Sources of error in acid-base analysis from a blood gas analyser result: a narrative review

Preservation of blood pH within a narrow range is essential to optimal physiological function. This narrow pH range is maintained via the interactions of various buffer systems. Blood gas analysis is thus essential in the diagnosis and management of disorders affecting blood pH. Common methods of acid-base interpretation in veterinary science are the traditional approach, the physicochemical approach and the semiquantitative approach. However, blood gas analysis is prone to error during the preanalytical, analytical and post-analytical phases of the laboratory process. The pre-analytical phase incorporates steps in obtaining the sample, thus sources of pre-analytical error are related to operator technique. Most errors occur during the pre-analytical phase. Pre-analytical errors include entrainment of air bubbles into the sample and delays between sampling and analysis, both of which cause inaccurate measurement of oxygen and carbon dioxide tensions. The analytical phase outlines processes within the analyser. Common analytical errors are related to substances confounding analyte measurements. The post-analytical phase mainly describes interpretation of the results. Some of the approaches to acid-base interpretation require extensive post-analytical calculations, thus lending themselves to error. Errors occurring during the prior phases will be amplified. Errors in the measurement of the carbon dioxide tension (from which bicarbonate concentration and base excess are calculated) will introduce error into all three methods of acid-base interpretation. Furthermore, errors occurring in the measurements of electrolytes and lactate will result in incorrect interpretations if the physicochemical and semiquantitative approaches are applied. The potential sources of error during the various phases are reviewed.