Suitability of a transport box for blood sample shipment over a long ...

G. Lippi et al. / Clinical Biochemistry 44 (2011) 1028–1029
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Fig. 1. Fluctuation of the inner temperature of a transportation box during the 8-h study period.
closure of the box, so that transportation from the private facility to the
core laboratory by courier as per manufacturer requirements started at
this time point. After 7 h and 30 min of transportation the box arrived
at the destination, in the core laboratory. Temperature data were
further analyzed with LogTag Analyser®. The limit of suitable
temperature fluctuation was established between 2 °C and 8 °C (i.e.,
35.6 °F—46.4°F), in agreement with the current recommendations of the
Clinical and Laboratory Standard Institute (CLSI) [8]. The environmental
temperature during transportation was comprised between 36 °C and
38 °C, whereas that of the private facility and the core laboratory was
~20 °C.
Results
The fluctuation of the temperature within the transport box during
the 8-h study period is shown in Fig. 1. Thirty minutes after the closure
of the box at the private facility the temperature rapidly fell from room
temperature (i.e., ~20 °C) to 6 °C, in agreement with manufacturer's
claim. After beginning of transportation, a nearly linear increase of
temperature was then observed, exceeding the upper suitable limit (i.e.,
8 °C) after 120 min (i.e., 90 min from the beginning of transportation).
Twenty min after arrival at the core laboratory, the internal temperature
of the transport box dropped down at 7 °C. As such, temperature
stability could be considered unsatisfactory during approximately 64%
of the transportation time, i.e., from 125 to 450 min.
Discussion
The increasing centralization of laboratory facilities has raised
important economical, organizational and preanalytical issues such as
the escalation of costs, the longer transportation times and the
potential increase of preanalytical errors due to the often challenging
conditions of transportation and storage of the specimens [5,6].
Establishment and maintenance of appropriate temperatures for
transportation is essential for preserving the quality of whole blood
and even centrifuged specimens, thus preventing irreversible physicochemical
alterations of blood components. According to the current
recommendations of the CLSI, chilled blood specimens should be
maintained at temperatures comprised between 2 °C and 8 °C until
separation [8]. As such, the transportation of samples and blood
components is increasingly accomplished by safety transport boxes,
especially in countries with high or even extreme environmental
temperatures and where shipment might occur over long distances.
Nevertheless, no published data are available to the best of our
knowledge on the performance of transportation boxes as regards
temperature stability throughout long periods of transportation, up to
several hours. Although limited to the evaluation of a single
commercial product the results of this investigation attest that the
recommended temperature for transportation (i.e., between 2 °C and
8 °C) might only be maintained for a limited period of time within a
transport box (e.g., up to 90 min), because the internal temperature
might be dramatically influenced by the environmental conditions. As
such, we hypothesized that some of these products might be
unsuitable to fulfil the requirements of some peripheral facilities
integrated within a network, especially those which ship the
specimens to very distant core laboratories. Rather understandably,
although all the experimental conditions were accurately standardized,
replication of this study at different temperature (e.g., high or
even extreme external temperatures) or humidity, as well as the use
of different types of containers made on different materials, might
provide different outcomes, so that additional studies should be
planned to test this hypothesis.
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