OLFATO, Miguel Alfonso M.

August 18, 2020

What is the extra-analytical phase and what is their significance in clinical testing?
The extra-analytical phase is composed of four parts: The pre-preanalytical phase, pre-analytical
phase, analytical phase, the post-analytical phase and the post-postanalytical phase. The extra-analytical
phase was first described by Lundberg as the “brain-to-brain loop in laboratory testing” meaning that
the first step will involve the physician ordering a series of laboratory tests and will end with the
physician interpreting the results and formulating a plan of treatment.
The pre-preanalytical phase of testing is one of the most significant part of the extra-analytical
phase. This involves communication of the patient and the physician’s analysis of the gathered
information that will be important in ordering the appropriate tests. This is the most critical phase the
mistake that would be made in this phase would affect the entire testing process. The pre-analytical
phase involves the identification of the patient up until the sample collection and transportation of the
specimen to the lab. This phase is of significance because the quality of the test results will be based on
this phase. The post-analytical phase involves the reporting of results and critical values to the physician.
The success of this phase relies on the coordination of the ordering physician and the laboratory
workers. The correct results combined with the correct communication of the critical values will result in
a better understanding of the patient’s condition which will lead to a diagnosis. The post-postanalytical
phase involves the clinician’s response to the results of the tests. This is significant because it will
determine the plan of action and the physician’s decision on what he/she thinks will be the best
treatment based on the test results and diagnosis.

What are the errors that can be found in each phase of lab testing?
Classify them if they are under random error.

Pre-preanalytical
 Inappropriate tests ordered or requested
 Incomplete filling in of request forms
 Unintelligible request
 Missing input of test
 Erroneous coding

Pre-analytical
 Improper sample drawing
 Prolonged tourniquet time
 Tube under filling
 Excessive mixing or vigorous shaking of the tube
 Not allowing clotting for sufficient time
 Mechanical Trauma during transport
 Improper and inadequate time of collection
 Inappropriate gel barrier formation in blood tubes
 Diluted samples
 Improper container for collecting was used
 Contamination of tubes
 Improper order of draw
OLFATO, Miguel Alfonso M. August 18, 2020

 Improper selection of the venipuncture site

 Temperature, humidity at the time of transport
 Length, speed and number of times the sample transported
 Centrifuge condition, speed, time and temperature
 Haemolysis
 Lipemia
 Slow transport of specimen
 Incorrect sample preparation
 Incorrect patient identification
 Needlestick injuries

Analytical

 instrument malfunction
 Reagents contamination
 Poor QC
 Interference
 Blocked tubing, modules jammed
 Sample mix up

Post-analytical
 Slow turnaround time
 Incorrect reference values
 Physician not notified of a critical value
 Transcription errors
 Lack of universal reference intervals
 Unnecessary repeat testing
 Wrong communication of critical results

Post-postanalytical
 Incorrect clinical response by the clinician
 Incorrect interpretation of lab results
 Delay in looking at results
 No follow-up testing
 No consultations