ACCURATE RESULTS IN THE CLINICAL LABORATORY A Guide to Error Detection and Correction
ACCURATE RESULTS IN THE CLINICAL LABORATORY A Guide to Error Detection and Correction Ebook PDF Clinical laboratory tests have a significant impact on patient safety and patient management because more than 70% of all medical diagnoses are based on labora- tory test results. Physicians rely on hospital laborato- ries for obtaining accurate results, and a falsely elevated or falsely low value due to interference or pre-analytical errors may have a significant influence on the diagnosis and management of patients. Usually, a clinician questions the validity of a test result if the result does not match the clinical evaluation of the patient and calls laboratory professionals for interpre- tation. However, clinically significant inaccuracies in laboratory results may go unnoticed and mislead clini- cians into employing inappropriate diagnostic and therapeutic approaches, sometimes with very adverse outcomes. This book is intended as a guide to increase the awareness of both clinicians and laboratory profes- sionals about the various sources of errors in clinical laboratory tests and what can be done to minimize or eliminate such errors. This book addresses not only sources of errors in the analytical methods but also various sources of pre-analytical variation because pre-analytical errors account for more than 60% all laboratory errors (Chapter 1). Important pre-analytical variables are addressed in the first three chapters of the book. In Chapter 2, the effects of ethnicity, gender, age, diet, and exercise on laboratory test results are addressed, whereas Chapter 3 discusses the effects of patient preparation and specimen collection. In Chapter 4, specimen misidentification and specimen processing issues are reviewed.
ACCURATE RESULTS IN THE CLINICAL LABORATORY A Guide to Error Detection and Correction Ebook PDF Various endogenous factors, such as bilirubin, lipe- mia, and hemolysis, can affect laboratory test results, and this important issue is addressed in Chapter 5. Immunoassays are widely used in the clinical laboratory, and more than 100 immunoassays are available commer- cially for measurement of various analytes. In Chapter 6, various immunoassay formats are discussed with an emphasis on the mechanism of interference of heterophi- lic antibodies and autoantibodies on immunoassays, especially sandwich immunoassays, and general approaches to eliminate such interference are reviewed.
Many Americans use herbal medicines, and use of these may affect clinical laboratory test results. In addition, certain herbal medicines may cause organ
damage, and an unexpected laboratory test result may be the first indication of such organ toxicity. For exam- ple, abnormal liver function tests in the absence of a hepatitis infection in an otherwise healthy person may be related to liver toxicity due to use of the herbal sedative kava. These important issues are addressed in detail in Chapter 7.
Clinical chemistry is a vast area of laboratory medicine, responsible for the largest volume of testing in the clinical laboratory and, arguably, affecting a majority of clinical decisions. Sources of errors for measuring common analytes in clinical chemistry are discussed in Chapters 8 and 9, whereas errors in bio- chemical genetics are discussed in Chapter 10. In Chapter 11, issues concerning measuring various hor- mones and endocrinology testing are reviewed, whereas Chapter 12 is devoted to challenges in mea- suring cancer biomarkers.
ACCURATE RESULTS IN THE CLINICAL LABORATORY A Guide to Error Detection and Correction Ebook PDF Therapeutic drug monitoring, drugs of abuse test- ing, and alcohol determinations are major functions of toxicology laboratories, and there are many interfer- ences in therapeutic drug monitoring, immunoassays used for screening of various drugs of abuse, mass spectrometry methods for drug confirmation, and alcohol determinations using enzymatic assays. These important issues are addressed in Chapters 13 16 with an emphasis on various approaches to eliminate or minimize such interferences.
Sources of errors in hematology and coagulation are addressed in Chapter 17, whereas critical issues in transfusion medicine are addressed in Chapter 18. In Chapter 19, challenges in immunology and serological testings are discussed, whereas sources of errors in microbiology testing and molecular testing are addressed in Chapters 20 and 21, respectively. The particular issues in molecular testing related to phar- macogenomics are addressed in Chapter 22.
The objective of this book is to provide a compre- hensive guide for laboratory professionals and clini- cians regarding sources of errors in laboratory test results and how to resolve such errors and identify discordant specimens. Error-free laboratory results are essential for patient safety. This book is intended as a practical guide for laboratory professionals and clinicians who deal with erroneous results on a regular.
ACCURATE RESULTS IN THE CLINICAL LABORATORY A Guide to Error Detection and Correction Ebook PDF