Üniversite Hastanesi Merkez Laboratuvarında Kalite Göstergelerinden Olan Pre-Preanalitik Hatalara Göre Numune Red Nedenlerinin Incelenmesi

Öz

Amaç: Preanalitik faz, laboratuvar test sürecinin hasta hazırlığından başlayarak numunenin alınması, etiketlenmesi, taşınması ve analiz için kabul edilmesine kadar olan aşamaları kapsar. Klinik laboratuvar hatalarının önemli bir kısmı bu aşamada meydana gelmekte ve hasta güvenliğini etkileyebilmektedir. Bu çalışmanın amacı, bir üniversite hastanesinin merkez laboratuvarında preanalitik hatalara bağlı numune red nedenlerini belirlemek ve red oranlarını değerlendirmektir. 
Materyal ve metod: Bu retrospektif çalışma, 01 Ocak 2025-30 Haziran 2025 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Merkez Laboratuvarı’na kabul edilen numunelerin laboratuvar bilgi sistemi (LIS) verilerinin incelenmesiyle gerçekleştirildi. Biyokimya, hemogram, hormon, spesifik hormon, koagülasyon, sedimantasyon, kardiyak ve HbA1c test istemleri değerlendirmeye alındı. Numune red nedenleri Sağlık Bakanlığı kalite göstergelerine göre sınıflandırıldı ve red oranları yüzde olarak hesaplandı. Bulgular: Altı aylık dönemde laboratuvara toplam 848.343 numune kabul edilirken 18.058 numune reddedildi ve toplam numune red oranı %2,13 olarak bulundu. En sık red nedenleri sırasıyla yetersiz numune (%54,75), pıhtılı numune (%38,91) ve yanlış tüp (%2,94) idi. Reddedilen numuneler en fazla sedimantasyon (%32,83), hemogram (%32,59) ve koagulasyon (%22,57) laboratuvar birimlerinde saptandı. 
Sonuç: Preanalitik hatalar laboratuvarlarda numune reddinin başlıca nedenleri arasında yer almaktadır. Özellikle yetersiz numune ve pıhtılı numune oranlarının yüksek olması, kan alma teknikleri ve preanalitik süreçlere yönelik eğitimlerin artırılması gerektiğini göstermektedir. Preanalitik süreçlerin etkin şekilde izlenmesi ve sağlık personeline düzenli eğitim verilmesi, laboratuvar kalite göstergelerinin iyileştirilmesine ve hasta güvenliğinin artırılmasına katkı sağlayacaktır. Laboratuvar birimleri arasında numune red oranları açısından istatistiksel olarak anlamlı fark saptandı (p<0,001).

Anahtar Kelimeler

• Preanalitik Hatalar
• Numune Reddi
• Laboratuvar Kalite Göstergeleri
• Preanalitik Faz
• Laboratuvar Bilgi Sistemi

Destekleyen Kurum

Dicle Üniversitesi Tıp Fakültesi

Etik Beyan

Ethical approval was obtained from the Dicle University Non-Interventional Clinical Research Ethics Committee (approval no: 36, date: June 18, 2025).

Investigation of Sample Rejection Reasons According to Pre-Preanalytical Errors, Which are Quality Indicators in the Central Laboratory of a University Hospital

Öz

Background: The preanalytical phase includes all steps from patient preparation to sample collection, labeling, transportation, and acceptance for analysis. A significant proportion of laboratory errors occur during this phase and may adversely affect patient safety. This study aimed to determine the causes of sample rejection due to preanalytical errors in the central laboratory of a university hospital and to evaluate rejection rates. 
Materials and Methods: This retrospective study analyzed data from the laboratory information system (LIS) for samples accepted between January 1 and June 30, 2025 in the Central Laboratory of University Faculty of Medicine. Samples requested for biochemistry, hemogram, hormone, specific hormone, coagulation, sedimentation, cardiac, and HbA1c tests were included. Sample rejection reasons were classified according to national laboratory quality indicators and rejection rates were calculated as percentages. 
Results: During the six-month period, 848,343 samples were accepted and 18,058 samples were rejected, resulting in an overall rejection rate of 2.13%. The most common reasons for rejection were insufficient sample volume (54.75%), clotted samples (38.91%), and incorrect tube type (2.94%). The highest proportions of rejected samples were observed in the sedimentation (32.83%), hemogram (32.59%), and coagulation (22.57%) laboratory units. Rejection rates differed significantly among laboratory units (p<0.001).
Conclusions: Preanalytical errors remain one of the main causes of sample rejection in clinical laboratories. The high frequency of insufficient and clotted samples indicates the need for improved phlebotomy practices and enhanced training programs for healthcare personnel. Continuous monitoring of the preanalytical process and regular staff training may contribute to improving laboratory quality indicators and ensuring patient safety.

Anahtar Kelimeler

• Preanalytical Errors
• Sample Rejection
• Laboratory Quality Indicators
• Preanalytical Phase
• Laboratory Information System

Destekleyen Kurum

Dicle University Faculty of Medicine

Etik Beyan

Ethical approval was obtained from the Dicle University Non-Interventional Clinical Research Ethics Committee (approval no: 36, date: June 18, 2025).

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