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Factors That May Influence Clinical Laboratory Results

The document discusses the factors influencing clinical laboratory results, categorizing them into pre-analytical, analytical, and post-analytical factors. It emphasizes the importance of proper patient preparation, sample collection, and handling to ensure accurate results, as well as the need for critical evaluation of laboratory findings in conjunction with clinical context. The conclusion highlights the necessity of quality control and awareness of reference ranges when interpreting laboratory results.

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14 views15 pages

Factors That May Influence Clinical Laboratory Results

The document discusses the factors influencing clinical laboratory results, categorizing them into pre-analytical, analytical, and post-analytical factors. It emphasizes the importance of proper patient preparation, sample collection, and handling to ensure accurate results, as well as the need for critical evaluation of laboratory findings in conjunction with clinical context. The conclusion highlights the necessity of quality control and awareness of reference ranges when interpreting laboratory results.

Uploaded by

mochamacynthia2
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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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FACTORS THAT MAY INFLUENCE

CLINICAL LABORATORY
RESULTS
Dr KB Sedumedi
DEPT OF CHEMICAL PATHOLOGY
OUTLINE
❑Clinical Laboratory Results
- Role in Clinical Medicine
❑ Task: Examples of patients’ results
❑Factors that may influence Laboratory Results
- Pre-Analytical Factors
- Analytical Factors
- Post-Analytical Factors
❑Handling Of Laboratory Results
- Interpretation of Laboratory Results
- Critical evaluation of Laboratory Results
❑ Conclusion & Recommendation
CLINICAL LABORATORY RESULTS (PATHOLOGY RESULTS)

Role in Clinical Medicine


➢ Pathology = the study of disease
➢ Pathology laboratory results – crucial in confirming or r/o
presence of disease
- Used for: screening, diagnosis, monitoring & prognosis
- require knowledge and understanding of biochemistry,
anatomy, physiology & pathophysiological mechanism of
diseases
➢ Applicable across all Medical Specialties
Please indicate possible pre-analytical factor that might be
responsible for each of the following pattern of results
(N=normal, ↑=high, ↓=low, - = not done)

Analyte Patient A Patient B Patient C Patient D


(Serum)
Na+ N N N ↑
K+ ↑↑ ↑ ↑ ↓
Cl- N N N ↑
Urea N N N ↓
LDH N ↑ - -
ALP ↓ - - -
TP N - ↑ ↓
Calcium ↓↓ N ↑ -
Mg ↓ N - -
PO4 N ↑ - -
FACTORS THAT MAY INFLUENCE LABORATORY RESULTS

→ Classified into:
❑ Pre-analytical factors
❑ Analytical factors
❑ Post-analytical factors

Process/ sequence of events in laboratory results production


Patient preparation -> sample collection -> transportation ->
receipt and registration in the lab -> sample preparation and
analysis -> results transmission/ manual entry into a computer ->
verification & authorisation -> printing
Pre-Analytical Factors
➢ From patient preparation -> sample collection -> transportation ->
receipt & registration in the laboratory
➢ Physiological & non physiological factors

1. Patient Preparation
a) Diet
e.g. Lipid profile (egg yolk, dairy products, poultry (skin),
organ meat, butter) glucose (high carbohydrate), uric acid
(high protein)
b) Drugs
- may influence normal physiological processes e.g. Phenytoin(ɤGT)
- may cause methodological interferences e.g. due to structural
similarities or non specificity of the analytical method.
e.g. salicylates & cimetidine (s-creatinine & creatinine clearance)
2. Sample collection
a) Posture
- Based on Starlings law of capillary exchange: Haemodynamic
adaptation to postural change (e.g. lying to sitting and vice
versa).
- These postural changes will affect proteins & protein bound
analytes e.g. Ca²˖, Fe²˖, Cholesterol, Triglycerides, etc.

