Phase in Laboratory Evaluation (Testing Process)

A. Pre-Analysis Pre-analysis refers to all the steps that must take place before a sample can be analyzed. This pre-analysis process is include : i. Pre-collection variable In preparing a patient for phlebotomy, care should be taken to minimize factors related to activities that might influence laboratory determinations a. Diurnal variation b. Exercise c. Diet d. Tobacco Smoking e. Stress f. Posture g. Age h. Sex Specimen Collection The Test Order Laboratory tests are usually ordered electronically (e.g., computer) or in writing (e.g., paper requisition). Most laboratories facilitate test ordering by providing a written or computerized medical information system which lists available tests, type of specimen required, collection method, color of blood collection tube used, amount of blood/body fluid required, turnaround time, reference intervals, test codes, costs, diagnostic information, etc Time of Collection The most common tests in this category are the ASAP( as soon as possible) and stat (American medical term meaning immediately ) collections. Timed specimens are ordered for a variety of reasons, usually to monitor changes in a patient's condition, to determine the level of a medication, or to measure how well a substance is metabolized Collection-Associated Variables Specimen Rejection All specimens must be collected, labeled, transported and processed according to established procedures that include sample volume, special handling needs and container type A. Blood Blood Collection collection technique : Venous Puncture Arterial Puncture Skin Puncture

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 Central Venous Access Device (CVAD) Anticoagulant: o Anticoagulant (-) serum o Anticoagulant (+) plasma B. Urine Collection Laboratory testing of urine generally falls under three categories: chemical, bacteriologic, and microscopic examination. There are also several kinds of collection for urine specimens: random, clean catch, timed, 24-hour and catheterized C. Other Body Fluid Collection Cerebrospinal fluid (CSF) Lumbar punctures (LPs) are performed to collect (CSF) for laboratory evaluation to establish a diagnosis of infection (bacterial, fungal, mycobacterial, or amebic meningitis), malignancy, subarachnoid hemorrhage, multiple sclerosis, or demyelinating disorders. Synovial Fluid Synovial fluid found in the joint cavities. It is collected by arthrocentesis, an aspiration of the joint using a syringe, moistened with an anticoagulant, usually 25 units of sodium heparin per mL of synovial fluid. Pleural Fluid, Pericardial Fluid and Peritonial Fluid Thoracentesis is a surgical procedure to drain fluid (effusions) from the thoracic cavity and is helpful in diagnosing inflammation or neoplastic disease in the lung or pleura. Pericardiocentesis and peritoneocentesis refer to the collection of fluid from the pericardium (effusion) and the peritoneal cavities (ascites), respectively Specimen Transport Transport of specimens from the collection site to the laboratory is an important component of processing. Specimens must be transported in a safe and convenient manner to prevent biohazard exposure or contamination of the specimen. Broken or leaking specimens are a biohazard to those who may come in contact with them and require collection of a new specimen; this can delay treatment of the patient and add to the cost. Specimen Processing Processing of specimens includes three distinct phases: Pre centrifugation Ideally, all measurements should be performed within 45 minutes to 1 hour after collection. Whenever this is not practical, the specimen should be processed to a point at which it can be properly stored in order to preclude alterations of constituents to be measured. Centrifugation

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A centrifuge uses centrifugal force to separate phases of suspensions by different densities and Post centrifugation B. Analysis This stage includes the laboratory activities that actually produce a result, such as running a sample on an automated analyzer. Two goals for automating specimen processing are (1) to minimize non-value-added steps in the laboratory process, e.g., sorting tubes, and (2) to increase available time for value-added steps in the tasks that technologists perform that help make a difference in the quality of the test result and ultimately, the diagnosis. Advantages for automating laboratory testing include: increasing the quality of the pre-analytical steps reducing error rates reducing operator exposure to potentially hazardous biological material eliminating repetitive stress injuries.

Tasks Included in the Analytical Stage of Laboratory Testing Sample Introduction transport to cuvet or dilution cup Addition of reagent Reagents used in automated analyzers require attention to several concerns that include: handling, preparation and storage proportioning dispensing. Mixing of sample and reagent There are many examples of unique mixing devices and techniques used in automated systems. They include the following: magnetic stirring rotating paddles forceful dispensing the use of ultrasonic energy vigorous lateral displacement.

Dry slide analyzers do not require mixing of sample and reagents. The sample is allowed to flow through the layers containing reagents Incubation

Warming components or solutions in automated analyzers is accomplished by heating air, water or metal. The warming process must be constant and accurate. Detection Calculations Readout and result reporting C. Post Analysis This phase is includes patient reporting and result interpretation. To interpret a test, one must first compare the result to a reference (normal) interval. A reference interval is usually defined as the range of values that represents the central 95% tendency of measurements from a population of nondiseased or normal individuals. Besides that we also need to make sure the Diagnostic Accuracy. Accuracy is the ability of a test to discriminate between two states, i.e., disease and no disease, and is described by two key parameters: sensitivity and specificity Sensitivity is the ability of a test to detect disease and is expressed as the proportion of persons with disease in whom the test is positive Specificity is the ability to detect absence of disease and is expressed as the proportion of persons without disease in whom the test is negative Test efficiency is the ability of a test to correctly identify the true outcome, in other words, true positives and true negatives. It is expressed as the percentage of true results or the proportion of true positives and true negatives among all results. While sensitivity and specificity refer to the ability of a test to distinguish between presence and absence of disease, efficiency measures the ability to detect all true results The likelihood ratio (LR) is the ratio of two probabilities: the probability of a test result when disease is present (true positive) divided by the probability of the same test result when disease is absent (false positive). In other words, the calculation gives the odds or likelihood of a test result occurring in a diseased patient as opposed to a healthy one. Evidence-based Medicie. There are five steps to practicing evidence-based medicine (1) Ask a clinical question based on a patient encounter; (2) acquire information by searching resources; (3) analyze and critically evaluate the information and reach a conclusion that answers the clinical question; (4) apply the information to individual patients; (5) audit the effectiveness and monitor the literature.