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Annals of Medicine and Medical Education
Volume 1, Issue 2 (June 2014), pp. 43-52

DOI: 10.12973/ejms.2014.109p

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Research Article

Published online on Apr 06, 2014

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Assessment of Serum Indices Implementation on Roche Cobas 6000 Analyzer

Fatma Emel Koçak, Ayfer Meral, Havva Koçak


Background: Hemolyzed, lipemic and icteric samples which can be determined by naked eye can cause erroneous results and wrong 
diagnosis and treatments, so they are considered to be unsuitable and thus rejected. However, visual evaluation is subjective and is
not sufficiently reliable. The aim of this study was to evaluate efficiency and advantages of serum index program on the basis of test
parameters for detection of visually unrecognized interferences by analysing the samples in an automated system that include a serum
index program.

Methods: After examining through the naked eye, 717 serum samples which were decided to not be hemolyzed, lipemic and icteric were
picked out for the study. These samples were analyzed on Roche Cobas 6000 autoanalyzer for 23 different parameters which were known
to be most affected from interferences. At the same time, serum indices were also analyzed using Roche serum index application program.

Results: In 108 of 717 serum samples interference that previously could not be detected by naked eye was detected. 102 of these were
hemolysis, 4 were lipemia and 2 were icterus. Tests that were affected by hemolysis were creatine kinase isoenzyme MB(CK-MB), lactate dehydrogenase (LDH), aspartat aminotransferase (AST), total bilirubin, direct bilirubin, unsaturated iron binding capacity (UIBC), 

Conclusion: In detection of hemolytic, icteric and lipemic samples, visual detection is not reliable and automatized systems that gives serum
indices results based on the test parameters should take the place of visual detection as a cheap and fast way of accelerating the standard 
laboratory process and making it easier.

Keywords: Serum index program, sample diagnosis

  1. Fraser CG. Biological variation: from principles to practice. Washington, DC : AACC Pres, 2001.
  2. Guder WG, Narayanan S, Wisser H, Zawta B.Samples: From the patient to the laboratory. The impact of preanalytical variables on the quality of laboratory results. 3rd edition, 2003. WILEY-VCH, GmbH&Co.KGaA. Weinheim.
  3. Narayanan S, Guder WG. Preanalytical variables and their influence on the quality of laboratory results. eJIFCC 2001; 13(1): 1-4. 301200107.htm. Accessed April 20, 2007.
  4. Piyophirapong S, Wongtirapom W, Srib hen K. Factitious results in clinical chemistry tests caused by common endogenous interferents. Siriraj Med J 2010; 62(4): 185-88.
  5. Plebani M, Carraro P. Mistakes in a stat laboratory: Types and frequency. Clin Chem 1997; 43(8): 1348-51.
  6. Roche Diagnostics. Serum indices: Reduction of clinical errors in laboratory medicine. http://www.rochediag download/program/Serum%20Indices_maly.pdf. July 15th 2012.
  7. Vermeer HJ, Thomassen E, de Jonge N. Automated processing of serum indices used for interference detection by the laboratory information system. Clin Chem 2005; 51(1): 244-7.
  8. Glick M, Ryder K, Jackson S. Graphical comparison of interferences in clinical chemistry instrumentations. Clin Chem 1986; 32(3): 470-75.
  9. Kroll M, Elin R. Interference with clinical laboratory analysis. Clin Chem 1994; 40(11 Pt 1): 1996-2005.
  10. Dale JC, Novis DA. Outpatient phlebotomy success and reasons for specimen rejection. Arch Pathol Lab Med 2002; 126(4): 416-19.
  11. Jones BA, Calam RR, Howanitz PJ. Chemistry specimen acceptability. A College of American Pathologists Q-probes study of 453 laboratories. Arch Pathol Lab Med 1997; 121(1): 19-26.
  12. Carraro P, Servidio G, Plebani M. Hemolyzed specimens: A reason for rejection or a clinical challenge? Clin Chem 2000; 46(2): 306-7.
  13. Yucel D, Dalva K. Effects of in vitro hemolysıs on routine biochemical tests. Turkiye Klinikleri J Med Sci 1991; 9 (4): 248-53.
  14. Sonntag O. Hemolysis as an interference factor in clinical chemistry. J Clin Chem Clin Biochem 1986; 24(2): 127-39.
  15. Thomas L. Hemolysis as influence & interference factor. Biochimica Clinica 2002; 26(2): 95-98.
  16. Koseoglu M, Hur A, Atay A, Cuhadar S. Effects of hemolysis interference on routine biochemistry parameters. Biochem Med 2011; 21(1): 79-85.
  17. Lippi G.,Salvagno GL, Montagnana M, Brocco G, Guidi GC. Influence of hemolysis on routine clinical chemistry testing. Clin Chem Lab Med 2006; 44(3): 311-16.
  18. Narayanan S. The preanalytic phase: An important component of laboratory medicine. Am J Clin Pathol 2000; 113(3): 429-52.
  19. Yigitbası T, Senturk BA, Baskin Y, Oney M, Ustuner F. The effect of hemolysis on routine emergency biochemistry tests. Turk J Clin Biochem 2010; 8(3): 105-10.
  20. Yucel D, Davla K. Effect of in vitro hemolysis on 25 common biochemical tests. Clin Chem 1992; 38(4): 575-7.
  21. Ji JZ, Meng QH. Evaluation of the interference of hemoglobin, bilirubin and lipids on Roche Cobas 6000 assays. Clin Chim Acta 2011; 412(17-18): 1550-3.
  22. Calmarza P, Cordero J. Lipemia interferences in routine clinical biochemical tests. Biochem Med 2011; 21(2): 160-6.
  23. Grafmeyer D, Bondon M, Manchon M, Levillain P. The influence of bilirubin, haemolysis and turbidity on 20 analytical tests performed on automatic analysers. Eur J Clin Chem Clin Biochem 1995; 33(1): 31-52
  24. Hinckley C. Defining the best quality control systems by design and inspection. Clin Chem 1997; 43(5): 873-9.
  25. Glick M, Ryder K, Glick S,Woods J. Unreliable visual estimation of the incidence and amount of turbidity, hemolysis and icterus in serum from hospitalized patients. Clin Chem 1989; 35(5): 837-9.
  26. Simundic AM, Nikolac N, Ivankovic V,Ruzic DF, Magdic B,Kvaternik M,Topic E. Comparison of visual vs. automated detection of lipemic, icteric and hemolyzed specimens: can we rely on a human eye? Clin Chem Lab Med 2009; 47(11): 1361-5.
  27. Lippi G, Salvagno GL, Blanckaert N, Giavarina D, Green S, Kitchen S, Palicka V, Vassault AJ, Plebani M. Multicenter evaluation of the hemolysis index in automated clinical chemistry systems. Clin Chem Lab Med 2009; 47(8): 934-9.
  28. Plebani M, Lippi G. Hemolysis index: quality indicator or criterion for sample rejection? Clin Chem Lab Med 2009; 47(8): 899-902.