What If There Is a Problem With My Sample?
To assure that you receive the most accurate and reliable test results, AVRL has put into place safeguards that constitute a very rigorous and interactive "Exception Handling" process. "Exception Handling" covers any process that could cause a delay in reporting of results or even prevent AVRL from giving you results on your patient. While we wish that errors never happened, unfortunately we know they do, and at AVRL our promise to you is that our personnel will make every effort to rectify problems, no matter how the error occurred such that you and your clients are satisfied. AVRL personnel will make every effort to advise you if we receive damaged, contaminated, or improper specimens.
Hemolysis, Lipemia, and Icterus
Hemolysis, lipemia and icterus can adversely affect the analytical accuracy of certain laboratory results. Most often the tests affected are spectrophotometric assays where light scattering (lipemia) or intense color (hemolysis and icterus) adversely affects the result. Assay manufacturers evaluate the performance of their test systems using samples with varying levels of these commonly encountered interfering pathologies. Typically, the level of hemolysis, lipemia, or icterus that causes greater than 10% variance in the result is considered significant interference.
Hemolysis, lipemia, and icterus levels are quantitatively determined by our automated chemistry analyzers and used to assess the possibility of interference with test results. If levels for any of these indices exceed the predetermined interference limits the result will be flagged and comments appended to the report indicating that interference has been detected and results should be evaluated accordingly. If specimen volume is adequate, removing the lipid components and retesting the sample for the non-lipid analytes may correct for interference by lipemia. In these cases, a comment indicating the use of lipid clearing procedures will be added to the report.
As stated under "venipuncture techniques" the two most common conditions of sample integrity that can affect results are hemolysis and lipemia. Both of these conditions are potentially preventable.
Hemolysis is usually due to venipuncture technique and sample handling. Improving technique and following the sample handling guidelines in this service directory usually results in avoidance of hemolysis. Uncommonly, hemolysis maybe due to abnormal physiologic processes and it is important to have excellent sample handling to improve the chances of determining the cause of hemolysis. Severe hemolysis will affect many biochemistry assays and render most results meaningless. This is also true for the CBC; severe hemolysis can make it difficult to impossible to interpret the CBC results. AVRL personnel will use hemolyzed samples if absolutely necessary, but if the specimen is too degraded to run specific assays AVRL customer service will contact you or your practice staff to determine how you want to proceed. If hemolysis is a result of a medical condition, please consider calling our consultation service to discuss the next step with an AVRL veterinary consultant.
Lipemia is much like hemolysis in that it can usually be avoided and when present, may render sample results meaningless. If a sample is lipemic, consider redrawing the sample after a period of fasting. If the sample is still lipemic, AVRL personnel may be able to centrifuge the sample to remove the effects of lipemia. Lipemia can degrade the sample to the point that neither the CBC nor biochemistry panel can be performed. There are other specialty tests that are also difficult to perform when the sample is lipemic. If you have any questions about the lipemic sample, please call AVRL customer service. If lipemia is a result of a medical condition, please consider calling our consultation service to discuss the next step with one of the AVRL expert veterinary consultants.
If a specimen arrives at AVRL in a tube or container that is not recommended for the ordered assay, AVRL personnel will first determine if the tests can be performed on the sample(s) in the condition in which they arrived. This may slightly delay performing the test as AVRL personnel discuss the feasibility of running the requested test(s) with our clinical pathologists. In most cases, it is our experience that a workaround can be developed to perform the requested tests and results will be sent to you in the normal fashion. Occasionally, only a portion of the requested tests can be performed. In this instance, you will be notified before the assay is performed so you are aware of the partial results. If AVRL is unable to run any of the requested assays, you will be contacted immediately and AVRL personnel will discuss various options. It is AVRL policy, in these instances, to not process any samples until we discuss the options with you or a member of your team. Until we can speak with you, the samples will be stored in a controlled environment to maintain their integrity.
Samples sent to AVRL with inadequate volume for the requested assays will be handled using one of two procedures. If you have listed on the AVRL request form, which tests you would like to have performed in case the sample volume is inadequate, the laboratory personnel will follow your direction. If you have not listed tests to run if the sample volume is insufficient or if there is not enough volume to perform the tests you have listed, AVRL customer service will call you or one of your team members. Our customer service personnel will work with you to provide information on which tests the laboratory can perform with the sample volume that was sent to AVRL. If you need further help or if it is not possible to retrieve more sample, consider discussing the situation with an AVRL expert veterinary consultant regarding how to best help your patient.
Incomplete or Illegible Information
Most tests can be performed even with incomplete owner and pet information, or illegible writing on the containers or request form. Even so, AVRL customer service will try to reach your hospital to fill in the missing information if it is necessary for processing. In other situations the samples will not be processed until the appropriate missing information is entered into the system. In these situations, AVRL customer service will attempt to contact you or one of your team members as soon as possible to correct the missing data. For these reasons, it is imperative that contact information for you and your hospital be as up-to-date as possible.
From the time a sample leaves your hospital until it arrives at AVRL, great care is taken to protect the sample integrity. Even with these safeguards in place, occasionally a sample will be damaged in transit. This typically leads to loss of some sample due to leakage. Any sample that appears damaged, is leaking, or has been contaminated by leakage will be sent to the "exception handling" team at AVRL. The personnel in this area of AVRL will thoroughly examine each sample and requisition form to record the general condition of the sample, to determine if there is adequate sample to perform the requested tests, and if sample integrity has been compromised to the point that the requested tests cannot be performed accurately or safely. After a careful evaluation, if no damage has occurred to the sample, the requested tests will be performed and results reported. If we determine that the specimen integrity is questionable or that there is not adequate sample to perform the requested tests, AVRL customer service will contact your hospital as soon as possible to rectify the situation and discuss additional options.