A-162 Improved Laboratory Workflow using Automated Detection of Hemolysis, Icterus, and Lipemia for Coagulation Testing
Authors: Wockenfus A , Kelley B , Wildeman D , Donato L , Karon B , Katzman B 
Published: October 2024

Abstract

Background
Managing preanalytical variables is critical to providing quality laboratory test results. However, this can be a challenge for laboratory staff, particularly with manual detection of interfering substances and complicated workflows. For coagulation testing, we assess specimen integrity and acceptability by visual checks and quantification of interfering substance on a chemistry analyzer. To improve this subjective process, we evaluated the technical performance of a new model of coagulation analyzer with automated preanalytical specimen integrity detection. Our objective was to determine if we could reduce the number of specimens requiring visual inspection/off-analyzer interference testing in order to simplify our testing workflow.

Methods
Citrated plasma specimens received in the Hospital Clinical Laboratory at Mayo Clinic (Rochester, MN) were tested on the TOP ACL 500 or TOP ACL 550 Series Coagulation analyzers (Werfen, Boston, MA) according to manufacturer’s instruction. Specimens tested on the TOP 500 were visually inspected for hemolysis, icterus, and lipemia (HIL). If the technologist detected a possible interferent, an aliquot of plasma was analyzed on our cobas c501 chemistry analyzer (c501) (Roche Diagnostics, Indianapolis, IN) to obtain HIL values. Laboratory-established or manufacturer-defined interference thresholds were applied in determining specimen acceptability. For samples tested on the TOP 550, specimen integrity was assessed by the instrument’s automated interference detection module. The analyzer reported HIL as an “interference cloud” or estimated range, rather than a single value like the c501. HIL values were estimated by visual assessment of the low end of the “interference cloud”. Values were confirmed on the c501 only for specimens with an “interference cloud” at/exceeding the test-specific interference thresholds. We analyzed data from a 2-month period pre- (TOP 500) and post-implementation (TOP 550). The percent of specimens requiring quantitation/confirmation on the c501 was calculated. Statistical significance was calculated using the Chi-squared test where significance was defined as p&lt;0.01. Correlation between c501 and TOP 550 estimated HIL values was evaluated.

Results
A total of 2.2% (171/7605) and 1.3% (113/8983) of specimens tested on the TOP 500 and TOP 550, respectively, required HIL measurements on the c501 (p&lt;0.001). Of those samples, 8.2% (14/171) and 14.2% (16/113) from the TOP 500 and TOP 550, respectively, had HIL values above the interference thresholds and were rejected by the laboratory. Comparison of the estimated HIL values from the “interference cloud” and from the c501 resulted in slopes (Pearson correlation coefficients) of: H 1.56 (0.77), I 0.67 (0.97), and L 1.35 (0.99).

Conclusions
In comparison to our workflow with visual assessment of interference, use of the automated interference detection functionality on the TOP 550 instrument resulted in a lower percentage of specimens requiring HIL measurements on the chemistry analyzer. Agreement between interference measurements obtained on the c501 and the TOP 550 was moderate where TOP 550 overestimated the degree of hemolysis and lipemia and underestimated icterus. Implementation of automated interference detection on the TOP 550 analyzer improved our workflow by eliminating the need for tedious and subjective visual checks and reducing the percentage of specimens requiring additional HIL measurements.