Sample processing and specimen misidentification issues: major sources of pre-analytical errors

Abstract Errors with laboratory specimens may lead to adverse outcomes for patients. These errors most commonly occur in the pre-analytical phase. Among these, problems with patient identification or specimen handling are most frequent. Laboratories must establish strict guidelines for appropriate specimen transport, processing, and in-lab storage for each analyte, based upon their stability at various times and temperatures. Serum and plasma specimens must be centrifuged at appropriate speeds, times, and temperatures to ensure integrity. To maintain stability, serum and plasma should be separated with an in-tube separator device, like a gel separator, or by manually aliquoting after centrifugation. Recentrifugation of gel tubes is not recommended by manufacturers, but recent studies show little to no impact of recentrifugation. Cross-contamination of specimens prior to analysis should be prevented. Laboratories should adopt strict guidelines for identifying and preventing misidentification of specimens. Patient misidentification is the most common cause of laboratory related adverse events, particularly in the blood bank. Utilization of new technology has significantly reduced these errors.