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Specimen Considerations CC

Specimen collection, handling, and processing are key areas for pre-analytical errors. Proper procedures must be followed for collection, transport, and processing of samples to minimize errors. Sample variables like physiologic factors, drugs, and pre-analytical issues can affect test results and must be considered. Laboratories must implement quality control plans to address all pre-analytical variables and document any errors or issues.

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184 views21 pages

Specimen Considerations CC

Specimen collection, handling, and processing are key areas for pre-analytical errors. Proper procedures must be followed for collection, transport, and processing of samples to minimize errors. Sample variables like physiologic factors, drugs, and pre-analytical issues can affect test results and must be considered. Laboratories must implement quality control plans to address all pre-analytical variables and document any errors or issues.

Uploaded by

Zeian Jacob Bayla
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Specimen Considerations and Variables

MT 315 – CLINICAL CHEMISTRY 1

Prepared by: Reyna May V. Gabutan, RMT


Types of Samples
Serum samples be
allowed to completely
Whole blood – uses both the clot (≈20 minutes) before
liquid portion of the blood being centrifuged.

called plasma and the cellular


components (red blood cells,
white blood cells, and
platelets).

Specimens should be
centrifuged for
approximately 10 minutes
at an RCF of 1,000g to
2,000g.
Types of Samples
Arterial blood samples – measures blood gases (partial pressures of
oxygen and carbon dioxide) and pH.
Syringes are used instead of
evacuated tubes because of the
Primary arterial sites:
pressure in an arterial blood
vessel.
Types of Samples
Urine – next most common fluid for
determination.
• Urine volume differs widely among
individuals; however, a 4 L container is
adequate (average output is ≈2 L).
• Creatinine analysis is often used to assess
the completeness of a 24-hour urine
sample.
Most quantitative analyses
of urine require a timed
sample (usually 24 hours)
Creatinine Clearance Test
Used to assess glomerular filtration rate, which compares urine
creatinine output with that in the serum or plasma in a specified time
interval and urine volume (often correcting for the surface area).
The generic formula is:

Urine Creatinine value Plasma or Serum


in mg/dL 𝑈𝑉/𝑃 Creatinine value in mg/dL

Urine Volume per


unit of Time
expressed in
mL/min
Types of Samples
Cerebrospinal fluid (CSF) – is an ultrafiltrate of the plasma and
reflect the values seen in the plasma.
Paracentesis fluids The color and characteristics
of the fluid before
• Pleural centrifugation should be
• Pericardial noted for these samples.
• Peritoneal
Amniotic fluids - the fluid that surrounds and protects an embryo
while it is growing in the uterus. Used to assess fetal lung
maturity (L/S ratio), congenital diseases, hemolytic diseases,
genetic defects, and gestational age.
All fluid samples should be handled immediately without delay
between sample procurement, transport, and analysis.
Blood Collection
Venipuncture – the puncture of a vein as part of a medical
procedure, typically to withdraw a blood sample or for an
intravenous injection.
• Syringe
• Evacuated System
Skin puncture – is the technique of choice to obtain a blood
specimen from newborns and pediatric patients.
Arterial puncture – is a medical procedure performed to
obtain a sample of arterial blood for gas analysis.
Sample Collection
• Proper sample collection and
handling
• Blood sample must be
collected in:
• Proper tubes or anticoagulants
• Correctly labeled
• Promptly transported to the
laboratory
Anticoagulants and Preservatives
Consideration
• Proper patient identification is the first step in sample
collection.
• The importance of using the proper collection tube, drawing
tubes in the proper order, and proper labeling of tubes.
• Prolonged tourniquet application causes a stasis of blood
flow and an increase in hemoconcentration and anything
bound to proteins or the cells.
• Having patients open and close their fist during phlebotomy
is of no value and may cause an ↑ potassium and, therefore,
should be avoided.
Specimen Labeling
Observe proper labeling.
• Label the tube carefully,
legibly, and clearly with all
pertinent information.
• NEVER leave the patient’s
bedside before properly
labeling the specimen.
• Strictly NO PRE-LABELING
of blood collection tubes.
Sample Handling, Transport and Processing
Clinical Chemistry Laboratory
Pre-analytical phase Analytical phase

Samples arrive in Samples are


the laboratory. processed inside
the laboratory.

Correct matching of
collection tube(s) with Serum or plasma should be
Proper Anticoagulants Samples should be analyzed
analyte request and patient separated from the cells if
Proper Preservatives within 4 hours. (minimize
identification labels. not analyzed immediately.
Properly Transported the effect of evaporation)
Sample Handling, Transport, Processing,
Storage and Preservation
the laboratory scientist should note the presence of any serum or
plasma characteristics:
Samples should be
appropriately stored Lipemia – increased
(Refrigeration at 4°C for 8 lipids
hours). Except ↓LDH,
↑ALP
Icterus – increased
bilirubin pigment
Samples may be frozen at -
20°C and stored for longer
periods. Repeated cycles of Hemolysis – the
freezing and thawing rupture or
should be avoided. destruction of red
blood cells
Specimen Considerations
The process of specimen collection,
handling, and processing remains one of
the primary areas of pre-analytic error.

All accreditation agencies require


laboratories to clearly define and
delineate the procedures used for proper
collection, transport, and processing of
patient samples and the steps used to
minimize and detect any errors, along
with the documentation of the resolution
of any errors.
Sample Variables
Sample variables include physiologic considerations, proper patient
preparation, and problems in collection, transportation, processing,
and storage.
• Laboratorians must include mechanisms to minimize the effect of
these variables on testing and must document each pre-analytic
incident.
• The best course of action:
• Critically assess or predict the weak areas
• Identify potential problems
• Put an action plan (Good communication)
Most accreditation agencies require that laboratories consider all aspects of pre-analytic
variation as part of their quality assurance plans, including effective problem solving and
documentation.
Sample Variables
Physiologic variation refers to changes that occur within
the body, such as cyclic changes (diurnal or circadian
variation) or those resulting from exercise, diet, stress,
gender, age, underlying medical conditions (e.g., fever,
asthma, and obesity), drugs, or posture.
• Most samples are drawn on patients who are fasting (usually
overnight for at least 8 hours).
• When fasting, many patients may avoid drinking water and
they may become dehydrated, which can be reflected in
higher than expected results.
Sample Variables
Drugs can affect various analytes.
• It is important to ascertain what, if any, medications the
patient is taking that may interfere with the test.
• Frequently encountered influences:
• Smoking (↑ Glucose)
• High amounts or chronic consumption of alcohol (Hypoglycemia,
↑ Triglycerides,↑ GGT and other liver function tests)
• Diuretics (↓ potassium and hyponatremia)
Preanalytical variables
1. Selection of assay relative to patient need
2. Implementation of assay selection
3. Patient identification and preparation
4. Specimen collection equipment and
technique
5. Specimen transport, preparation, and
storage
6. Monitoring of specimen condition
Analytical variables
1. Laboratory staff competence
2. Assay and instrument selection
3. Assay validation, including linearity, accuracy,
precision, analytical limits, and specificity
4. Internal quality control
5. External quality assessment
Postanalytical variables
1. Accuracy in transcription and filing of results
2. Content and format of laboratory report,
narrative report
3. Reference interval and therapeutic range
4. Timeliness in communicating critical values
5. Patient and physician satisfaction
6. Turnaround time
7. Cost analysis
8. Physician application of laboratory results

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