MLS1004SEF_ Clinical Chemistry & Immunonology_Lecture 1 _18 Jan 2024.pdf

Introduction to MLS Instrumentation II MLS 1004SEF Clinical Chemistry & Immunology Specimen Collection & Quality Assurance (QA) Simon Fung Senior Lecturer/SMT 18 Jan 2024 Insight into a Clinical Chemistry Laboratory https://www.youtube.com/watch?v=NxutOVA7DbI Summary from the film Clinical Lab – Cli...

Introduction to MLS Instrumentation II MLS 1004SEF Clinical Chemistry & Immunology Specimen Collection & Quality Assurance (QA) Simon Fung Senior Lecturer/SMT 18 Jan 2024 Insight into a Clinical Chemistry Laboratory https://www.youtube.com/watch?v=NxutOVA7DbI Summary from the film Clinical Lab – Clinical Chemistry , Haematology, Medical Microbiology, Histopathololgy & Cytology Specimen reception & transport – e.g. pneumatic tube system Centrifuge, important tool in CC to separate serum/plasma from blood Bench measuring HbA1c, marker for Diabetes Mellitus (DM) Autoanalyzers – Chemistry & Immunology Point of Care Testing (POCT) in urgent lab./ wards- osmometer, blood gas analyzers Highlights Introduction Laboratory testing process specimen processing – reception, sample types, anticoagulant tubes/containers Automation  Quality Assurance QC materials Internal QC/External QC Westgard rules Acknowledgment: slides adopted and modified from Dr Szeto Yim Tong Savio Case Scenario Disciplines of Clinical Pathology Roles of Laboratory Testing Where are the tests done? Test requirement? Laboratory work cycle Clinical Biochem. 3 rd Ed Gaw et al, 2004, Churchill Livingstone Summary of laboratory work cycle 1.Clinical question 2.Request form 3.Specimen collection 4.Transport to laboratory 5.Specimen reception/accessioning (e.g.barcode) /processing (aliquoting) etc. in laboratory 6.Analysis (chemical, immunological, chromatography, electrophoresis etc.) with calibration and quality control 7.Post-analysis (e.g. calculation, compliation with data collected 8.Result interpretation 9.Reporting with standard format Clinical Chemistry Features 1. Auto-analysers for daily high throughput laboratory result in routine bench (e.g. thousands of tests/day) except specialized benches (e.g. urgent lab., metabolic screening lab.) 2. Quantitative measurement with various measurement methodologies 3. Stringent quality assurance from sample collection to result reporting (Preanalytical/Analytical/Post-analytical) 4. Comprehensive case results interpretation in multiple testings (e.g. Albumin, liver enzymes- ALT,AST, ALP) for validating the diagnosis and aiding in prompt and accurate treatment Clinical Chemistry Lab. Running Features All Starts With A Request ! Specimen Reception Types of Specimen Blood Types of Specimen Urine Blood Gas Analysis https://www.mdpi.com/2218-1989/10/6/229 Cerebrospinal fluid (CSF) Pleural fluid Anticoagulant tubes Transport specimen inside hospital/lab. Transport methods outside/inside hospital & laboratory Pneumatic Tube System e.g. Wards to urgent lab Laboratory Automation Transport distances involved: From wards on same site Other local hospitals General Practitioner (GP) surgeries Further afied (remote) Special arrangements may be necessary: Taxi for urgent specimens Transport on ice for unstable analytes (e.g. blood gas) Transport in heat blocks for certain protiens (e.g.cryoglobulin)  Safetey – all samples potentially infectious Storage devices - short/long term purpose Factors affect sample quality/integrity (e.g.time, temp.) http://ije.oxfordjournals.org/content/32/1/125.full Rejected specimens 1. No sample available 2. Presence of needle 3. Inadequate blood volume (quantity Insufficient)  Incorrect blood to anticoagulant ratio Quality of blood sample Types of blood specimen commonly at laboratory reception: 1. 2. 1 2 3 4 Hemolysed blood (RBC hemolysis) Lipaemic blood – No fasting (fat/lipid after meal e.g 2 hrs) 3. Normal 4. Icteric blood - high bilirubin, degradation product of haemoglobin by liver e.g. patient with liver disease) Sample preparation e.g. Hemolysis     Prolonged blood tube storage at room temp (RT) Delayed plasma/serum separation from blood Vigorous mixing with anticoagulant tubes Push collected blood too fast through the traditional syringe with narrow needle Patient preparation e.g. Lipaemia  No fasting  Take blood soon after meal (inappropriate sampling time) Automation , Laboratory Automation Process Pre-analytical Process cobas® prime Pre-analytical System (roche.com) Overview on Pre-analytical Process Pre-analytical (major error in lab. e.g.