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  • Report of Laboratory Analysis
  • Uses of Laboratory Data
  • Request for Laboratory Test
  • Quality Control Assurance

The request form constitutes a referred form, which is a medicolegal form and can be presented in a court. Hence, be very careful while filling the request form.

The filling of the form constitutes the first step in making a laboratory request.

Basically divided into 3 parts.

Ø BIODATA [everything here must be filled]

A Laboratory result is just the basic result of tests done.

A Laboratory report is the Laboratory result interpreted by a professional.

As a medical practitioner, never use the Laboratory result to make diagnosis, always use the laboratory report.

  •  
  • Age: helps to identify normal lab. Results. Always put a definite age. Don’t just write Adult/Child.
  • Gender: is important to interpret results, especially hormonal panels.
  • Ward/Clinic: for easily finding the patient if result indicates an emergency.
  • Laboratory number: useful when more than one person has a particular name.
  • Clinic diagnosis/Drugs: this helps the professional technician to better interpret the result.

E.g., in requesting a blood glucose level test on a diabetic patient, we should state there that the patient is diabetic.

  • Specimen: it is important to specify also for medicolegal reason. e.g. arterial blood, capillary blood, venous blood etc. Also helps to interpretation of results.

 Occupation

  • Consultant: it is important to know the critical value reporting i.e. if emergencies are seen in the result.
  • Date and time of Specimen: some hormone levels are subject to the time taken(diurnal rhythm)
  • Patient’s Phone number: is important because some tests might need to be repeated.

 

 

Ø A PROFILE

Is a group of tests, taken together in order for you to interpret eg, don’t order a total protein test, without sending for an albumen test, because albumen will constitute 60-80% of total protein. In fertility profile, you have to check for LH, FSH, Estrogen, and Progesterone.

 

ØPATHOLOGIST COMMENT

This is the Laboratory report. The result must be signed by the medical lab. Scientist. The report should be signed by a Pathologist/Resident.

 

 

 LABORATORY DATA

The information on the Laboratory request form is a good source of the Laboratory data. The form in which they appear is unorganized and the need to organize, analyse and draw certain inferences makes them useful data.

 

Uses of Laboratory Data

  • Monitoring
  • Evaluation
  • Planning
  • Research

 

Request for Laboratory Test.

It is based on;

  • Type of Test
  • Availability i.e. equipment available to do the test.
  • Turn around time i.e. times it takes for report to be generated Place of Practice.

Reasons for Request.

  • For Monitoring
  • For Diagnosis
  • For Treatment
  • For Prognosis Type of Request.

Single – one request that can be interpreted e.g., Fasting Blood Glucose Profile- battery of tests done in order to be able to interpret the result.

 

 

Examples of Profile

  • Electrolyte/Urea/Creatinine

Na+, K+, HCO3, Cl-, urea and creatinine.

  • Calcium /Phosphate

Ca2+, PO2-

  • Lipid Profile

Total Cholesterol, Triacylglyceride, LDL-C, HDL-C

  • CSF profile

Glucose, Protein, Chloride.

  • Liver Function Profile

Transaminase, ALP, GGT, AST, ALT, Total Protein/Albumen, Unconjugated/Conjugated.

  • Bilirubin Profile Unconjugated/conjugated
  • Protein Profile Total Protein, Albumin
  • Infertility profile

Progesterone, Estrogen, Prolactin, LH, Testosterone, FSH.

  • Thyroid Function Profile

Free (fT4) and Total (T4) thyroxine Hormone

Free (fT3) and total (T3) tri-iodo thyroxine

Thyroid Stimulating Hormone (TSH)

Thyroid Releasing Hormone (TRH)

Thyroid Hormone Binding Protein (THBP)

 

QUALITY ASSURANCE CONTROL

Definition

Quality Assurance is a sum total procedure put in place to get a reliable result.

It refers to all procedures done .i.e. from form filling to sample collection.

v Pre-Laboratory, Laboratory and Post-Laboratory.

A reliable result must be accurate and precise.

Accuracy is nearness to true value.

Precision.

 

Elements of QA

The elements are related to the process of analysis (Laboratory)

  1. Pre- Analytical: Procedure done before analysis. This is strictly related to the samples for analysis. (Issues on the wards/clinics/onward the laboratory).
  2. Analytical: Procedures related to the inside Laboratory. (issues inside the Laboratory).
  3. Post – Analytical: Procedures after the analysis. (issues with dispatch of Laboratory result.

 

Pre Analytical Variables

  • Test Results e.g. Fasting Blood Glucose vs. Random Blood Glucose.
  • Client preparation.
  • Identification: complete filling of request form.
  • Sample acquisition.
  • Sample/Specimen transport- in terms of degradation/hemolysis.
  • Sample/Specimen processing- rejection criteria
  • Sample/Specimen distribution
  • Preparation of work lists and logs
  • Sample storage
  • Sample timing- diurnal rhythm and analytic concentration.

 

Analytic Variable

  • Analytical methodology- simple/easy
  • Standardization and Calibration procedures- use of blank solution, standard preparations, controls.
  • Documentation of analytical protocols eg. Standard operating procedures.
  • Monitoring of critical equipment and materials: use of electric stabilizers, maintenance /service, plan, temperature chart.

 

Post Analytical Variable

  • The preparation of test reports with the inclusion of decimal points.
  • Correct units of measurement.
  • Technical and clinical validation – critical
  • Test results- (dispatch/collection)

Pre emptying QA issues

 

Pre Analytical Solutions Development of: 

  • Test Protocol
  • Sample acceptance/rejection criteria
  • Standard operating procedure
  • Laboratory manual Analytical Solutions Development of:
  • Laboratory process audio
  • Use/interpretation of QC charts (Quality Control Charts)
  • Test development protocol/SOP
  • Appointment of Quality Control offices/teams
  • Daily/Monthly etc. maintenance
  • External quality control program

 

 

Post Analytical Solutions

  • Development of critical value reporting system  Deployment of hospital information system  Electric laboratory dispatch system- emails, sms etc.
  • Good documentation/ record keeping