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Updated: Mar 18, 2026
Biochemical Measurement of Neonatal Hypoxia
Published on: August 24, 2011
Neonatal Intensive Care Unit Quality Initiative: Identifying Preanalytical Variables Contributing to Specimen
Nicole V Tolan1, Erin J Kaleta2, Jennifer L Fang3
1From the Department of Laboratory Medicine and Pathology Department of Pathology and Laboratory Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Objectives:
Blood specimen hemolysis is a major cause of sample recollection in the neonatal intensive care unit. We aimed to reduce the hemolysis rate from 6.3% at baseline to less than 4% within the 9 months' duration of the study.
Methods:
Intravenous infusion of lipid emulsion during sample collection, sample collection site, and blood sample transportation methods were investigated as possible contributors to hemolysis. Subsequently, two practice improvements were implemented: pausing lipid emulsion infusion prior to collection and slowing withdrawal rates through arterial catheters.
Results:
Samples were more likely to be hemolyzed if they were collected during lipid infusion and subsequently transported by pneumatic tube or collected through an arterial catheter. Retrospective analysis demonstrated a decreased number of tests cancelled due to specimen hemolysis (3.5%) after our interventions.
Conclusions:
We identified three variables contributing to hemolysis and instituted two clinical practice interventions to significantly reduce test cancellations due to hemolysis.
