Causes and Prevention Of Laboratory

Errors
Pre-analytical Errors

Analytical Errors
Objective

Post analytical
Errors
 Phases of Laboratory Tests
Pre-Analytical phase
Specimen Collection, Specimen Storage & Transport, Test Ordering
Analytical phase
Test Performance check by Quality Control, Sample Analysis, Result
Review
Post-Analytical phase
Result handling, Result Communication, Result Interpretation

2
 Errors
A laboratory error is defined as “a defect occurring at any part of the
laboratory cycle from ordering tests to reporting”.
Inadequate knowledge and training of lab staff is a proven contributor
to lab errors.
 Post
analyt-
ical
23%

Analytical
Percentage Of 13% Pre an-
Laboratory Errors alytical
64%

Pre analytical Analytical Post analytical

Pre-analytical Error
Missing sample or test request
Wrong or missing identification
Contamination from infusion route
Haemolysed, clotted and insufficient samples
Inappropriate container
Inappropriate blood to anticoagulant ratio
Inappropriate transport and storage conditions.
 How to remedy Pre-analytical error

1. Proper Venipuncture technique

Specimen Collection
2. Appropriate Collection Tube
3. Specimen Labeling
4. Proper Filling
5. Proper Mixing
6. Specimen Storage, Handling and Processing
7. Specimen Transport
8. Test Ordering

6
Analytical error
.These errors occur during the test and include equipment dysfunction
Test system not calibrate
Result reported when control results out of range
Improper measurement
Reagent prepared incorrectly
Reagents stored inappropriately or used after expiration date
Improper instrument maintenance
Dilution and pipetting error
Classifying the analytical errors
1) Systemic errors : Indicates low accuracy
Poor calibration
Incorrect procedure
Wrong standard
2) Random errors : Indicates poor precision
Pipetting error
Transcription error
Incorrect sample numbering
Reader fluctuation
Random Error vs Systemic Error
 How to minimize systemic and Random error
Systematic error can be minimized by 
Routinely calibrating equipment
Using controls in experiment
Warming up instruments prior to taking readings
Comparing values against standards.
Random errors can be minimized by
Increasing sample size and
Averaging data
It's harder to compensate for systematic error.
Post analytical errors
These errors happen after the test is conducted:
Improper data entry
Failure to report test result
Delay in reporting
Incorrect calculation
Critical results not reported or delayed
Results sent to the wrong patient
Preventive action of Post analytical errors

Standardized procedure

Proper training or education

Computerized critical result reporting

 Objective

ECL CLA
ELISA
Technology Technology
ELISA principle
 Advantages of ELISA
 ELISA is based on antigen–antibody reaction
 High specificity and sensitivity
 High efficiency

Disadvantages of ELISA
 Insufficient blocking of immobilized antigen results in false
results
 High possibility of false positive/negative
 Antibody instability
 CLA Technology
Chemiluminescence immunoassay (CLIA) is an assay that combine
chemiluminescence technique with immunochemical reactions.
Chemiluminescence is the
emission of photons
(electromagnetic radiation as
light) when chemically
excited molecules decay to
ground state following a
chemical reaction.
Difference Between CLIA and ELISA
Chemiluminescence vs Electrochemiluminescence
Chemiluminescence is the emission of light as a result of a chemical
reaction.
Electrochemiluminescence is the emission of light due to an
electrochemical reaction occurring at an electrode surface.
 ECL Principle

a Recognition: a specific antigen is mixed together with an antigen-specific biotinylated monoclonal antibody (in
green) and an antigen-specific monoclonal antibody labeled with ruthenium(II) (Ru2+ in red) to form a sandwich
complex which bind to streptavidin-coated microparticles (brown spheres); b separation: microparticles are
magnetically captured onto the surface of the electrode and unspecific substances are removed; c detection: a voltage
is applied to the electrode inducing ECL emission, which is measured by a photomultiplier tube (PMT). TPrA: tri-n-
propylamine.
Comparison between CLIA and ECLIA
Advantages of ECL technology

High sensitivity & precision

Stable reagent
Short reaction time
Broad dynamic range
Controlled reaction
Low sample volume
Easy to use
 About
Bio Tech Services
 BioTech Services
Founder: Engineer Md. Ramjan Ali
Address: ENA Tower 9th Floor, 57/3 & 57/4 Panthapath,
Dhaka-1205, Bangladesh.

Established : April, 2001

Business Activities
Acronym : BTS • Import & Indenting
• Sales & Marketing
• After Sales Services
Company Logo :
• Distributions

Field of activity : Health Care Sector

© BioTech Services 23
 Our principals
R R Mechatronics,
The Netherland
Arkray corporation, Japan
Roche diagnostics,
Switzerland

Helena biosciences,
UK

Sysmex corporation,
Japan

© BioTech Services 24
 BTS PRODUCTS VERTICLES (Total 16)

POC IMMUNO
Hematology MD
DP

SYSMEX
ROCHE
HEMOST
ASIS VENTANA

SYSMEX
FLOWCY Urinaly
BTS ROCHE
TOMETR sis
Y
BIOCHEM THERAPY
NAT

HELEN
A ARKRAY
CAPILARY RR
& GEL
ELECTROPH MECHAT
ORESIS RONICS
HELENA
ARKRAY HPLC

AGREGO
ESR
RR MECHATRONICS
METRY
 Roche Diagnostic Analyzer

• Cobas c 311
Cobas 4000
Analyzer series
• Cobas e411

• Cobas c501
Cobas 6000
Analyzer series
• Cobas e601

• Cobas c502
Cobas 8000
Analyzer series
• Cobas e602
c=chemistry
e=elecsys