b) Prolonged application of tourniquet


- ↑ Protein & protein bound analytes

c) IV solutions
- e.g. NaCl drip: ↑Na & Cl (other analytes ±↓)
d) Hemolysis
- narrow bore needle, tight tourniquet, sample clotting during
collection → ↑K, Mg, PO3, AST, LDH
e) Sample tubes
- e.g. K-EDTA will influence the following analytes: K(↑), Ca(↓),
Mg(↓), Zn(↓), ALP(↓)
f) Sequence of sample collection (multiple tubes)
- tubes without preservatives 1st
g) Sample volume & mixing where necessary
h) Type of sample
- e.g. arterial vs venous blood: PCO2, PO2
i) Mislabeling of sample tubes
j) Exercise
- e.g. ↑ CK, AST, LDH etc.
k) Sex
- e.g. ↑ PSA
i) Timing for sample collection
Diurnal variation e.g. Cortisol
NB: Age and gender
- e.g. ALP, creatinine, testosterone, oestradiol, etc.

3. Sample transportation
a) Improper preservation e.g ice or not
e.g. ACTH, ammonia, lactate, etc.
b) Delayed transportation to the lab
e.g. K, AST, ALT etc.

4. Sample receipt and registration


a) Transcription or sample labelling error
Analytical Factors
➢ From sample preparation -> analysis -> results production

1. Incomplete/ improper sample preparation


2. Poor instrument/ method performance
Ensured by: - proper instrument/ method selection & evaluation
(accurate/ precise/ sensitive & specific)
- performance monitoring through rigorous quality
assurance procedures (calibration & QC measures)

Post-Analytical Factors
➢ From results transmission/ manual entry into computer-> verification &
authorization -> printing

1. Transcription/ transmission error of results


Ensured by: - evaluation of the performance of the LIS
- verification of results prior authorization
Handling of Laboratory Results

❑ Interpretation Of Laboratory Results


- Based on RR or RI values defined for a specific analyte
-> ‘normal’/ within or ‘abnormal’/ outside?
-> significantly different from ‘normal’/ previous results (if available)?
-> consistent with the clinical findings?

Reference Ranges (RR)/ Reference Interval (RI)


- Definition: prediction interval/ range between which 95% (mean ± two SD)
of values of a reference population will fall and 5% will be outside (2.5% on
each side of this interval, i.e. below & above)
-> determined statistically using values obtained from a healthy population

- Limitations: 1) may differ across populations or subsets of populations


2) may differ across individuals within same population
NB -> abnormal results not always = presence of disease
-> normal results not always = absence of disease
-> the greater the variation from the RI/ RR, the greater the
probability of disease presence
Reference Ranges

NORMAL DISTRIBUTION OR GAUSSIAN CURVE

68.3%
Frequency

95.5%

99.7%

12
OVERLAP OF A “NORMAL” AND A SICK POPULATION

NORMAL SICK

13
❑ Critical evaluation of laboratory results

Requires the following:


-> thorough review of clinical findings (hx & exam)
(require sufficient knowledge & understanding of normal
physiology and biochemical processes as well as the
pathophysiological mechanisms of various clinical conditions)
-> awareness of the limitations of the laboratory test RR/ RI
-> consideration of possibility of pre-analytical, analytical & or
post-analytical factors which might have affected the results
Conclusion and Recommendation

❑ Quality of laboratory results relies on the quality of the sample as well as


that of the analytical instrument/ method
→ crucial to ensure good quality sample & quality analytical process at all
times: - proper patient prep & timing of sample collection,
- correct; - sample collection technique & sequence,
- sample tube, -sample volume & tube labelling
- proper sample handling & transportation
NB: The lab to provide information & support
- quality analytical method & QC measures

❑ Awareness of the limitations of the RR/ RI is crucial


→ always interpret results in conjunction with clinical findings +
other results
→ if in doubt, do not treat, rather consult the lab or repeat the
test to verify or determine the trend of results
(NB: local EGK rules)

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