Acil Servisin Kurtulamadığı Sıkıntı: Hemoliz

Özet

Amaç: Laboratuvar test sonuçlarını etkileyen en önemli preanalitik hatalardan biri hemolizdir. Laboratuvarımıza kabul edilen kan örnekleri arasında en çok acil servisten gelen kan örneklerinde hemoliz görülmektedir. Bu durumda hemolizden etkilenen testler çalışılmamakta ve yeni bir kan örneği istenmektedir. Laboratuvar testlerinin gecikmesi hasta ve klinisyen memnuniyetsizliğine neden olmaktadır. Hatta bu sebeple acil servis hekimleri ile tartışmalar yaşanmakta ve hemolizin laboratuvar kaynaklı olduğu iddia edilmektedir. Bu çalışma ile acil servis hekimleri ile başta hemoliz olmak üzere preanalitik hatalara yönelik bilgi paylaşımı sağlanarak gereksiz tartışmaların önüne geçilmesi ve daha iyi sağlık hizmeti vermek için bir bilgilendirme ve değerlendirme toplantısı yapılması planlandı. Toplantı öncesi ve sonrası hemoliz ile ilgili bilgi düzeyinin ölçülmesi ile de verilen eğitimin etkisinin belirlenmesi amaçlandı.

Abstract

Purpose: Hemolysis is one of the most important preanalytical factors affecting the laboratory test results. It is mostly seen in blood samples sent from the emergency department compared to all samples accepted to the laboratory. If hemolysis is present, the tests affected by hemolysis are not analyzed and a new blood sample is requested. The delay in laboratory results causes dissatisfaction both in the physicians and the patients. Even arguments are made with the emergency department physicians claiming that the cause of the hemolysis is the laboratory. In this study, it was planned to make a meeting to share knowledge about foremost hemolysis and preanalytical errors with the physicians in emergency department in order to prevent unnecessary arguements and to give beter health care. It was aimed to determine the effect of the meeting by making a survey before and after the meeting. Material and methods: A presentation was made to 40 emergency department doctors in training meeeting in May 2016. Beeing a general problem, first the definition of hemolysis was made and it was explained that the vast majority of hemolysed specimens is seen in samples sent from the emergency departments worldwide. The hemolysis rate of the emergency department was given besides the causes of in vitro and in vivo hemolysis, the effect of the hemolysis on the laboratory test results and the efforts to decrease the hemolysis rates were discussed. Six questions related with these subjects were prepared and 40 doctors were asked to answer them before and after the presentation. The data related to the answers to the questions were evaluated according to the numbers and ratios. Besides, the statistics of hemolysed specimens were taken from the hospital's information system. Results: The causes of hemolysis question was fully answered correctly by the 30% of the participants before the presentation. The ratio increased to 60% after thepresentation. Blood collection with unsuitable devices such as catheters were not known to be a cause of hemolysis by 65% of the doctors which dropped to 10% after the presentation. It was determined that hemolysis rate of emergency department compared to all hemolysed samples were between 47-65% in 7 months period this year. Conclusion: It is thought that, an awareness was created in emergency department doctors about hemolysis which was defined as "a problem that emergency departments can not get rid of" that slow down the patient circulation in emergency department. Similar interactions with clinical departments will help to understand the role of the Medical Biochemists in correct test results