Download PDF
CC BY 4.0 · TH Open 2019; 03(04): e367-e376
DOI: 10.1055/s-0039-3401002
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Breakfast can Affect Routine Hematology and Coagulation Laboratory Testing: An Evaluation on Behalf of COLABIOCLI WG-PRE-LATAM

Maria Elena Arredondo   *
1   BIONET S.A., Santiago, Chile
,
Eduardo Aranda   *
2   Laboratory of Thrombosis and Hemostasis, Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
,
Rubén Astorga
1   BIONET S.A., Santiago, Chile
,
Lorena Michele Brennan-Bourdon   *
3   Clinical Laboratory Network from the State of Jalisco, Public Health State Laboratory (LESP), Comisión Para la Protección Contra Riesgos Sanitarios del Estado de Jalisco (COPRISJAL), Guadalajara, Mexico
,
Marise Danielle Campelo
4   Clinical Laboratory Bioanalise, Teresina, Piaui, Brazil
,
Silvia Flores   *
5   Universidad Peruana Cayetano Heredia, Lima, Perú
,
Claudio Medel
1   BIONET S.A., Santiago, Chile
,
Ignacio Manríquez
6   Clínica Dávila y Servicios Médicos S.A., Santiago, Chile
,
Patricia Ochoa   *
7   Facultad de Medicina, Universidad Católica de Cuenca, Cuenca, Ecuador
,
Beatriz Varela   *
8   LAC, Montevideo, Uruguay
,
Carlos Vega Salinas
6   Clínica Dávila y Servicios Médicos S.A., Santiago, Chile
,
Gabriel Lima-Oliveira    *
9   Section of Clinical Biochemistry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
› Author Affiliations Funding None declared.
Further Information

Publication History

30 August 2019

25 October 2019

Publication Date:
17 December 2019 (online)

   Permissions and Reprints

Abstract

Laboratories worldwide perform both hematological and coagulation testing on patients avoiding fasting time. In 2017, the Latin America Confederation of Clinical Biochemistry (COLABIOCLI) commissioned the Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) to study preanalytical variability and establish guidelines for preanalytical procedures to be applied by clinical laboratories and health care professionals. This study, on behalf of COLABIOCLI WG-PRE-LATAM, aims to evaluate the effect of the breakfast on routine hematology and coagulation laboratory testing. We studied 20 healthy volunteers who consumed a breakfast containing a standardized amount of carbohydrates, proteins, and lipids. We collected blood specimens for routine hematology and coagulation laboratory testing before breakfast and 1, 2, and 4 hours thereafter. Significant differences between samples were assessed by the Wilcoxon ranked-pairs test. Statistically significant differences (p < 0.05) between basal and 4 hours after the breakfast were observed for red blood cells, hemoglobin, hematocrit, mean corpuscular volume, white blood cells, neutrophils, lymphocytes, monocytes, mean platelet volume, and activated partial thromboplastin time. In conclusion, the significant variations observed in several hematological parameters, and activated partial thromboplastin time due to breakfast feeding demonstrate that the fasting time needs to be carefully considered prior to performing routine hematological and coagulation testing to avoid interpretive mistakes of test results, and to guarantee patient safety. Therefore, COLABIOCLI WG-PRE-LATAM encourages laboratory quality managers to standardize the fasting requirements in their laboratory, i.e., 12 hours.

Keywords

reproducibility of results - postprandial period - fasting - diagnostic errors - blood specimen collection

* Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.


 