> 60 %) 1.Patient preparation a) Fasting e.g. Triglyceride b) Sampling time (daytime/night time) e.g cortisol with circadian rhythm c) Exercise e.g CK-MB d) Posture e.g Renin-aldosterone e) Age e.g ALP, estrogen/testosterone f) Gender e.g creatinine, PSA g) Menopause e.g LH,FSH, ALP-bone & liver marker 2.Sample preparation a) Swap samples/aliquots b) Wrong use of anticoagulant tubes e.g. EDTA blood instead of heparin blood high K c) Inappropriate temperature storage e.g. Blood gas sample, ammonia (need on ice) d) Transport delay e.g blood gas Timing of sample collection e.g. cortisol e.g. estrogen https://www.mdpi.com/2218-1989/10/6/229 Analytical (e.g. on autoanlayser) 1.Serum index (Roche) to indicate the extent of interference to target analyte analysis Hemolysis  plasma or serum hemoglobin/LDH elevated by hemolysed blood  affecting measured analytes e.g K+, Mg+, phoshate,LDH, AST, ALT by intracellular release into plasma/serum Icteric  elevated plasma/serum bilirubin from diseases  affecting measured analytes e.g. creatinine with Jaffe method, total protein with Biuret method, Ca, cholesterol, coagulation parameters by spectral/chemical interference Lipaemic elevated triglyceride/chylomicron/lipoproteins (e.g. VLDL) after meal or non-fasting can affect measured analytes e.g creatinine, total protein, phosphate, Ca, by turbidity or absorbance/light scattering/volume displacement (on Indirect ISE) interference on spectrophotometric/turbidimetric or nephelometric methods. Lipemia may also interfere in some immunoassays, since lipoproteins may interfere with antigen-antibody reaction by blocking the binding sites of antibodies (with different extent, usually well documented with the limits in reagent kit inserts) 2.Endogenous – spectral/physical/chemical interference etc. Hemoglobin on bilirubin measurement (e.g. end point mode) Glucose on osmolality (DM) Osmolality = 2 x (Na+ + K+) + Urea + glucose or 2 (Na+) + Glucose + Urea (all in mmol/l) 3.Exogenous 2. Alcohol on e.g. ethanol, enzymes 3. Steroid on e.g. cortisol Post-analytical Sources Calculation Transcription error Copy & paste in excel Solutions: Manual cross check LIS Middleware Program e.g Excel VBA Errors/Issues in Different Phases Quality Assurance (QA) Quality Definition Pre-analytical Westgard Rules in QC Charts "Westgard Rules" and Multirules - Westgard Reference links Clinical Chemistry/Clinical Lab Insight into a Clinical Chemistry Lab Clinical Chemistry 1 Instrumentation part 1 (Lecture) Clinical Chemistry 1 Instrumentation part 2 (Lecture) Clinical Laboratory Instrumentation (Background) - Part 1 Clinical Laboratory Instrumentation (Background) - Part 2 Total Laboratory Automation (TLA) Roche  cobas 8100 Automated Workflow Series | Roche Workflow Solutions - YouTube  Total Lab Automation - Reference site  Daily prep and maintenance overview for your cobas 8000 modular analyzer series Other  Automation in Clinical Chemistry  Northwell's Brand-New Automated Clinical Laboratory Pre-analytical/analytical/post-analytical  Pre-analytical phase management: a review of the procedures from patient preparation to laboratory analysis http://dx.doi.org/10.1080/00365513.2017.1295317 Harmonization of pre-analytical quality indicators https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936970/  Recognizing and Reducing Analytical Errors and Sources of Variation in Clinical Pathology Data in Safety Assessment Studies https://pubmed.ncbi.nlm.nih.gov/28178899/  Post-analytical laboratory work: national recommendations from theWorking Group for Post-analytics on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine https://pubmed.ncbi.nlm.nih.gov/31223256/  Managing the Pre- and Post-analytical Phases of the Total Testing Process https://www.annlabmed.org/journal/view.html?doi=10.3343/alm.2012.32.1.5 Related insights for clinical laboratory in Asia 부산 우리들병원 진단검사의학실을 소개합니다! / 무슨 검사를 하는 곳일까? / 혈관탐지기로 한 번에 채혈! 부산척추병원 (Phlebotomy, urinalysis etc.) 하루에만 1000명😲! 국립암센터 채혈실 임상병리사의 알찬(?) 하루 (Phlebotomy in ward, blood banking, Cryopreservation etc. Reminder for practical class - read & understand manual Be calm & relaxed Think about carefully with 1st or 2nd thought Do everything stepwise and steady, No Hurry! Ask for question wisely and help from supportive staff!