Incorrect order of draw could be mitigate the patient safety: a phlebotomy management case report

Procedures involving phlebotomy are critical for obtaining diagnostic blood specimens and represent a well known and recognized problem, probably among the most important issues in laboratory medicine. The aim of this report is to show spurious hyperkalemia and hypocalcemia due to inadequate phlebotomy procedure. The diagnostic blood specimens were collected from a male outpatient 45 years old, with no clinical complaints. The tubes drawing order were as follows: i) clot activator and gel separator (serum vacuum tube), ii) K₃EDTA, iii) a needleless blood gas dedicated-syringe with 80 I.U. lithium heparin, directly connected to the vacuum tube holder system. The laboratory testing results from serum vacuum tube and dedicated syringe were 4.8 and 8.5 mmol/L for potassium, 2.36 and 1.48 mmol/L for total calcium, respectively. Moreover 0.15 mmol/L of free calcium was observed in dedicated syringe. A new blood collection was performed without K₃EDTA tube. Different results were found for potassium (4.7 and 4.5 mmol/L) and total calcium (2.37 and 2.38 mmol/L) from serum vacuum tube and dedicated syringe, respectively. Also free calcium showed different concentration (1.21 mmol/L) in this new sample when compared with the first blood specimen. Based on this case we do not encourage the laboratory managers training the phlebotomists to insert the dedicated syringes in needle-holder system at the end of all vacuum tubes. To avoid double vein puncture the dedicated syringe for free calcium determination should be inserted immediately after serum tubes before EDTA vacuum tubes.     

Environmental conditions,air pollutants,and airway cells in runners: A longitudinal field study

Abstract

Runners have increased numbers of neutrophils in the airways at rest and after exercise compared with sedentary individuals. The aim of this study was to determine whether Mediterranean seasonal changes in temperature, humidity or airborne pollutants affect the airway cells of runners training outdoors in an urban environment. In nine male amateur runners, cell composition, apoptosis, and inflammatory mediators were measured in induced sputum collected at rest (baseline) and the morning after races held in the fall (21 km), winter (12 km), and summer (10 km). Concentrations of air pollutants were below the alert threshold at all times. Neutrophil differential counts tended to increase after all races (P = 0.055). Apoptosis of neutrophils increased with ozone (P < 0.005) and particulate matter <10 μm (PM₁₀) (P < 0.05) exposure. Bronchial epithelial cell counts were low at all times and weakly correlated with ozone and PM₁₀ concentrations. Apoptotic bronchial epithelial cells increased after all races (P < 0.05). Inflammatory mediators in induced sputum were low at baseline and after the races, and correlated with neutrophil differential counts only at rest. In conclusion, apoptosis of airway cells in runners appears to be affected by both exercise and environmental conditions. Apoptosis of neutrophils increased with exposure to environmental pollutants while apoptosis of bronchial epithelial cells increased after intense exercise. Since no relationship was observed between neutrophil counts and inflammatory mediators 20 h after races, airways inflammation at this time point appears blunted in healthy runners and little affected by exposure to mild seasonal changes and airborne pollutants.     

Repeated sprint ability in young basketball players: one vs. two changes of direction (Part 2)

The aim of this study was to compare the training effects based on repeated sprint ability (RSA) (with one change of direction) with an intensive repeated sprint ability (IRSA) (with two changes of direction) on jump performance and aerobic fitness. Eighteen male basketball players were assigned to repeated sprint ability and intensive repeated sprint ability training groups (RSAG and IRSAG). RSA, IRSA, squat jump (SJ), countermovement jump (CMJ) and Yo-Yo intermittent recovery level 1 test were assessed before and after four training weeks. The RSA and IRSA trainings consisted of three sets of six sprints (first two weeks) and eight sprints (second two weeks) with 4-min sets recovery and 20-s of sprints recovery. Four weeks of training led to an overall improvement in most of the measures of RSA, but little evidence of any differences between the two training modes. Jump performance was enhanced: CMJ of 7.5% (P < 0.0001) and 3.1% (P = 0.016) in IRSAG and RSAG respectively. While SJ improved of 5.3% (P = 0.003) for IRSAG and 3.4% (P = 0.095) for RSAG. Conversely the Yo-Yo distance increased 21% (P = 0.301) and 34% (P = 0.017) in IRSAG and RSAG respectively. Therefore, short-term repeated sprint training with one/two changes of direction promotes improvements in both RSA and IRSA respectively but the better increase on jump performance shown a few changes on sprint and endurance performances.     

