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Pre-analytical Errors in a Pathology Lab context & Need for better phlebotomy practices

Pankaj Dhole | Bioteknika Technologies | Pathology | Insights Care

High Quality accurate test report by a pathology Laboratory is extremely crucial for a clinician to decide the correct line of treatment for the patient and ultimately the fate of the patient. Furthermore its patient’s right to obtain accurate report for his hard earned hefty sum paid towards testing.

The most crucial factor which actually ensures HIGH QUALITY TEST REPORTS is patient’s specimen or SAMPLE which is being tested and unfortunately this factor is MOST NEGLECTED in most of the pathology lab set ups in India. Though the path labs invest heavily on medical equipments for biological measurements, they hardly care for pre Analytical area which is sample collection area in laymen’s words.

What is Pre-analytical Process?

  • Patient Identification
  • Phlebotomy
  • Blood Collection
  • Specimen Transport
  • Specimen Processing

Why to focus on pre-analytical?

  • The pre-analytical stage is the most important and can be critical to patient wellbeing
  • The analytical stage and post analytical stages depend primarily on the Quality and Integrity of the specimen submitted to the laboratory (Pre-Analytical)
  • Laboratory staff involved in specimen collection has a direct impact on the outcome of patient’s lab results
  • Errors made in the period prior to sample analysis may influence the final test result.
  • Approximately 32 – 75% of all test errors occur in the pre-analytical phase

Possible errors in Pre-analytical Process

  • Wrong patient ID on the sample
  • Missing patient ID on the sample
  • Wrong collection time
  • Inadequate/ inappropriate container
  • Inadequate volume, inappropriate volume to anticoagulant ratio
  • Contaminated from IV line


  • Phlebotomy is a highly complex skill requiring expert knowledge and critical judgment
  • Phlebotomy errors may cause harm to patients or result in needle stick injury to the phlebotomist
  • Pediatric and Adult Collections should be carefully done considering Size differentiation, Angle of penetration, Rigidity of vein, Reliable vein development versus development of muscle, tendon and subcutaneous tissue and Psychology of patient

Suggested solutions to avoid Pre-analytical Errors

  • Every lab should have Standard operating procedures for specimen acceptance /rejection to be followed by all staff
  • There has to be a manual for Identification and monitoring of reasons for specimen rejection
  • Effect of improvement initiative in decreasing the rate of specimen rejection should be monitored
  • Path labs should be very careful in selecting blood collections tubes and quality should be the foremost criteria instead of price. The Blood collection tubes should be thoroughly checked for quality standards before putting them for collection use.

Most importantly, Path labs need to accept the effects of Pre-analytical Variables and believe that there is indeed room for Improvement.

Also, path labs need to accept the fact that most errors affecting laboratory test results occur in the pre-analytical phase primarily because of the difficulty in achieving standardized procedures for sample collection and selection of high quality blood collection tube is vital for high quality test results.

Remember… Concern for the change is the most important step towards change.


Pankaj Dhole






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