PRE-ANALYTICS
Wrong diagnosis: the testing problem nobody wants to own
Kevin Moore looks at the causes and consequences of pre- analytical errors in phlebotomy and asks how the problem can be addressed.
Many healthcare systems depend on paper forms, handwriten labels, and fragmented communication between clinical and laboratory teams.
Every blood sample collected has a biological deadline. Laboratories have a four-hour window to process specimens before cellular degradation sets in and haemolysis begins to compromise results. In a busy laboratory which handles thousands of samples a day, the window is sliding shut to make samples unusable or inaccurate. In a best-case scenario the patient is recalled, re-bled, and rebooked, at least doubling the cost of the diagnostic testing. In a worst case their treatment is compromised. Despite the extent of the problem, the
conversation about why NHS trusts are still missing these targets continues to be misdirected: laboratories are routinely under the microscope but the process of phlebotomy is overlooked.
Sources of errors Around 70% of ‘laboratory errors’ are not laboratory errors at all, as they occur before a sample even reaches the laboratory analyser: at the point of ordering, collection, labelling, or transport. Poor quality barcode labels mean that
12-15% of all tubes labelled with a barcode have to be pulled from the analyser and manually re-labelled – leading to delays and errors. And the worst of it? Most tubes that arrive from Community Diagnostic Centres or GP surgeries have to be re- labelled. Pre-analytical error rates remain
stubbornly high despite advances in laboratory technology and may lead to clinical errors. Common missteps in blood- draw technique, patient verification, tube selection, or transport timing can skew results or lead to misdiagnoses. These errors are not simple administration mishaps; they have very real and dangerous consequences on patients. Doctors and clinicians depend on the reliability and accuracy of laboratory results when investigating patients with undiagnosed symptoms.
Re-labelling Each year in the UK over 50 million blood tubes are re-labelled when they arrive in the laboratories. Many laboratories have to re-label 10,000 to 15,000 tubes/
34
WWW.PATHOLOGYINPRACTICE.COM August 2026
day. In Emergency Room or Accident and Emergency departments, where haemolysis is more common, rates reach 17-25%, while for inpatients, it varies between 4.5% to 10%.1,2
This staggering re-
labelling problem is a direct consequence of labels not being read by the auto- analyser or being spoiled during transit or application. The only way laboratories can avoid
blood degradation with this volume of unreadable tubes arriving, is to stabilise the tubes for as long as possible through centrifugation. Literally thousands of blood tubes get centrifuged, so the plasma or serum separates from the erythrocytes and the sample is stabilised. Failure to stabilise samples causes potassium leakage from the erythrocytes leading to a higher blood potassium (hyperkalaemia) or the masking of hypokalaemia, which is more harmful and much more common.
Errors causing serious harm A poorly deployed pre-analytic phase in phlebotomy is a systemic failure with serious clinical and financial
AdobeStock / zakharova ievgeniia
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56
