The process of laboratory testing, also known as the “Total Testing Process,” begins and ends with the patient. It includes the entire process from ordering the test to interpretation of the test results by the clinician. The use of modern laboratory instrumentation has allowed for very few analytical errors within hemostasis testing due to high levels of test reliability and appropriate quality assurance measures. Nevertheless, incorrect, or inappropriate test results are still reported, often due to events outside the control of the laboratories performing the tests. This is due primarily to pre-analytical events associated with sample collection and processing, as well as pre-pre-analytical events associated with test selection and identification of test needed. This presentation focuses on the pre-analytical and pre-pre-analytical phases, highlighting contributory elements and providing suggestions on how problems can be minimized or prevented, to improve the likelihood that reported test results represent the true clinical status of the patient rather than that of an inappropriate sample.
- Describe three common pre-analytical errors in hemostasis testing and the patient population(s) most at risk for these errors.
- Discuss the impact of anticoagulants (e.g. warfarin, heparin, DOACs) on routine coagulation tests.
- Propose strategies for preventing at least one type of pre-analytical error common in hemostasis testing.