Increased specimen minimum volume reduces turnaround time and hemolysis

• Published in: Clinical biochemistry 2023-05, Vol.115, p.137-143
• Main Authors: Qavi, Abraham J., Franks, Caroline E., Grajales-Reyes, Gary, Anderson, Jeanne, Ashby, Lori, Zohner, Kimberly, Gronowski, Ann M., Farnsworth, Christopher W.
• Format: Article
• Language: English
• Subjects: Clinical Laboratory Services; Hemolysis; Hospitals; Humans; Laboratories; Laboratories, Clinical; Short samples; Turn-Around-Time
• ISSN: 0009-9120; 1873-2933
• DOI: 10.1016/j.clinbiochem.2022.03.008

Quantity not sufficient (QNS) specimens with minimal blood volume for testing are common in clinical laboratories. However, there is no universal definition of minimum volume for a QNS specimen and little data is available addressing the impact of QNS / low volume specimens on turnaround time (TAT) and sample hemolysis. We compared the TAT and hemolysis index from samples ≤1.0 mL to all specimens received and quantified the number of specimens with reduced blood volume. A new QNS policy requiring ≥1.5 mL of sample in a blood tube for laboratory analysis was implemented and the results were assessed by sample hemolysis and TAT. The median laboratory TAT for samples with ≤1.0 mL of blood was 61 min (Interquartile Range, IQR: 50–82), in contrast to 28 min (26–34) for all samples. The hemolysis index for samples ≤1.0 mL was 112 (65–253) and 15 (8–29) for all samples. Requirement of a minimum volume of 1.5 mL of blood resulted in the proportion of samples with TAT ≥ 60 min to decrease from 10.4% to 4.24% in the ED, and for specimens cancelled due to hemolysis to decrease from 4.24% to 3.38%. This policy was introduced hospital wide with similar effects. Together, we correlate limited specimen volume with an increase in laboratory TAT and hemolysis. Implementation of a QNS policy of ≥1.5 mL and provider education provided a significant and durable reduction in TAT and specimen hemolysis.