Author(s): Stretton A.; Cornes M.; Atherton J.; Thomas A.; Costelloe S.; Goulding N.; Hepburn S.; Mistry H.; De La Salle B.
Source: Clinical Chemistry and Laboratory Medicine; Apr 2019; vol. 57 (no. 4)
Publication Date: Apr 2019
Publication Type(s): Conference Abstract
Abstract:BACKGROUND-AIM: Haemolysis (H), icterus (I) and lipaemia (L) are frequent interferants in laboratory medicine and result in incomplete reports, delayed patient management, repeated venesection, and increased cost. This survey reviews practice for the management of HIL in medical laboratories in the UK and ROI. METHOD(S): A SurveyMonkey link was sent to members of the ACB, the Association of Clinical Biochemists in Ireland, and the Academy of Clinical Science and Laboratory Medicine (ROI). RESULT(S): Responses from 124 laboratories are broken down by country as follows: England (52%); ROI (36%); Scotland (7%); Wales (2%); and Northern Ireland (2%). Most respondents were from public hospitals (90%), with biochemistry services (90%). Laboratories served primary care (91%), inpatients (91%), and outpatients (89%), and monitored H (98%), I (88%), and L (96%). Laboratories detected HIL using automated indices (51%), visual inspection (8%), or a combination approach (42%). Manufacturer cut-offs for HIL are used by 83% of respondents. Cut-offs are applied to all general chemistries in 79%, and all immunoassays in 50% of laboratories. Where HIL cut-offs are breached, 64% withhold test results, and 96% report the interference to users. HIL were defined using numeric scales in 70%, and ordinal scales in 26% of laboratories. HIL targets exist in 35% of laboratories and 54% have made attempts to reduce HIL. Internal Quality Control for HIL has never been performed in 62% of laboratories and 18% have never participated in External Quality Assurance. Laboratories agree manufacturers should: standardise HIL reporting (94%); ensure comparability between platforms (94%); and provide information on HIL cross-reactivity (99%). Most respondents (99%) showed interest in evidence-based, standardised, HIL cut-offs. CONCLUSION(S): Although almost all respondents monitor HIL, a wide variation in practice may lead to differences in clinical care. Laboratories appear receptive to education and advice on HIL management from experts and industry.