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QUALITY CONTROL To perform accurate investigations:

QUALITY CONTROL To perform accurate investigations: Good preparation of patient Record data : age, sex, name, time Good specimen collection Proper diagnosis given by clinician. Sources of Variation

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QUALITY CONTROL To perform accurate investigations:

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  1. QUALITY CONTROL • To perform accurate investigations: • Good preparation of patient • Record data : age, sex, name, time • Good specimen collection • Proper diagnosis given by clinician.

  2. Sources of Variation • Genetic variation • Sex variation • Age variation • Nutrition variation • Posture variation • Exercise variation • Pregnancy variation • Drugs variation

  3. Genetic Variation • Sickle cell anaemia • Thalassaemia • Haemophilia • Hypercholesterolaemia • Hypothyroidism • Variation in blood groups

  4. Sex Variation Males and females give different ranges in the followings: @ ESR @ Hb @ Haematocrit @ Uric acid @ ALT @ AST @ GGT

  5. Age Variations Adults and children have different ranges in the followings: @ WBC @ Lymphocytes @ Haemoglobin @ Calcium @ Potassium @ GGT @ Alkaline phosphatase

  6. Nutrition Variations * Dehydration elevates urine glucose. * Excessive water decreases urine glucose * Alcohol increases ALT, AST, and GGT. * Obesity increases plasma volume.

  7. @ Fats elevate Triglycerides @ Milk elevates Phosphate and Calcium @ Meat elevates Urea @ Carbohydrates elevate Glucose @ Iron-deficient diet lowers Iron @ Vegetables elevate Urine pH

  8. Exercise Variations @ It increases: CK, AST, Hb, PCV, RBC WBC, platelets, coagulation factors @ Exercisedecreases: plasma volume. @ Running and horse riding lead to Haemoglobinuria

  9. PregnancyVariations @ Increases: Neutrophils, ESR, Coagulation factors Alkaline phosphatase @ Decreases: Hb , PCV, and RBC

  10. Drugs Variations • @ Anticoagulants disturb coagulation • profile • @ Aspirin gives false negative urine • glucose among diabetics • @ Tranquilizer (chlorpromazine) gives • false positive urine bilirubin

  11. Specimen Collection, Transport, and Storage • Changes in the composition of a specimen can be caused during: • collection • transportation • centrifugation • storage

  12. Blood Collection @ Capillary blood is collected from newborns & adults with difficult veins @ Capillary bloodis not collectedfor platelets @ Arterial blood is collected by doctors.

  13. @ Select the patient working arm because veins are more easily seen @Tie tourniquet 10 cm above elbow, and leave for not more than 2 min. to prevent disruption of blood quality @ Pull syringe plunger slowly to avoid vein collapse, foaming, and hemolysis .

  14. @ Open tourniquet first, expel blood slowly along side of tube to avoid haemolysis . @ Do not take blood from intravenous line to avoid sample dilution . @ If tube contains an anticoagulant , mix gently

  15. Capillary Blood Collection • For Hb, PCV,WBC, RBC, reticulocytes • Ensure free flow of blood. • No squeezing. • Ignore first drop • Sites: • @ Ear-tips • @ Fingertips • @ Big toe or heal • @ Medial and lateral plantar surfaces

  16. Preservation of blood @ EDTA : 1.5 mg/ml blood. @ Insufficient EDTA may lead to low PVC, & shrinkage of blood cells . @ Sodium citrate is used for coagulation profile & ESR. @ Heparin in clinical chemistry.

  17. Blood films @ Microscopic examination should be done by an experienced investigator. @ Blood collected into EDTA is spread within 1 hour after collection

  18. @ Thick film is for detecting the genus and thin film is to detect the species @ Press blood drop with a cover glass until center of film is almost colorless

  19. @ Prick lateral side of finger ball away from nail bed. @ You should be able to see hands of a watch through the thin film. @ Fix thin films. Do not fix thick films

  20. Errors in Preparing Films * End of film is lost @ To Correct: Use a small blood drop * Film ends in a thick line @To Correct:Don’t lift spreader too early * End of film is ragged @ To Correct: Use even edge spreader

  21. * Lines along film • @ To Correct: Do not use clotted blood • * Lines across film • @To Correct: Don't push spreader jerkily • * Holes in film • @ To Correct: Do not use greasy slides

  22. Prevention of Haematoma @ Always use major veins @ Bevel of needle must be inside vein @ Do not transverse vein @ Open tourniquet before pulling needle @ Press by gauze before pulling needle

  23. Transport and Storage of Blood @ Blood clotting is faster in glass tubes. @ Lipid profile is not done in a cooled, stored serum @ Store serum by freezing at -10°C for one month or at – 20°C for more than that.

  24. Analytes affected by blood storage @ CBC * Reticulocyte count * ESR * PT * Coagulation factors V, VII, VIII @ Creatinine * Glucose * Iron * LDH * K * Chloride * Phosphorus * Alk. Phosp. * AST

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