Preanalytical interventions to reduce hemolysis and improve specimen quality: a systematic review and meta-analysis
Young-Hee Lee, Ho-Keun Choi, Kyung A Jung, Hyun Ho SungAbstract
Introduction
Hemolysis and other preanalytical errors compromise laboratory test accuracy, delay reporting, and may require repeat specimen collection.
Methods
We conducted a PROSPERO-registered systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. PubMed/MEDLINE and KoreaMed were searched from inception to May 17, 2026, with supplementary manual and institutional source searching. Eligible studies evaluated preanalytical interventions related to blood specimen collection or handling and reported hemolysis, specimen rejection, recollection, misidentification, or broader preanalytical error outcomes. Risk ratios for hemolysis were pooled using a random-effects model; secondary outcomes were summarized narratively.
Results
Seventeen studies were included in the qualitative synthesis, and 7 provided event and denominator data for hemolysis meta-analysis. Preanalytical interventions reduced hemolysis compared with conventional practice (risk ratio, 0.48 [95% CI, 0.28-0.81]; P = .0066), representing an approximately 52% relative risk reduction. Heterogeneity was substantial (I2 = 92.4%). Secondary studies generally reported reductions in sample rejection, nonconforming specimens, or broader preanalytical errors. Certainty of evidence was low for hemolysis and very low for secondary outcomes.
Discussion
Preanalytical quality interventions may reduce hemolysis and improve specimen quality, but evidence remains limited by heterogeneity, nonrandomized designs, and inconsistent outcome reporting.