  • References

  • 1 Lima-Oliveira G, Volanski W, Lippi G, Picheth G, Guidi GC. Pre-analytical phase management: a review of the procedures from patient preparation to laboratory analysis. Scand J Clin Lab Invest 2017; 77 (03) 153-163
    CrossrefPubMedGoogle Scholar
  • 2 Lima-Oliveira G, Lippi G, Salvagno GL, Picheth G, Guidi GC. Laboratory diagnostics and quality of blood collection. J Med Biochem 2015; 34 (03) 288-294
    CrossrefPubMedGoogle Scholar
  • 3 International Organization for Standardization. Medical Laboratories - Requirements for Quality and Competence ISO Document 15189. Geneva, Switzerland: International Organization for Standardization; 2012
    Google Scholar
  • 4 Lippi G, Lima-Oliveira G, Salvagno GL. , et al. Influence of a light meal on routine haematological tests. Blood Transfus 2010; 8 (02) 94-99
    PubMedGoogle Scholar
  • 5 Simundic AM, Bölenius K, Cadamuro J. , et al; Working Group for Preanalytical Phase (WG-PRE), of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI). Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med 2018; 56 (12) 2015-2038
    CrossrefPubMedGoogle Scholar
  • 6 Lima-Oliveira G, Guidi GC, Salvagno GL, Danese E, Montagnana M, Lippi G. Patient posture for blood collection by venipuncture: recall for standardization after 28 years. Rev Bras Hematol Hemoter 2017; 39 (02) 127-132
    PubMedGoogle Scholar
  • 7 Lippi G, Salvagno GL, Lima-Oliveira G, Danese E, Favaloro EJ, Guidi GC. Influence of posture on routine hemostasis testing. Blood Coagul Fibrinolysis 2015; 26 (06) 716-719
    CrossrefPubMedGoogle Scholar
  • 8 Lima-Oliveira G, Lippi G, Salvagno GL. , et al. Transillumination: a new tool to eliminate the impact of venous stasis during the procedure for the collection of diagnostic blood specimens for routine haematological testing. Int J Lab Hematol 2011; 33 (05) 457-462
    PubMedGoogle Scholar
  • 9 Lima-Oliveira G, Salvagno GL, Lippi G. , et al. Elimination of the venous stasis error for routine coagulation testing by transillumination. Clin Chim Acta 2011; 412 (15-16): 1482-1484
    CrossrefPubMedGoogle Scholar
  • 10 Lima-Oliveira G, Lippi G, Salvagno GL. , et al. Venous stasis and whole blood platelet aggregometry: a question of data reliability and patient safety. Blood Coagul Fibrinolysis 2015; 26 (06) 665-668
    CrossrefPubMedGoogle Scholar
  • 11 Lima-Oliveira G, Guidi GC, Salvagno GL, Lippi G. The impact of fist clenching and its maintenance during venipuncture on routine hematology testing. J Clin Lab Anal 2017; 31 (05) 31
    PubMedGoogle Scholar
  • 12 Lippi G, Lima-Oliveira G, Guidi GC. Does fist pumping/clenching during venipuncture activate blood coagulation?. Blood Coagul Fibrinolysis 2016; 27 (03) 357-358
    CrossrefPubMedGoogle Scholar
  • 13 Lima-Oliveira G, Lippi G, Salvagno GL, Brocco G, Guidi GC. In vitro diagnostic company recalls and medical laboratory practices: an Italian case. Biochem Med (Zagreb) 2015; 25 (02) 273-278
    CrossrefPubMedGoogle Scholar
  • 14 Simundic AM. Practical recommendations for statistical analysis and data presentation in Biochemia Medica journal. Biochem Med (Zagreb) 2012; 22 (01) 15-23
    PubMedGoogle Scholar
  • 15 Westgard J. Desirable Biological Variation Database Specifications. Available at: http://www.westgard.com/biodatabase1.htm2014 . Accessed August 12, 2019
    PubMedGoogle Scholar
  • 16 Matsuzawa T, Sakazume M. Effects of fasting on haematology and clinical chemistry values in the rat and dog. Comp Haematol Int 1994; 4: 152-156
    CrossrefPubMedGoogle Scholar
  • 17 Unger G, Benozzi SF, Campion A, Pennacchiotti GL. Preanalytical phase: effects of water ingestion during fasting on routine hematological parameters in a small cohort of young women. Clin Chim Acta 2018; 483: 126-129
    CrossrefPubMedGoogle Scholar
  • 18 Niv Y, Fraser GM. The alkaline tide phenomenon. J Clin Gastroenterol 2002; 35 (01) 5-8
    CrossrefPubMedGoogle Scholar
  • 19 Rune SJ. The metabolic alkalosis following aspiration of gastric acid secretion. Scand J Clin Lab Invest 1965; 17 (04) 305-310
    CrossrefPubMedGoogle Scholar
  • 20 Rune SJ. Comparison of the rates of gastric acid secretion in man after ingestion of food and after maximal stimulation with histamine. Gut 1966; 7 (04) 344-350
    CrossrefPubMedGoogle Scholar
  • 21 Martin HE. Physiological leucocytosis: II. Post-prandial leucocytosis and Widal's haemoclasic test for hepatic efficiency. J Physiol 1932; 77 (01) 63-67
    CrossrefPubMedGoogle Scholar
  • 22 Van Oostrom AJ, Sijmonsma TP, Rabelink TJ, Van Asbeck BS, Cabezas MC. Postprandial leukocyte increase in healthy subjects. Metabolism 2003; 52 (02) 199-202
    CrossrefPubMedGoogle Scholar
  • 23 Mohamed-Ali V, Goodrick S, Rawesh A. , et al. Subcutaneous adipose tissue releases interleukin-6, but not tumor necrosis factor-alpha, in vivo. J Clin Endocrinol Metab 1997; 82 (12) 4196-4200
    PubMedGoogle Scholar
