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Clinical Chem Lab

Clinical chemistry laboratory tests can be used to confirm diagnoses, aid differential diagnosis, refine diagnoses, assess disease severity, monitor disease progress, and detect complications. The accuracy of these tests depends on factors like specimen collection and analytical processes. Specimen collection is important - the right tube must be used, contamination avoided, and samples sent to the lab promptly. Timing of sample collection also matters, as does providing patient details and test requests clearly. Laboratory tests are most useful when interpreted in the clinical context, considering biological variations and test limitations. Appropriate test ordering and specimen collection are necessary for reliable results.

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136 views

Clinical Chem Lab

Clinical chemistry laboratory tests can be used to confirm diagnoses, aid differential diagnosis, refine diagnoses, assess disease severity, monitor disease progress, and detect complications. The accuracy of these tests depends on factors like specimen collection and analytical processes. Specimen collection is important - the right tube must be used, contamination avoided, and samples sent to the lab promptly. Timing of sample collection also matters, as does providing patient details and test requests clearly. Laboratory tests are most useful when interpreted in the clinical context, considering biological variations and test limitations. Appropriate test ordering and specimen collection are necessary for reliable results.

Uploaded by

rdp106
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Clinical chemistry laboratory

Factors affecting laboratory tests


investigations
To confirm a diagnosis eg TSH and free T4 • Specimen collection
To aid differential diagnosis eg jaundice, causes of
abdominal pain
• Analytical factors
To refine a diagnosis eg plasma ACTH • Biological variations
To assess severity of disease eg plasma creatinine • Intra-individual variation
To monitor progress of disease eg HbA1c • Inter-individual variation
To detect complications or side effects eg liver, renal
toxicity • Sensitivity, specificity and predictive value
To monitor drug therapy to check compliance or of a test
toxicity

Specimen collection Specimen collection


• Most investigations carried out on blood, • Identification of patients and of specimens
next being urine – Request forms to be properly filled, can now be
• Others include undertaken electronically using e-quest
– CSF, faeces, sweat, amniotic fluid – Clinical details and tests requested should be
clearly stated
– Ascitic and pleural fluid, saliva, duodenal and
jejunal secretions, semen etc – Timing of sampling should be indicated
– Destination of results should also be indicated

Specimen collection
Specimen collection
common errors
• Avoid collecting from a drip arm • Drugs
– Aspirin at least 6h post dose
• Use appropriate specimen tube, avoid
– Digoxin at least 6h post dose
contamination
– Most other drugs should be pre-dose
• Avoid haemolysis – If not certain collect samples on admission and
• Send samples to the lab ASAP at the optimal times since admission
• Blood gases to be analysed immediately – Paracetamol at least 4 h post ingestion
– Timing should be clearly indicated, aids
• Specific transport requirements interpretation

1
Specimen collection
Test over-requesting
common errors
• Troponin requesting- • Ideally only one Troponin measurement
• sample should be taken at least 10 h since onset • Follow up TFTs every 4 – 6 weeks
of chest pain or symptoms. If not sure, sample
should be taken on admission and at 10 h • HbA1c at most 2 per year
afterwards • Tumour markers not a diagnostic test
• Optimal sampling time for cortisol deficiency is • Iron studies not interpretable in the acutely
9.0 am otherwise state ill. FBC more appropriate
• Samples for lipids and glucose ideally fasting,
otherwise state • FSH only is required for the diagnosis of
the menopause

Factors affecting laboratory tests Conclusions


• In the interpretation of results, always • Laboratory tests play a key role in the
consider: management of patients
• Biological variations • Should be interpreted in the light of the
patients clinical details and other
• Intra-individual variation investigations and previous results
• Inter-individual variation • Appropriate specimens should be collected
• Sensitivity, specificity and predictive value into appropriate specimen containers
of a test • Avoid test over requesting

Factors affecting laboratory tests

Always ask if not sure ! ! !

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