Blood Microsampling for Complete Blood Count: Take Heed of Preanalytical Errors


  • Barbara Koscielniak Department of Clinical Biochemistry, Jagiellonian University Medical College, Cracow, Poland
  • Andrzej Zajac Departament of Pediatric Surgery, University Children Hospital, Cracow, Poland
  • Przemysaaw Tomasik Department of Clinical Biochemistry, Jagiellonian University Medical College, Cracow, Poland



Phlebotomy, preanalytical error, nurse training, children


Background: The credibility of the result of a complete blood count is closely connected with the preanalytical phase.

Objectives: This study evaluated accordance of filling of microtubes with manufacturer's recommendation and assessed the effect of storage of overfilled and underfilled samples on the results of complete blood count.

Design and Methods: Volume of blood samples collected into microtubes in the wards of the University Children's Hospital in Cracow during one month was analyzed. In the stability studies, overfilled and underfilled samples stored at ambient temperature were analyzed at 1, 2, 3 and 12 hours after phlebotomy. The analysis was made using the SYSMEX XT-1800i analyzer.

Results: More than half of the analyzed samples were incorrectly filled. 63% of the samples were filled above the manufacturer's recommended volume and 15% of test-tubes were filled below the recommendation. We observed differences between collected blood volume in accordance to the age of patients (p=0.001). The storage of overfilled and underfilled microtubes for complete blood count for 1,2,3 and 12 h at room temperature had no effect on the results of this test.

Conclusion: Medical staff does not follow the instructions of the manufacturers. It might lead to a decrease of the quality and credibility of the results.


[1] Narayanan S. The preanalytic phase. An important component of laboratory medicine. Am J Clin Pathol 2000; 113: 429-452.
[2] Lippi G, Chance JJ, Church S, Dazzi P, Fontana R, Giavarina D et al. Preanalytical quality improvement: from dream to reality. Clin Chem Lab Med 2011; 49: 1113-1126.
[3] Gilor S, Gilor C. Common laboratory artifacts caused by inappropriate sample collection and transport: how to get the most out of a sample. Top Companion Anim Med 2011; 26: 109-18.
[4] Lippi G, Bassi A, Brocco G, Montagnana M, Salvagno GL, Guidi GC. Preanalytic error tracking in a laboratory medicine department: results of a 1-year experience. Clin Chem 2006; 52: 1442-1443.
[5] World Health Organization, Guidelines on Drawing Blood: Best Practices in Phlebotomy Blood-sampling systems. Geneva, Switzerland, 2011.
[6] Ko?cielniak BK, Kowalczyk PK, Manda-Handzlik AM, Tomasik PJ. The influence of overfilling of microsamples on the results of a Complete Blood Count. Int J Lab Hematol 2015; 37:e141-4.
[7] Simundic AM, Church S, Cornes MP, Grankvist K, Lippi G, Nybo M et al. Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: An observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE). Clin Chem Lab Med 2015; 53: 1321-1331.
[8] Adcock DM, Kressin DC, Marlar RA. Minimum specimen volume requirements for routine coagulation testing: dependence on citrate concentration. Am J Clin Pathol 1998; 109: 595-9.
[9] Dale JC, Ruby SG. Specimen collection volumes for laboratory tests. Arch Pathol Lab Med 2003; 127: 162-8.
[10] Lippi G, Caola I, Cervellin G, Milanesi B, Morandini M, Giavarina D. Error rates during blood collection in emergency departments and outpatient clinics: Results of a prospective multicenter study. Clin Chim Acta 2015; 445: 91-92.
[11] Valentine SL, Bateman ST. Identifying factors to minimize phlebotomy-induced blood loss in the pediatric intensive care unit. Pediatr Crit Care Med 2012; 13: 22-7.
[12] Sztefko K, Beba J, Mamica K, Tomasik P. Blood loss from laboratory diagnostic tests in children. Clin Chem Lab Med 2013; 1: 1-4.
[13] Pabla L, Watkins E, Doughty HA. A study of blood loss from phlebotomy in renal medical inpatients. Transfus Med 2009; 19: 309-14.
[14] Lowe G, Stike R, Pollack M, Bosley J, O’Brien P, Hake A,
et al. Nursing blood specimen collection techniques and hemolysis rates in an emergency department: analysis of venipuncture versus intravenous catheter collection techniques. J Emerg Nurs 2008; 34: 26-32.
[15] Rana SV. No Preanalytical Errors in Laboratory Testing: A Beneficial Aspect for Patients. Indian J Clin Biochem 2012; 27: 319-321.
[16] Patel N. Why is EDTA the anticoagulant of choice for hematology use? Tech Talk, 2009; 7: 1.
[17] Lillo R, Salinas M, Lopez-Garrigos M. Reducing preanalytical laboratory sample errors through educational and technological interventions. Clin Lab 2012; 58: 911-7.
[18] Lippi G, Becan-McBride K, Behúlová D. Preanalytical quality improvement: in quality we trust; Clin Chem Lab Med 2013; 51: 229-41.
[19] de Baca ME, Gene Gulati G, Kocher W, Schwarting R. Effects of Storage of Blood at Room Temperature on Hematologic Parameters Measured on Sysmex XE-2100. Lab Med 2009; 37: 28-36.
[20] Vogelaar SA, Posthuma D, Boomsma D, Kluft C. Blood sample stability at room temperature for counting red and white blood cells and platelets. Vascul Pharmacol 2002; 39: 123-125.






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