suggest some strategies for improvement.

Methods: The presence of PAMs, as sample rejection criteria, in samples submitted from PHCC to our laboratory during October and November 2007 was retrospectively analysed.

Results: Overall, 3885 PAMs (7.4%) were detected from 52,669 samples for blood analyses. This included missed samples (n=1763; 45.4% of all PAMs, 3.3% of all samples), haemolysed samples (n=1408; 36.2% and 2.7%, respectively), coagulated samples (n=391; 10% and 0.7%, respectively), incorrect sample volume (n=110; 2.8% and 0.2%, respectively), and others (n=213; 5.5% and 0.4%, respectively). For urine samples (n=18,852), 1567 of the samples were missing (8.3%).

Conclusions: We found the proportion of PAMs in blood and urine samples to be 3-fold higher than that reported in the literature. Therefore, strategies for improvement directed towards the staff involved, as well as an exhaustive audit of preanalytical process are needed. To attain this goal, we first implemented a continued education programme, financed by our Regional Health Service and focused in Primary Care Nurses.

Clin Chem Lab Med 2009;47:1549–52.

Keywords: blood sampling; mistake detection; preanalytical mistakes; primary health care

About the article

Corresponding author: Adolfo Romero, Sede Provincial SATSE, C/La Regente 20 Bajo B, 29007 Málaga, Spain Phone: +34 677 215 287, Fax: +34 952 303 119,

Received: 2009-05-27

Accepted: 2009-08-03

Published in Print: 2009-12-01

Citation Information: Clinical Chemistry and Laboratory Medicine, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2009.338.

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©2009 by Walter de Gruyter Berlin New York. Copyright Clearance Center

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