  • 24 Khan IM, Pokharel Y, Dadu RT. , et al. Postprandial monocyte activation in individuals with metabolic syndrome. J Clin Endocrinol Metab 2016; 101 (11) 4195-4204
    CrossrefPubMedGoogle Scholar
  • 25 Motton DD, Keim NL, Tenorio FA, Horn WF, Rutledge JC. Postprandial monocyte activation in response to meals with high and low glycemic loads in overweight women. Am J Clin Nutr 2007; 85 (01) 60-65
    CrossrefPubMedGoogle Scholar
  • 26 Klop B, van de Geijn GJ, Njo TL. , et al. Leukocyte cell population data (volume conductivity scatter) in postprandial leukocyte activation. Int J Lab Hematol 2013; 35 (06) 644-651
    CrossrefPubMedGoogle Scholar
  • 27 Cordova CMM, Galgowski C. Flexibilization of fasting for laboratory determination of the lipid profile in Brazil: science or convenience?. Arq Bras Cardiol 2018; 111 (05) 747-749
    PubMedGoogle Scholar
  • 28 Guidi GC, Simundic AM, Salvagno GL, Aquino JL, Lima-Oliveira G. To avoid fasting time, more risk than benefits. Clin Chem Lab Med 2015; 53 (10) e261-e264
    PubMedGoogle Scholar
  • 29 Hyson DA, Paglieroni TG, Wun T, Rutledge JC. Postprandial lipemia is associated with platelet and monocyte activation and increased monocyte cytokine expression in normolipemic men. Clin Appl Thromb Hemost 2002; 8 (02) 147-155
    CrossrefPubMedGoogle Scholar
  • 30 Kälsch T, Elmas E, Nguyen XD. , et al. Effects of alimentary lipemia and inflammation on platelet CD40-ligand. Thromb Res 2007; 120 (05) 703-708
    CrossrefPubMedGoogle Scholar
  • 31 Eikelboom JW, Hirsh J. Monitoring unfractionated heparin with the aPTT: time for a fresh look. Thromb Haemost 2006; 96 (05) 547-552
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Nazari SSH, Mansournia MA. Case-crossover and case-time-control studies: concepts, design, and analysis. J Biostat Epidemiol 2015; 1: 59-69
    PubMedGoogle Scholar
  • 33 Jensen AK, Gerds TA, Weeke P, Torp-Pedersen C, Andersen PK. On the validity of the case-time-control design for autocorrelated exposure histories. Epidemiology 2014; 25 (01) 110-113
    CrossrefPubMedGoogle Scholar
  • 34 Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. The effective reduction of tourniquet application time after minor modification of the CLSI H03-A6 blood collection procedure. Biochem Med (Zagreb) 2013; 23 (03) 308-315
    PubMedGoogle Scholar
  • 35 Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Impact of the phlebotomy training based on CLSI/NCCLS H03-a6 - procedures for the collection of diagnostic blood specimens by venipuncture. Biochem Med (Zagreb) 2012; 22 (03) 342-351
    PubMedGoogle Scholar
  • 36 Lima-Oliveira G, Guidi GC, Salvagno GL. , et al. Is phlebotomy part of the dark side in the clinical laboratory struggle for quality?. Lab Med 2012; 43: 172-176
    CrossrefPubMedGoogle Scholar
  • 37 Lippi G, Salvagno GL, Radišić Biljak V. , et al. Filling accuracy and imprecision of commercial evacuated sodium citrate coagulation tubes. Scand J Clin Lab Invest 2019; 79 (04) 276-279
    CrossrefPubMedGoogle Scholar
  • 38 Recommendations of the International Council for Standardization in Haematology for Ethylenediaminetetraacetic Acid Anticoagulation of Blood for Blood Cell Counting and Sizing. International Council for Standardization in Haematology: Expert Panel on Cytometry. Am J Clin Pathol 1993; 100 (04) 371-372
    CrossrefPubMedGoogle Scholar
  • 39 Lima-Oliveira G, Lippi G, Salvagno GL. , et al. Brand of dipotassium EDTA vacuum tube as a new source of pre-analytical variability in routine haematology testing. Br J Biomed Sci 2013; 70 (01) 6-9
    PubMedGoogle Scholar
  • 40 Lima-Oliveira G, Lippi G, Salvagno GL. , et al. K(3)EDTA vacuum tubes validation for routine hematological testing. ISRN Hematol 2012; 2012: 875357
    PubMedGoogle Scholar
  • 41 Lewis SM, England JM, Rowan RM. Current concerns in haematology. 3: blood count calibration. J Clin Pathol 1991; 44 (11) 881-884
    CrossrefPubMedGoogle Scholar
  • 42 Goossens W, Van Duppen V, Verwilghen RL. K2- or K3-EDTA: the anticoagulant of choice in routine haematology?. Clin Lab Haematol 1991; 13 (03) 291-295
    PubMedGoogle Scholar
  • 43 Ricós C, Alvarez V, Cava F. , et al. Current databases on biological variation: pros, cons and progress. Scand J Clin Lab Invest 1999; 59 (07) 491-500
    CrossrefPubMedGoogle Scholar
  • 44 Ricós C, Cava F, García-Lario JV. , et al. The reference change value: a proposal to interpret laboratory reports in serial testing based on biological variation. Scand J Clin Lab Invest 2004; 64 (03) 175-184
    CrossrefPubMedGoogle Scholar
  • 45 Coskun A, Braga F, Carobene A. , et al; European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group on Biological Variation and Task Group for the Biological Variation Database. Systematic review and meta-analysis of within-subject and between-subject biological variation estimates of 20 haematological parameters. Clin Chem Lab Med 2020; 58 (01) 25-32
    PubMedGoogle Scholar