Ammonium oxalate treatment: Evaluation by μ-Raman mapping of the penetration depth in different plasters

This study is focused on the evaluation by μRaman mapping of the penetration depth achieved by ammonium oxalate treatment in different plaster specimens, a hot issue in the conservation field. The role of the carbonatic aggregate particles and the influence of the different variables of the treatment on the penetration depth and on the distribution of the newly-formed phase (whewellite) have been ascertained. Based on the results of μRaman mapping, analyses with Field Emission Scanning Electron Microscopy have been carried out in order to observe the whewellite crystals and the carbonatic aggregate particles involved in the reaction with ammonium oxalate.     

Physiological characteristics of America's Cup sailors

The aim of this study was to assess the physiological profile of America's Cup grinders and mastmen, by measuring energy expenditure during sailing and assessing their aerobic and anaerobic fitness. The study focused on estimating the energy used during grinding activity, by measuring oxygen uptake (VO(2)) during sail setting in real sailing conditions. In the laboratory, using an arm-cranking ergometer, we measured VO(2peak) during an incremental maximal exercise test and total energy expended during the effort and recovery phases of an all-out test that simulated grinding activity, in six grinders and mastmen and ten sailors of the same crew. Total energy used during grinding corresponded to 45% (s = 9) and 51% (s = 5) of that used in the all-out test (234 kJ, s = 21.7) for tacks and gybes, respectively. In both grinding activity and the all-out test, VO(2) increased during and after the effort. The "VO(2) top value" was 53% (s = 8.6), 68% (s = 5.5), and 78% (s = 3.1) of VO(2peak) (4.7 l . min(-1), s = 0.43) in tacks, gybes, and the all-out test, respectively. During fast sequences of grinding activity, the "VO(2) top value" reached 65% (s = 7.1) VO(2peak) in tacks and 91% (s = 3.3) VO(2peak) in gybes. Our results suggest that grinders and mastmen are characterized by a high anaerobic capacity but their performance can be improved by powering aerobic fitness, to increase this energy contribution to all-out efforts and to guarantee fast recovery when grinding activity is repeated with short rest intervals.     

Critical review and meta-analysis of spurious hemolysis in blood samples collected from intravenous catheters

Background:

A number of preanalytical activities strongly influence sample quality, especially those related to sample collection. Since blood drawing through intravenous catheters is reported as a potential source of erythrocyte injury, we performed a critical review and meta-analysis about the risk of catheter-related hemolysis.

Materials and methods:

We performed a systematic search on PubMed, Web of Science and Scopus to estimate the risk of spurious hemolysis in blood samples collected from intravenous catheters. A meta-analysis with calculation of Odds ratio (OR) and Relative risk (RR) along with 95% Confidence interval (95% CI) was carried out using random effect mode.

Results:

Fifteen articles including 17 studies were finally selected. The total number of patients was 14,796 in 13 studies assessing catheter and evacuated tubes versus straight needle and evacuated tubes, and 1251 in 4 studies assessing catheter and evacuated tubes versus catheter and manual aspiration. A significant risk of hemolysis was found in studies assessing catheter and evacuated tubes versus straight needle and evacuated tubes (random effect OR 3.4; 95% CI = 2.9–3.9 and random effect RR 1.07; 95% CI = 1.06–1.08), as well as in studies assessing catheter and evacuated tubes versus catheter and manual aspiration of blood (OR 3.7; 95% CI = 2.7–5.1 and RR 1.32; 95% CI = 1.24–1.40).

Conclusions:

Sample collection through intravenous catheters is associated with significant higher risk of spurious hemolysis as compared with standard blood drawn by straight needle, and this risk is further amplified when intravenous catheter are associated with primary evacuated blood tubes as compared with manual aspiration.     

Glycogen phosphorylase isoenzyme BB in the diagnosis of acute myocardial infarction: a meta-analysis

Background

Early diagnosis is crucial for management of patients with suspected acute myocardial infarction (AMI). Among innovative and promising biomarkers, the recent interest raised on glycogen phosphorylase isoenzyme BB (GPBB) has prompted us to perform a meta-analysis of published studies.

Materials and methods:

A systematic electronic search was carried out on PubMed, Web of Science and Google Scholar, with no date restriction, to retrieve all articles that have investigated the early diagnostic performance of GPBB in patients with suspected AMI, and directly reported or allowed calculation of sensitivity and specificity. A meta-analysis of the reported sensitivity and specificity of each study and pooled area under the curve (AUC) was then performed by random effect approach. Heterogeneity was assessed by I-square statistics.

Results:

Eight studies were finally selected for analysis (941 subjects; 506 cases and 435 controls), with a high heterogeneity (I-squared, 86.3%). The resulting pooled estimates and 95% confidence interval were 0.854 (0.801–0.891) for sensitivity, 0.767 (0.713–0.815) for specificity, 0.826 (0.774–0.870) for negative predictive value, 0.802 (0.754–0.844) for positive predictive value, and 0.754 (0.602–0.907) for AUC. In those studies that have simultaneously assessed GPBB and a troponin immunoassay, the combination of these biomarkers did not significantly improve the performance of troponin alone.

Conclusion:

GPBB does not meet the current requirements for an efficient diagnosis of AMI when used as a stand-alone test, whereas its combination with troponin merits further investigation in larger trials.     

Contamination of lithium heparin blood by K2-ethylenediaminetetraacetic acid (EDTA): an experimental evaluation

Introduction:

The contamination of serum or lithium heparin blood with ethylenediaminetetraacetic acid (EDTA) salts may affect accuracy of some critical analytes and jeopardize patient safety. The aim of this study was to evaluate the effect of lithium heparin sample contamination with different amounts of K₂EDTA.

Materials and methods:

Fifteen volunteers were enrolled among the laboratory staff. Two lithium heparin tubes and one K₂EDTA tube were collected from each subject. The lithium-heparin tubes of each subject were pooled and divided in 5 aliquots. The whole blood of K₂EDTA tube was then added in scalar amount to autologous heparinised aliquots, to obtained different degrees of K₂EDTA blood volume contamination (0%; 5%; 13%; 29%; 43%). The following clinical chemistry parameters were then measured in centrifuged aliquots: alanine aminotranspherase (ALT), bilirubin (total), calcium, chloride, creatinine, iron, lactate dehydrogenase (LD), lipase, magnesium, phosphate, potassium, sodium.

Results:

A significant variation starting from 5% K₂EDTA contamination was observed for calcium, chloride, iron, LD, magnesium (all decreased) and potassium (increased). The variation of phosphate and sodium (both increased) was significant after 13% and 29% K₂EDTA contamination, respectively. The values of ALT, bilirubin, creatinine and lipase remained unchanged up to 43% K₂EDTA contamination. When variations were compared with desirable quality specifications, the bias was significant for calcium, chloride, LD, magnesium and potassium (from 5% K₂EDTA contamination), sodium, phosphate and iron (from 29% K₂EDTA contamination).

Conclusions:

The concentration of calcium, magnesium, potassium, chloride and LD appears to be dramatically biased by even modest K₂EDTA contamination (i.e., 5%). The values of iron, phosphate, and sodium are still reliable up to 29% K₂EDTA contamination, whereas ALT, bilirubin, creatinine and lipase appear overall less vulnerable towards K₂EDTA contamination.     

Avoidance to wipe alcohol before venipuncture is not a source of spurious hemolysis

Background

It is still uncertain whether or not avoidance to let disinfectant alcohol dry at the site of venipuncture is a source of spurious hemolysis when drawing venous blood.

Methods:

In a consecutive series of 52 outpatients referred for routine laboratory testing, venous blood was drawn by direct venipuncture with (odd group) or without (pair group) wiping 70% isopropyl alcohol at the site of venipuncture. A 3.5 mL evacuated tube with clot activator and gel separator was drawn from a vein of the upper limb, serum was immediately separated with standard centrifugation and tested for potassium, lactate dehydrogenase (LD), aspartate aminotransferase (AST) and hemolysis index (HI) on Roche Cobas.

Results:

No specimen was discarded for unsatisfactory venipuncture. No differences for age and gender were observed between groups. As regards the four parameters investigated, no significant differences could be observed between patients in whom blood was drawn with or without letting the alcohol dry. It is also noteworthy that no sample in both groups exceeded the conventional sample rejection threshold of cell-free hemoglobin.

Conclusions:

The results of our prospective, randomized study attest that failure to wipe alcohol at the site of venipuncture should not be considered as a potential source of spurious hemolysis when drawing blood.     

Disambiguated query suggestions and personalized content-similarity and novelty ranking of clustered results to optimize web searches

In this paper, we face the so called “ranked list problem” of Web searches, that occurs when users submit short requests to search engines. Generally, as a consequence of terms’ ambiguity and polysemy, users engage long cycles of query reformulation in an attempt to capture relevant information in the top ranked results.